CAJ | 학술논문

目的探讨不明原因胸痛患者抑郁情绪的发生及其可能的机制.方法收集2009年10月至2013年12月在汕头大学医学院第一附属医院就诊的118例患者的临床资料.根据病史将患者分为不明原因胸痛组(38例)、急性心肌梗死组(有典型胸痛的急性心肌梗死患者,48例)和抑郁症对照组(有抑郁而无胸痛的患者,32例),另外选取同年龄段健康体检者38名为健康对照组.对各组受试者采用汉密尔顿抑郁量表(HAMD)进行抑郁评分,采用高效液相色谱法检测血小板5-羟色胺水平,流式细胞术测定外周血CD4+、CD8+细胞百分比,酶联免疫吸附测定法检测炎性因子C反应蛋白(CRP)、白细胞介素6(IL-6)水平.结果不明原因胸痛组CRP、CD4+/CD8+明显低于急性心肌梗死组[3.3(2.2,4.3) mg/L比11.4(5.8,29.6)mg/L,(1.6±0.8)比(2.5±1.5)],差异有统计学意义(P＜0.05);IL-6水平[6.7(4.4,7.9) ng/L]明显高于健康对照组[2.3(1.3,4.3)ng/L],但明显低于急性心肌梗死组[14.8(10.0,22.4) ng/L]和抑郁症对照组[12.3(5.5,34.0) ng/L],差异均有统计学意义(均P＜0.05);5-羟色胺水平[674(228,1 214) nmol/L]明显低于急性心肌梗死组[1 336(738,1 793) nmol/L]及健康对照组[850(582,1 815) nmol/L],但高于抑郁症对照组[256(130,689) nmol/L],差异均有统计学意义(均P＜0.05).不明原因胸痛组抑郁评分明显高于急性心肌梗死组与健康对照组[(16.5±4.8)分比(10.3±3.1)、(8.2±2.7)分],差异有统计学意义(P＜0.05),其中14例患者HAMD评分＞20分,占36.8％.5-羟色胺是不明原因胸痛患者抑郁发生的独立危险因素(比值比=0.997,95％置信区间0.995～0.999,P＜0.05).结论不明原因胸痛患者中有36.8％伴随有抑郁.5-羟色胺是不明原因胸痛患者的独立危险因素.
목적 탐토불명원인흉통환자억욱정서적발생급기가능적궤제.방법 수집2009년10월지2013년12월재산두대학의학원제일부속의원취진적118례환자적림상자료.근거병사장환자분위불명원인흉통조(38례)、급성심기경사조(유전형흉통적급성심기경사환자,48례)화억욱증대조조(유억욱이무흉통적환자,32례),령외선취동년령단건강체검자38명위건강대조조.대각조수시자채용한밀이돈억욱량표(HAMD)진행억욱평분,채용고효액상색보법검측혈소판5-간색알수평,류식세포술측정외주혈CD4+、CD8+세포백분비,매련면역흡부측정법검측염성인자C반응단백(CRP)、백세포개소6(IL-6)수평.결과 불명원인흉통조CRP、CD4+/CD8+명현저우급성심기경사조[3.3(2.2,4.3) mg/L비11.4(5.8,29.6)mg/L,(1.6±0.8)비(2.5±1.5)],차이유통계학의의(P＜0.05);IL-6수평[6.7(4.4,7.9) ng/L]명현고우건강대조조[2.3(1.3,4.3)ng/L],단명현저우급성심기경사조[14.8(10.0,22.4) ng/L]화억욱증대조조[12.3(5.5,34.0) ng/L],차이균유통계학의의(균P＜0.05);5-간색알수평[674(228,1 214) nmol/L]명현저우급성심기경사조[1 336(738,1 793) nmol/L]급건강대조조[850(582,1 815) nmol/L],단고우억욱증대조조[256(130,689) nmol/L],차이균유통계학의의(균P＜0.05).불명원인흉통조억욱평분명현고우급성심기경사조여건강대조조[(16.5±4.8)분비(10.3±3.1)、(8.2±2.7)분],차이유통계학의의(P＜0.05),기중14례환자HAMD평분＞20분,점36.8％.5-간색알시불명원인흉통환자억욱발생적독립위험인소(비치비=0.997,95％치신구간0.995～0.999,P＜0.05).결론 불명원인흉통환자중유36.8％반수유억욱.5-간색알시불명원인흉통환자적독립위험인소.
Objective To explore the incidence and the mechanism of depression in patients with unidentified chest pain.Methods Totally 118 patients from October 2009 to December 2013 were enrolled and divided into unidentified chest pain group (38 cases),acute myocardial infarction group (48 cases) and depression group (32 cases),in addition,38 healthy volunteers were enrolled as control group.The Hamilton's depression scale (HAMD) was used to assess the depressed state,the high performance liquid chromatography was used to detect the serotonin (5-HT) in platelet,the flow cytometry was used to measure the percentage of the CD4+/CD8+ immunocyte in the peripheral blood,the enzyme-linked immunosorbent assay was used to detect the levels of C-reaction protein (CRP) and interleukin (IL)-6.Results The CRP level and percentage of CD4+/CD8+ immunocyte in unexplained chest pain group were significantly lower than those in acute myocardial infarction group [3.3 (2.2,4.3) mg/L vs 11.4 (5.8,29.6) mg/L,(1.6 ± 0.8) vs (2.5 ± 1.5)] (P ＜ 0.05).The IL-6 level in unidentified chest pain group [6.7 (4.4,7.9) ng/L] was significantly higher than that in control group [2.3 (1.3,4.3) ng/L],but was significantly lower than that in depression group [12.3 (5.5,34.0) ng/L] and myocardial infarction group [14.8 (10.0,22.4) ng/L] (all P ＜ 0.05).The 5-HT level in unidentified chest pain group [674 (228,1214) nmol/L] was significantly lower than that in control group [850 (582,1 815) nmol/L] and acute myocardial infarction group [1 336 (738,1 793) nmol/L] (P ＜ 0.05),but was higher than that in depression group [256 (130,689) nmol/L] (all P ＜ 0.05).In unidentified chest pain group,there were 14 with HAMD score ＞ 20,and the score was significantly higher than that in control group and acute myocardial infarction group [(16.5 ±4.8) scores vs (10.3 ±3.1),(8.2 ±2.7) scores] (all P＜0.05).5-HT was an independent risk factor of depression in patients with unidentified chest pain (OR =0.997,95％ CI:0.995-0.999).Conclusions The incidence of depression in unidentified chest pain patients is high.5-HT is an independent risk factor of depression in patients with unidentified chest pain.