CAJ | 학술논문

目的探讨抑郁对冠心病患者行再血管化治疗包括冠状动脉旁路移植术(CABG)和冠状动脉介入治疗(PCI)预后的影响.方法采用ZUNG抑郁自评量表(SDS)分别对345例CABG和308例PCI患者术前及术后进行抑郁评分,根据评定结果分为抑郁组和非抑郁组,其中CABG患者抑郁组84例、非抑郁组261例,PCI患者抑郁组88例、非抑郁组220例.随访12个月,观察抑郁状态分别对2种治疗方式主要不良心血管事件(MACE)发生率及再住院率的影响.结果 345例行CABG的患者,术后抑郁患病率明显高于术前(40.9％比24.3％,P＜0.01)；术后抑郁患者12个月内MACE的发生率高于无抑郁患者[8.5％( 12/141)比2.9％ (6/204),P＜0.05]；其中,抑郁组再次血运重建率和12个月累积再住院率均高于非抑郁组[4.9％( 7/141)比1.0％( 2/204)和12.8％( 18/141)比6.4％ (13/204),P均＜0.05].308例行PCI患者,术后抑郁患病率亦高于术前(36.4％比28.6％,P＜0.05)；术后抑郁患者12个月MACE发生率和再住院率均高于无抑郁患者[8.0％ (9/112)比2.0％ (4/196)和12.5％ (14/112)比4.6％ (9/196),P均＜0.05].对同期行PCI和CABG的两组患者手术前后抑郁评分进行比较,PCI与CABG术前两组患者SDS评分比较差异无统计学意义(P＞0.05).CABG术后患者SDS评分明显高于PCI组(48.9±9.8比45.7±10.5,P=0.01).166例行PCI患者测定血清IL-6水平,抑郁患者IL-6水平高于非抑郁者,差异有统计学意义(P＜0.05).结论再血管化治疗术后有较高比例的患者存在不同程度的抑郁.术后抑郁状态与患者再缺血事件相关,并可能影响预后.
목적 탐토억욱대관심병환자행재혈관화치료포괄관상동맥방로이식술(CABG)화관상동맥개입치료(PCI)예후적영향.방법 채용ZUNG억욱자평량표(SDS)분별대345례CABG화308례PCI환자술전급술후진행억욱평분,근거평정결과분위억욱조화비억욱조,기중CABG환자억욱조84례、비억욱조261례,PCI환자억욱조88례、비억욱조220례.수방12개월,관찰억욱상태분별대2충치료방식주요불양심혈관사건(MACE)발생솔급재주원솔적영향.결과 345례행CABG적환자,술후억욱환병솔명현고우술전(40.9％비24.3％,P＜0.01)；술후억욱환자12개월내MACE적발생솔고우무억욱환자[8.5％( 12/141)비2.9％ (6/204),P＜0.05]；기중,억욱조재차혈운중건솔화12개월루적재주원솔균고우비억욱조[4.9％( 7/141)비1.0％( 2/204)화12.8％( 18/141)비6.4％ (13/204),P균＜0.05].308례행PCI환자,술후억욱환병솔역고우술전(36.4％비28.6％,P＜0.05)；술후억욱환자12개월MACE발생솔화재주원솔균고우무억욱환자[8.0％ (9/112)비2.0％ (4/196)화12.5％ (14/112)비4.6％ (9/196),P균＜0.05].대동기행PCI화CABG적량조환자수술전후억욱평분진행비교,PCI여CABG술전량조환자SDS평분비교차이무통계학의의(P＞0.05).CABG술후환자SDS평분명현고우PCI조(48.9±9.8비45.7±10.5,P=0.01).166례행PCI환자측정혈청IL-6수평,억욱환자IL-6수평고우비억욱자,차이유통계학의의(P＜0.05).결론 재혈관화치료술후유교고비례적환자존재불동정도적억욱.술후억욱상태여환자재결혈사건상관,병가능영향예후.
Objective To investigate the impact of depression on clinical outcome of patients undergoing revascularization.Methods Self-rating depression scale (SDS) assessment was made before and after coronary artery bypass grafting (CABG,n =345 ) and percutaneous coronary intervention( PCI,n =308 )procedure.Patients were divided into depression and non-depression group.All patients were followed up for 12 months after procedure for the occurrence of rehospitalization and major adverse cardiovascular events (MACE) including all-cause mortality,nonfatal myocardial infarction or target lesion revascularization.Results Depression was present in 40.9％ ( n =141 ) of patients after CABG,which was significantly higher than before procedure (24.3％,P ＜ 0.01 ).The MACE rate was significantly higher in patients with post-procedure depression[ 8.5％ ( 12/141 ) ] than in patients without depression [ 2.9％ (6/204),P ＜0.05 ] and the incidences of target lesion revascularization and rehospitalization were also significantly higher in depression patients than in non-depression patients during the 12 months follow-up ( all P ＜ 0.05 ).Depression was present in 36.4％ (n =112) of patients after PCI,which was significantly higher than that before procedure (28.6％,P ＜0.05).The MACE rate [8.0％ (9/112) vs.2.0％ (4/196)]and rehospitalization rate [ 12.5％ ( 14/112 ) vs.4.6％ ( 9/196 ) ] were significantly higher in depression patients than in patients without depression during the 12 months follow-up ( P ＜ 0.05 ).There was no significant difference on SDS score between the PCI and CABG before the procedure.However,after the procedure,the SDS score for patients undergoing CABG was significantly higher than in patients undergoing PCI (48.9 ± 9.8 vs.45.7 ± 10.5 P =0.01 ).The level of serum IL-6 was significantly higher in depression patients than in patients without depression ( P ＜ 0.05 ).Conclusion Prevalence of depression is high in patients treated with revascularization procedures and is linked with poor post-procedure prognosis.