冠心病患者焦虑抑郁与炎症反应、血管内皮功能的关系

摘要

目的 探讨冠状动脉粥样硬化性心脏病(冠心病)患者焦虑抑郁与炎症反应、血管内皮功能的关系.方法 选择2014年2月~2017年4月于石家庄市第一医院心血管内科收治的冠心病患者99例,其中男性51例,女性48例,年龄50~78岁,平均(62.11±3.49)岁.存在焦虑抑郁纳入研究组(n=41),不存在焦虑抑郁纳入对照组(n=58).通过医院焦虑抑郁量表(HADS)测定焦虑抑郁水平,包括HADS总表(HADS-t)、焦虑亚量表(HADS-a)和抑郁亚量表(HADS-d).检测患者血清髓过氧化物酶(MPO)、脂氧素A4(LXA4)、C反应蛋白(CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及可溶性血管细胞粘附分子-1(sVCAM-1)水平.测定肱动脉血流介导的内皮依赖性舒张功能(FMD)以及硝酸甘油介导的内皮非依赖性舒张功能(NMD).结果 研究组患者HADS-t、HADS-a及HADS-d评分均明显高于对照组,差异均具有统计学意义(P均<0.05).与对照组相比,研究组患者血清MPO、LXA4、CRP、IL-8及TNF-α水平明显升高,差异均具有统计学意义(P均<0.05).研究组患者sVCAM-1水平明显高于对照组,而FMD和NMD水平显著低于对照组,差异均具有统计学意义(P均<0.05).合并焦虑抑郁的冠心病患者血清MPO、LXA4、CRP、IL-8、TNF-α及sVCAM-1水平与HADS-t、HADS-a及HADS-d评分均呈正相关(P均<0.05),而FMD、NMD与HADS-t、HADS-a及HADS-d评分均呈负相关(P均<0.05).结论 合并焦虑抑郁的冠心病患者炎症反应及血管内皮功能损伤更严重,且炎症因子水平与焦虑抑郁水平呈正相关,血管内皮功能与焦虑抑郁水平呈负相关.%Objective To discuss the relationship among anxiety-depression, inflammatory response and vascular endothelial function in patients with coronary heart disease (CHD). Methods CHD patients (n=99, male 51, female 48, aged from 50 to 78 and average age=62.11±3.49) were chosen from the Department of Cardiovascular Medicine, First Hospital of Shijiazhuang City from Feb. 2014 to Apr. 2017. The patients with anxiety-depression were included into study group (n=41) and those without anxiety-depression, into control group (n=58). The level of anxiety-depression was determined by using hospital anxiety and depression scale (HADS), including total HADS (HADS-t), HADS for anxiety (HADS-a) and HADS for depression (HADS-d). The levels of serum myeloperoxidas (MPO), lipoxin A4 (LXA4), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) and soluble vascular cell adhesion molecules-1 (sVCAM-1) were detected. The endothelium-dependent brachial artery flow-mediated dilation (FMD) and non-endothelium-dependent nitroglycerin-mediated dilatation (NMD) were determined. Results The scores of HADS-t, HADS-a and HADS-d were all higher in study group than those in control group (all P<0.05). Compared with control group, levels of MPO, LXA4, CRP, IL-8 and TNF-α increased significantly in study group (all P<0.05). The level of sVCAM-1 was significantly higher, and levels of FMD and NMD were significantly lower in study group than those in control group (all P<0.05). The levels of serum MPO, LXA4, CRP, IL-8, TNF-α and sVCAM-1 were positively correlated to scores of HADS-t, HADS-a and HADS-d (all P<0.05). The levels of FMD and NMD were negatively correlated to scores of HADS-t, HADS-a and HADS-d (all P<0.05). Conclusion Inflammatory response and injury of vascular endothelial function are more serious in CHD patient complicated by anxiety-depression. The levels of inflammatory factors are positively correlated to anxiety-depression severity, and vascular endothelial function is negatively correlated to anxiety-depression severity.