急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后抑郁发生状况及其危险因素调查  

Investigation of prevalence and risk factors of depression in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

作　　者：王嵬民[1] 杜馥曼[2] 杨艳[3] 霍红[1] 车琳[1] 李欣[1] 张明亮 Wang Weimin;Du Fuman;Yang Yan;Huo Hong;Che Lin;li Xin;Zhang Mingliang(Department of Cardiology,Heilongiang Provincial Hospial,Harbin,Heilongjiang 150036,China;Department of Endocrinology,Heiogiang Provincial Hospital,Harbin,Heilongiang 150036,China;Department of Cardiology,Nangang Branch of Heilongiang Provincial Hospial,Harbin,Heilongjiang 150036,China)

机构地区：[1]黑龙江省医院心血管内科,哈尔滨150036 [2]黑龙江省医院内分泌科,哈尔滨150036 [3]黑龙江省医院南岗院区心血管内科,哈尔滨150036

出　　处：《中国基层医药》2020年第20期2491-2495,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：黑龙江省卫生健康委员会科研课题(2017471)。

摘　　要：目的 观察急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后的抑郁发生状况及其危险因素.方法 随机选取2019年1-12月于黑龙江省医院心血管内科因STEMI行PCI治疗的患者205例,应用Zung抑郁自评量表(SDS)对PCI术后1周的STEMI患者进行抑郁评分.另外选择同期该院体检健康者200例作为健康对照组.同时调查患者的社会人口学资料,包括:年龄、性别、文化程度、居住地、医疗付费方式、月收入、婚姻状况、吸烟史、饮酒史、糖尿病史、其他心脑血管疾病史.测定STEMI患者的临床指标,包括:身高、体质量、腰围(WC)、臀围(HC),计算体质量指数(BMI)和腰臀围比值(WHR),空腹血糖(FPG)、空腹血清胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR),血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、收缩压(SBP)和舒张压(DBP).结果 STEMI组抑郁患病率(17.07%)显著高于健康对照组(9.50%)(x2=5.025,P =0.025).两组间抑郁程度差异有统计学意义(x2=8.360,P=0.039).logistic多因素回归分析显示,按危险因素的OR值大小排列分别为:FPG、女性、年龄≥65岁、BMI、月收入<5000元、HOMA-IR、自费医疗(OR=1.894、1.812、1.545、1.428、1.335、1.285、1.202).结论 STEMI患者PCI术后抑郁发生率较高,合并糖尿病、女性、高龄、肥胖、低收入、胰岛素抵抗和自费医疗是STEMI患者行PCT术后易患抑郁的危险因素.Objective To invesigate the prevalence and risk factors of depression in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods From January 2019 to December 2019,205 patients with STEMI who underwent PCI were selected randomly in Department of Cardiology of Heilongjiang Provincial Hospital.And 200 health examined people from our hospital at the same time were selected as health control group.The Zung self-rating depression scale(SDS)was used to score the depression in STEMI patients one week after PCI.The social demographic data were investigated,including age,gender,education status,place of residence,medical payments,monthly income,marital status,smoking history,drinking history,diabetic history,cardiovascular and cerebrovascular diseases history.The clinical indicators were measured,including height,weight,waist cireumference(WC),hip circumference(HC),body mass index(BMI),waist-hip rate(WHR),fasting plasma glucose(FPG),fasting serum insulin(FINS),homeostasis model asessment-insulin resistance index(HOMA-IR),serum total cholesterol(TC),total triglyceride(TG),low density lipoprotein-C(LDL-C),high density liprotein-C,(HDL-C),systolie blood pressure(SBP)and diastolic blood pressure(DBP).Results The prevalence of depression in the STEMI group was obviously higher than that in the control group(17.07%vs.9.50%,χ2=5.025,P=0.025).There was statistically significant difference in the severity of depression between the two groups(χ2=8.360,P=0.039).Mulivariate Logistic regression analysis showed that the risk factors for depression in order of OR values were FPG,gender(female),age(65 or old),BMI,monthly income(<5000 RMB),HOMA-IR,self-paying for medical services(OR=1.894,1.812.I.545,1.428,1.335,1.285,1.202)..Conclusion The prevalence of depression in STEMI patients after PCI is increased.The risk factors for depression include female,old age,obesity,low income,insulin resistance and self-paying for medical services.

关 键 词：心肌梗死 急性冠脉综合征 经皮冠状动脉介入治疗 抑郁 糖尿病 肥胖 胰岛素抵抗 老年人 

分 类 号：R542.22[医药卫生—心血管疾病]