冠心病患者冠状动脉支架内再狭窄与抑郁障碍的相关性研究  

The correlation study between coronary in-stent restenosis and depression disorder in patients with coronary heart disease

作　　者：张金国[1] 谭洪勇[2] 张传芝[3] 刘向群[4] 廖玉华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院心内科,武汉430022 [2]济宁医学院临床学院 [3]山东省安康医院 [4]山东大学齐鲁医院干部保健科

出　　处：《中华行为医学与脑科学杂志》2010年第10期929-931,共3页Chinese Journal of Behavioral Medicine and Brain Science

摘　　要：目的 探讨冠心病（coronary heart disease,CHD）患者经皮冠状动脉支架置人（PCI）术后抑郁障碍对支架内再狭窄（In-stent Restenosis,ISR）的影响,以及可能的病理生理学机制.方法 根据患者汉密尔顿抑郁量表（HAMD-24）、抑郁自评量表（SDS）评分,选择冠心病行PCI术后合并抑郁障碍（HAMD-24评分＞8分并SDS评分＞53分）的95例患者为研究组,246例冠心病行PCI无抑郁障碍患者为对照组,观察两组患者12月内ISR的发生情况,并测定术后血清醛固酮（aldosterone,ALD）、高敏C反应蛋白（hs-CRP）及瘦素（Leptin）水平.结果 研究组患者发生ISR者明显高于对照组（P=0.003）;研究组不同抑郁程度的患者其ISR差异有显著性（χ2=8.148,P=0.017）;研究组患者血清ALD、hs-CRP及Leptin水平术后分别高于对照组[ALD（277.4±35.9）ng/L,（258.9±60.9）ng/L,t=3.459,P=0.001 ;hs-CRP（12.03±3.06）mg/L.（11.10±2.806）mg/L,t=2.573,P=0.008;Leptin（5.27±1.07）ng/L,（4.98±0.99）ng/L,t=2.323,P=0.021];Pearson相关分析显示,研究组患者HAMD-24评分分别与术后血清ALD、hs-CRP及;Lptin相关（r=0.291,P=0.026;r=0.350,P=0.014;r=0.312,P=0.023）,SDS评分与血清hs-CRP具有相关性（r=0.302,P=0.020）.结论 冠心病PCI术后合并抑郁障碍患者血清ALD、hs-CRP及Leptin水平较高,ISR发生率明显高于无抑郁障碍冠心病患者,且随抑郁程度加重ISR发生率增加.Objective To study the impact of depression disorder in patients after coronary stent implantation on incidence rate of in-stent restenosis （ISR） in the coronary heart disease（ CHD ）, and its possible pathophysiological mechanisms. Methods According to the Hamilton Depression Scale （HAMD-24） and Self-rating Depression Scale（SDS） score,95 patients with unstable angina received coronary drug-eluting stent implantation combined with depression disorder were serve as the study group; randomly selecte 246 cases without depression due to unstable angina pectoris after coronary stent implantation as the control group in the same period. The incidence rate of ISR in these two group were observed, and serum aldosterone （ ALD）, high-sensitivity C-reactive protein （hs-CRP） ,Leptin levels in two groups were compared. Results The incidence rate of ISR in study group were significantly higher than that of the control group （28/95 vs 46/246, P〈0. 05）. Following with the aggravation of depression disorder,the incidence rate of ISR were elevated（ χ2 =8. 148, P=0.017）. Serum ALD,hs-CRP and Leptin levels of study group were significantly higher than the control group 7 days later after drug-eluting stent implantation （ ALD：277.4 ± 35.9 vs 258.9 ± 60.9, t= 3. 459, P= 0. 001; hs-CRP： 12.03 ± 3.06 vs 11.10 ±2. 806, t = 2.573, P = 0.008; Leptin：5.27 t 1.07 vs 4.98 ± 0.99, t= 2.323, P= 0.021 ）. Pearson correlation analysis showed that its HAMA-24 score was positively correlated with serum ALD ,hs-CRP and Leptin（ r=0.291,P=0.026; r=0.350, P=0.014; r=0. 312, P=0.023） ,and SDS score was positively correlated with hs-CRP（ r=0. 302, P= 0. 020）. Conclusion Serum ALD, hs-CRP and Leptin levels are higher in patients after coronary stent implantation combined with depression in patients, and the incidence rate of ISR is also higher in these patients, and the rates are elevated according to the aggravation of depression disorder.

关 键 词：冠状动脉支架内再狭窄 抑郁障碍 醛固酮 瘦素 高敏C反应蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]