拟诊冠状动脉粥样硬化性心脏病入院患者抑郁情况及相关影响因素分析  

Prevalence and predictors of depression in patients with admitting diagnosis of coronary heart disease

作　　者：尹晗 刘于庭 马欢[2] 汪萍[2] 郭兰[2] 耿庆山 YIN Han;LIU Yu-ting;MA Huan;WANG Ping;GUO Lan;GENG Qing-shan(School of Medicine,South China University of Technology,Guangzhou 510010,China;Cardiovascular Department,Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510010,China)

机构地区：[1]华南理工大学医学院,广州510010 [2]广东省心血管病研究所心内科广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2019年第4期399-405,共7页South China Journal of Cardiovascular Diseases

摘　　要：目的调查拟诊冠状动脉粥样硬化性心脏病(冠心病)入院患者的抑郁情况及相关影响因素.方法采用9条目患者健康问卷(9-item patient health questionnaire,PHQ-9)、西雅图心绞痛发作情况量表(Seattle angina questionnaire-angina frequency,SAQ-AF)等开展问卷调查,不间断于心内科病区纳入拟诊冠心病患者705例,依据冠状动脉造影结果、出院诊断等将患者详细分类并进行组间统计学比较和相关因素分析.结果以冠心病收诊住院患者抑郁患病率达到40.0%,其中排除冠心病(55.6%)及冠状动脉粥样硬化患者(60.0%)抑郁患病率显著高于心绞痛(38.8%)及急性心肌梗死患者(33.1%),差异有统计学意义(P<0.05).女性、高龄、受教育水平低、无爱人陪伴、长病程、入院前胸部不适频率高、服用呋塞米、内生肌酐清除率低、罹患糖尿病、低运动强度、短运动时间的心绞痛患者更易发生抑郁.多因素Logistic回归分析结果提示,入院前胸部不适频率高、内生肌酐低清除率、罹患糖尿病对抑郁症状影响最大.长病程心源性不适急性心肌梗死患者更易抑郁.结论以冠心病收诊住院患者抑郁发生率高,其中以冠状动脉无明显病变患者最为严重.抑郁症状受多方面因素影响,对患者抑郁症状的持续追踪可能对疾病转归更有预测价值.Objectives To determine the prevalence and influencing factors of depression in patients with admitting diagnosis of coronary heart disease(CHD). Methods The 9-item patient health questionnaire(PHQ-9)and Seattle angina questionnaire-angina frequency(SAQ-AF)were applied in this cross-sectional study. Totally 705 consecutive in-patients with admitting diagnosis of CHD were included and systematically classified based on coronary angiography and discharge diagnosis. Prevalence of depression and clinical data between the groups were compared. Results 40.0%of in-patients with admitting diagnosis of CHD were with depression symptoms. The prevalence of depression symptoms in patients diagnosed as not having CHD(55.6%)and coronary atherosclerosis(60.0%)were higher than those in patients with angina pectoris(38.8%)and acute myocardial infarction(AMI)(33.1%),and the differences were significant(P<0.05). Angina pectoris in-patients of female,higher age,lower education background,lack of company,with longer course of CHD,higher angina frequency,usage of loop diuretics,lower creatinine clearance(CCR),diabetes,lower exercise intensity and shorter daily exercise duration were at higher risk of depression. Multi-factor Logistic analysis confirmed that higher angina frequency,lower CCR and diabetes were the most predominant. AMI inpatients with longer course of CHD seemed more depressed. Conclusions The prevalence of depression in in-patients with admitting diagnosis of CHD is high,especially in those with comparatively normal coronary artery. Multiple factors influence the assessment result of depression symptoms. The dynamic change of depression symptoms may be more important for prognosis.

关 键 词：冠状动脉疾病 抑郁 冠状动脉造影 心绞痛 

分 类 号：R541.4[医药卫生—心血管疾病]