稳定型冠心病患者精神压力诱发心肌缺血的相关临床研究  

Mental stress-induced myocardial ischemia in patients with stable coronary heart disease:a relevant clinic study

作　　者：何东方[1] 张丽军[1] 杨娅[2] 蒲利红[2] 徐丽媛 刘梅颜[1] He Dongfang;Zhang Lijun;Yang Ya;Pu Lihong;Xu Liyuan;Liu Meiyan(Center for Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏中心,北京100029 [2]首都医科大学附属北京安贞医院超声一部,北京100029

出　　处：《中国循证心血管医学杂志》2018年第3期319-323,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：北京市科学技术委员会首都市民健康项目培育(Z151100003915085)

摘　　要：目的探究稳定型冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉狭窄程度、钙化程度、抑郁焦虑与精神压力引发的心肌缺血(MSIMI)的关系,精神压力下血压反应与冠状动脉钙化的关系。方法入选2017年6月1日~2017年11月8日于安贞医院心内科住院的冠心病患者48例,其中男性33例,女性15例,平均年龄(58.04±10.41)岁。患者健康问卷抑郁自评量表(PHQ-9)评估抑郁状态,广泛性焦虑障碍问卷(GAD-7)评估焦虑状态。Gensini评分以及钙化分级标准分别评估冠状动脉狭窄程度和钙化分级。进行压力超声检查,测试前后采集患者静脉血,用于检测心功能指标,同时测定血压。结果冠心病患者MSIMI发生率为18.8%,其中单支病变患者MSIMI发生率为22.2%,双支病变为6.7%,三支病变为25.0%。冠心病患者0级钙化MSIMI发生率为19.2%,1级钙化为28.6%,2级钙化为14.3%,3级钙化为12.5%。MSIMI组与非MSIMI组在性别、年龄、精神压力测试前后心脏标志物(hs-c Tn I、CK-MB、Myo)、PHQ-9评分、GAD-7评分、冠状动脉狭窄评分、支架数量等方面比较,差异无统计学意义(P均>0.05)。冠心病患者冠状动脉钙化、抑郁、焦虑以及测试过程中出现紧张均未增加MSIMI的发生危险。测试前、测试中以及测试后,冠状动脉钙化组收缩压均高于非冠状动脉钙化组,差异有统计学意义(P均<0.05)。校正性别、年龄、体质指数、高血压、糖尿病、高脂血症等因素后,精神压力测试前、测试中以及测试后收缩压,是冠状动脉钙化发生的危险因素。结论冠状动脉的病变程度及钙化程度可能不是冠心病患者发生MSIMI的关键因素,而心理状态可能与MSIMI有密切关系,且精神压力下收缩压是冠状动脉钙化发生的危险因素。Objective To study the relationship among severity of coronary artery stenosis,severity of coronary artery calcification(CAC),depression-anxiety and mental stress-induced myocardial ischemia(MSIMI),and relationship between blood pressure response and CAC under mental stress in patients with stable coronary heart disease(CHD).Methods CHD patients(n=48,male 33,female 15 and average age=58.04±10.41)were chosen from Department of Cardiology of Beijing Anzhen Hospital from June 1,2017 to Nov.8,2017.The depression status was reviewed by using self-rating scale of 9-item patient health questionnaire(PHQ-9),and anxiety status was reviewed by using questionnaire of 7-item generalized anxiety disorder(GAD-7).The severity of coronary artery stenosis and grades of CAC were reviewed respectively by using Gensini scoring and CAC grading criterion.The patients were given ultrasonic inspection of mental stress.The venous blood samples were collected for detecting indexes of heart function before and after mental stress inspection,and meanwhile blood pressure(BP)was detected.Results The incidence of MSIMI was 18.8%in CHD patients,which was 22.2%in those with 1-vessel lesion,6.7%in those with 2-vessel lesion and 25.0%in those with 3-vessel lesion.The incidence of MSIMI was 19.2%in patients with grade 0 CAC,28.6%in those with grade 1 CAC,14.3%in those with grade 2 CAC,and 12.5%in those with grade 3 CAC.The comparison between MSIMI group and non-MSIMI group showed that the difference in sex,age,and cardiac biomarkers(hs-cTnI,CK-MB,MYO),PHQ-9 scores,GAD-7 scores,scores of coronary artery stenosis and stents numbers before and after mental stress inspection had no statistical significance(all P>0.05).CAC,depression,anxiety and tension occurred during the inspection had no increasing effect on MSIMI risk.The level of systolic blood pressure(SBP)was higher in CAC group than that in non-CAC group before,during and after the inspection(all P<0.05).After correcting sex,age,BMI,hypertension,diabetes and hyperlipidmia,SBP before,during and

关 键 词：冠心病 冠状动脉狭窄 冠状动脉钙化 精神压力诱发心肌缺血 

分 类 号：R541.4[医药卫生—心血管疾病]