CAJ | 학술논문

目的：分析冠心病（ CAD）患者心理抑郁状态，评价心理抑郁对P选择素（ P-selectin）、超敏C反应蛋白（ hs-CRP）等指标的影响，观察心理抑郁与主要不良心血管事件（ mACE）及再住院率的关系。方法选取2012-01-01至2013-12-31在华北理工大学附属医院由于胸闷、胸痛症状就诊，以CAD收住院的患者538例，其中排除CAD者69例作为对照组，诊断为CAD者469例作为CAD组。CAD组患者又进一步分为稳定型心绞痛亚组47例、不稳定型心绞痛亚组222例、心肌梗死亚组200例。应用汉密尔顿抑郁量表（ HAmD）评价受试者心理抑郁状态；并检测生化指标、血脂指标、hs-CRP、P-selectin水平。对CAD患者随访1年，记录其mACE发生及再住院情况。结果对照组抑郁发生率为18.8%（13/69），CAD组为35.4%（166/469），CAD组抑郁发生率高于对照组（χ2=7.424， P=0.006）。对照组、稳定型心绞痛亚组、不稳定型心绞痛亚组、心肌梗死亚组抑郁发生率比较，差异有统计学意义（χ2=7.424，P=0.006）。将CAD组心理抑郁患者作为抑郁亚组（166例），不存在抑郁的患者作为非抑郁亚组（303例）。两亚组性别、年龄比较，差异均有统计学意义（ P<0.05）；抑郁亚组P-selectin、hs-CRP、收缩压、心率、低密度脂蛋白胆固醇（ LDL-C）、病变数（冠状动脉狭窄程度≥50%）、严重病变数（冠状动脉狭窄程度≥75%）均高于非抑郁亚组（ P<0.05）。非抑郁亚组 mACE 发生率为23.8%（72/303），再住院率为14.2%（43/303）；抑郁亚组mACE发生率为33.7%（56/166），再住院率为22.9%（38/166）。两亚组mACE发生率、再住院率比较，差异均有统计学意义（χ2=5.375，P=0.020；χ2=5.681，P=0.017）。结论抑郁不仅与CAD相关，而且与CAD的严重程度密切相关。老年、女性CAD患者心理抑郁的患病率明显升高。CAD心理抑郁患者不仅血小板活化水平高、炎性反应明显，而且聚集常见的心血管疾病危险因素，影响患者转归和预后。目的：分析冠心病（ CAD）患者心理抑鬱狀態，評價心理抑鬱對P選擇素（ P-selectin）、超敏C反應蛋白（ hs-CRP）等指標的影響，觀察心理抑鬱與主要不良心血管事件（ mACE）及再住院率的關繫。方法選取2012-01-01至2013-12-31在華北理工大學附屬醫院由于胸悶、胸痛癥狀就診，以CAD收住院的患者538例，其中排除CAD者69例作為對照組，診斷為CAD者469例作為CAD組。CAD組患者又進一步分為穩定型心絞痛亞組47例、不穩定型心絞痛亞組222例、心肌梗死亞組200例。應用漢密爾頓抑鬱量錶（ HAmD）評價受試者心理抑鬱狀態；併檢測生化指標、血脂指標、hs-CRP、P-selectin水平。對CAD患者隨訪1年，記錄其mACE髮生及再住院情況。結果對照組抑鬱髮生率為18.8%（13/69），CAD組為35.4%（166/469），CAD組抑鬱髮生率高于對照組（χ2=7.424， P=0.006）。對照組、穩定型心絞痛亞組、不穩定型心絞痛亞組、心肌梗死亞組抑鬱髮生率比較，差異有統計學意義（χ2=7.424，P=0.006）。將CAD組心理抑鬱患者作為抑鬱亞組（166例），不存在抑鬱的患者作為非抑鬱亞組（303例）。兩亞組性彆、年齡比較，差異均有統計學意義（ P<0.05）；抑鬱亞組P-selectin、hs-CRP、收縮壓、心率、低密度脂蛋白膽固醇（ LDL-C）、病變數（冠狀動脈狹窄程度≥50%）、嚴重病變數（冠狀動脈狹窄程度≥75%）均高于非抑鬱亞組（ P<0.05）。非抑鬱亞組 mACE 髮生率為23.8%（72/303），再住院率為14.2%（43/303）；抑鬱亞組mACE髮生率為33.7%（56/166），再住院率為22.9%（38/166）。兩亞組mACE髮生率、再住院率比較，差異均有統計學意義（χ2=5.375，P=0.020；χ2=5.681，P=0.017）。結論抑鬱不僅與CAD相關，而且與CAD的嚴重程度密切相關。老年、女性CAD患者心理抑鬱的患病率明顯升高。CAD心理抑鬱患者不僅血小闆活化水平高、炎性反應明顯，而且聚集常見的心血管疾病危險因素，影響患者轉歸和預後。
목적：분석관심병（ CAD）환자심리억욱상태，평개심리억욱대P선택소（ P-selectin）、초민C반응단백（ hs-CRP）등지표적영향，관찰심리억욱여주요불양심혈관사건（ mACE）급재주원솔적관계。방법선취2012-01-01지2013-12-31재화북리공대학부속의원유우흉민、흉통증상취진，이CAD수주원적환자538례，기중배제CAD자69례작위대조조，진단위CAD자469례작위CAD조。CAD조환자우진일보분위은정형심교통아조47례、불은정형심교통아조222례、심기경사아조200례。응용한밀이돈억욱량표（ HAmD）평개수시자심리억욱상태；병검측생화지표、혈지지표、hs-CRP、P-selectin수평。대CAD환자수방1년，기록기mACE발생급재주원정황。결과대조조억욱발생솔위18.8%（13/69），CAD조위35.4%（166/469），CAD조억욱발생솔고우대조조（χ2=7.424， P=0.006）。대조조、은정형심교통아조、불은정형심교통아조、심기경사아조억욱발생솔비교，차이유통계학의의（χ2=7.424，P=0.006）。장CAD조심리억욱환자작위억욱아조（166례），불존재억욱적환자작위비억욱아조（303례）。량아조성별、년령비교，차이균유통계학의의（ P<0.05）；억욱아조P-selectin、hs-CRP、수축압、심솔、저밀도지단백담고순（ LDL-C）、병변수（관상동맥협착정도≥50%）、엄중병변수（관상동맥협착정도≥75%）균고우비억욱아조（ P<0.05）。비억욱아조 mACE 발생솔위23.8%（72/303），재주원솔위14.2%（43/303）；억욱아조mACE발생솔위33.7%（56/166），재주원솔위22.9%（38/166）。량아조mACE발생솔、재주원솔비교，차이균유통계학의의（χ2=5.375，P=0.020；χ2=5.681，P=0.017）。결론억욱불부여CAD상관，이차여CAD적엄중정도밀절상관。노년、녀성CAD환자심리억욱적환병솔명현승고。CAD심리억욱환자불부혈소판활화수평고、염성반응명현，이차취집상견적심혈관질병위험인소，영향환자전귀화예후。
Objective To investigate the depressive state of patients with coronary artery disease( CAD),evaluate the influence of depressive state on indexes such as P-selectin and hypersensitive C-reactive protein( hs-CRP),and explore the relation between depression and major cardiovascular events( mACE) and readmission rate. Methods We enrolled 538 patients who visited a doctor due to chest distress and chest pain and were hospitalized with a diagnosis of CAD in the Affiliated Hospital of North China University of Science and Technology from January 1,2012 to December 31,2013. The patients with CAD excluded were assigned into control group,and the patients who were definitely diagnosed as CAD were assigned into CAD group. The CAD group was further divided into stable angina pectoris subgroup(n=47),unstable angina pectoris subgroup(n=222)and myocardial infarction subgroup(n =200). HAmD was employed to evaluate the depressive state of subjects. Biochemical indexes,serum lipid index,serum hs-CRP and P-selectin level were examined. We undertook one-year follow-up,during which mACE incidence and readmission rate were recorded. Results The depression rates of control group and CAD group were 18. 8%(13/69)and 35. 4%(166/469),with CAD group higher than control group(χ2 =7. 424,P=0. 006). Control group, stable angina pectoris subgroup, unstable angina pectoris subgroup and myocardial infarction subgroup were significantly different in depression rate(χ2 =7. 424,P=0. 006). CAD patients with depression were assigned into depression subgroup(n=166),and CAD patients without depression were assigned into non-depression subgroup(n=303). The two subgroups were significantly different in gender and age(P<0. 05);depression subgroup was higher(P<0. 05)than non-depression subgroup in P-selectin,hs-CRP,systolic blood pressure,heart rate,LDL-C,number of lesion( coronary artery stenosis degree≥50%) and number of serious lesion ( coronary artery stenosis degree≥75%). The incidence rate of mACE and readmission rate were 23. 8%( 72/303 ) and 14. 2%( 43/303 ) for non -depression subgroup and were 33. 7%( 56/166) and 22. 9%(38/166) for depression subgroup. The two subgroups were significantly different in the incidence of mACE and admission rate(χ2 =5. 375,P =0. 020;χ2 =5. 681,P =0. 017). Conclusion Depression is not only related with CAD,but also closely related with the severity of CAD. Elderly CAD patients and female CAD patients have higher prevalence of depression. CAD patients with depression not only have high platelet activation level and obvious inflammatory reaction,but also have risk factors for common cardiovascular diseases,which may influence the lapse and prognosis of CAD patients.