出 处:《现代预防医学》2024年第23期4398-4404,共7页Modern Preventive Medicine
基 金:湖南省自然科学基金课题面上项目(2021JJ30592);湖南省卫生健康委科研课题(D202309037942)。
摘 要:目的本研究旨在探讨抑郁症和心绞痛的关系及共病的死亡风险,为心绞痛患者治疗和预后管理提供参考。方法基于美国国家健康和营养调查数据库(NHANES)2009—2018年中11232名≥40岁的中老年人群,采用logistic回归分析及限制性立方样条模型探讨抑郁症和心绞痛的关系。采用绘制生存曲线(K-M)法和Cox回归模型探讨4个组别死亡风险的差异。结果Logistic回归分析发现各抑郁组中心绞痛患病风险均有统计学意义(轻度抑郁组:OR=1.78,95%CI:1.48~2.20;中度抑郁组:OR=3.40,95%CI:2.62~4.42;重度抑郁组:OR=5.16,95%CI:3.94~6.77),且抑郁程度越高心绞痛患病风险更高(W=151.93,P<0.001),提示抑郁是心绞痛的危险因素。总人群中两者的剂量-反应关系呈现斜率逐渐降低的递增曲线形状,随着抑郁程度加重,心绞痛患病风险呈增加趋势。K-M曲线和Cox回归模型显示,在调整了所有可能混杂因素后抑郁共病心绞痛组的死亡风险高于抑郁症组和心绞痛组(HR=2.35,95%CI:1.77~3.12)。结论抑郁症与心绞痛之间存在显著相关关系,且抑郁共病心绞痛组的死亡风险高于单纯抑郁症组和单纯心绞痛组。在今后治疗心绞痛的同时,应该重视抑郁症的评估、预防和治疗,以改善患者的长期预后。Objective To explore the relationship between depression and angina pectoris,as well as the mortality risk associated with their comorbidity,providing references for the treatment and prognostic management of angina pectoris patients.Methods Based on the National Health and Nutrition Examination Survey(NHANES)database from 2009 to 2018,data from 11232 individuals aged 40 and older were analyzed using logistic regression and restricted cubic spline models to investigate the relationship between depression and angina pectoris.Survival curves(Kaplan-Meier)and Cox regression models were employed to examine the differences in mortality risk among four groups.Results Logistic regression analysis revealed statistically significant risks of angina pectoris across various depression groups(mild depression group OR=1.78,95%CI:1.48-2.20;moderate depression group OR=3.40,95%CI:2.62-4.42;severe depression group OR=5.16,95%CI:3.94-6.77),indicating that higher levels of depression correlate with greater risk of angina pectoris(W=151.93,P<0.001),suggesting that depression was a risk factor for angina pectoris.In the overall population,the dose-response relationship between the two exhibited a gradually decreasing slope,indicating an increasing trend in angina pectoris risk with worsening depression.The Kaplan-Meier curves and Cox regression models demonstrated that the mortality risk in the comorbid depression and angina pectoris group was higher than that in the depression-only and angina pectoris-only groups,even after adjusting for all potential confounding factors(HR=2.35,95%CI:1.77-3.12).Conclusion There is a significant correlation between depression and angina pectoris,with the mortality risk in the comorbid depression and angina pectoris group being higher than in either the depression-only or angina pectoris-only groups.Future treatment of angina pectoris should also emphasize the assessment,prevention,and treatment of depression to improve long-term patient outcomes.
分 类 号:R749.4[医药卫生—神经病学与精神病学] R541.4[医药卫生—临床医学]
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