精神压力介导的外周血神经递质变化与冠状动脉迂曲进展的相关性  

Correlation of Stress-Mediated Peripheral Blood NeurotransmitterChanges with the Progression of Coronary Artery Tortuosity

作　　者：夏长伟 齐大屯 崔佳佳 XIA Changwei;QI Datun;CUI Jiajia(Department of Cardiology,Fuwai Central China Cardiovascular Hospital,Zhengzhou 451450,China)

机构地区：[1]阜外华中心血管病医院心内科,河南郑州451450

出　　处：《河南医学研究》2024年第24期4433-4437,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230137)。

摘　　要：目的 探究精神压力介导的外周血神经递质变化与冠状动脉迂曲(CAT)进展的相关性。方法 纳入2018年1—12月阜外华中心血管病医院心内科收治的465例CAT治疗前患者为研究对象,根据压力知觉量表(CPSS)和汉密尔顿焦虑量表(HAMA)评分将受试者分为无焦虑和抑郁症状组(275例)与有焦虑和抑郁症状组(190例)。收集患者的一般资料,采用CPSS和HAMA量表及C型人格行为模式问卷评价患者抑郁状况;采用酶联免疫吸附试验检测外周血神经递质[去甲肾上腺素(NE)、肾上腺素(E)、多巴胺(DA)、γ-氨基丁酸(GABA)、5-羟色胺(5-HT)以及谷氨酸(Glu)]和C反应蛋白(CRP)水平。随访统计患者冠状动脉粥样硬化(AS)发生率和发生时间。采用Pearson法进行CPSS和HAMA评分与C型人格行为模式的相关性分析,采用logistic回归分析探究CAT患者发生终点事件的影响因素。结果 与无焦虑和抑郁症状组相比,有焦虑和抑郁症状组患者的压力知觉总分、HAMA得分和焦虑、抑郁、愤怒内向评分升高,乐观、愤怒、愤怒外向和社会支持评分降低;外周血NE、E、DA、Glu和5-HT水平均下降,CRP水平升高;AS发生率增加,AS发生时间缩短(P<0.01)。有焦虑和抑郁症状组的CPSS和HAMA评分与C型人格行为模式问卷中的焦虑、抑郁、愤怒、愤怒内向和愤怒外向呈正相关,而与乐观和社会支持呈负相关(P<0.05),但与控制和理智无相关性(P>0.05)。logistic回归分析显示,CAT患者血清中NE、E、DA、5-HT、Glu和CRP水平升高是患者发生AS的危险因素(P<0.01)。结论 CAT患者的精神压力与AS发生密切相关,焦虑抑郁引起的外周血神经递质NE、E、DA、5-HT和Glu水平变化为AS发生的影响因素,其机制可能与长期压抑状态引起的炎症反应有关。Objective To investigate the correlation between stress-mediated peripheral blood neurotransmitter changes and the progression of coronary artery tortuosity(CAT).Methods A total of 465 CAT pre-treatment patients admitted to the Department of Cardiology of Fuwai Central China Cardiovascular Hospital from January to December 2018 were included as study subjects,and the subjects were divided into a group without anxiety and depressive symptoms(275 cases)and a group with anxiety and depressive symptoms(190 cases)based on the scores of Chinese perceived stress scale(CPSS)and the Hamilton anxiety scale(HAMA).The general data of the patients were collected,and the depression status was evaluated using the CPSS and HAMA scales and the type C personality behavioral patterns questionnaire,the peripheral blood neurotransmitters[norepinephrine(NE),epinephrine(E),dopamine(DA),gamma-aminobutyric acid(GABA),5-hydroxytryptamine(5-HT),and glutamate(Glu)]and C-reactive protein(CRP)levels were measured by enzyme-linked immunosorbent assay.The incidence of coronary atherosclerosis(AS)and the occurrence time were counted in patients at follow-up.Correlation analysis of CPSS and HAMA scores with type C personality behavioral patterns was performed by Pearson’s method,and logistic regression analysis was used to explore the factors influencing the occurrence of endpoint events in CAT patients.Results Compared with the group without anxiety and depressive symptoms,patients in the group with anxiety and depressive symptoms had higher total stress perception scores,HAMA scores,and anxiety,depression,and anger introversion scores,and lower optimism,anger,anger extroversion,and social support scores,peripheral blood levels of NE,E,DA,Glu,and 5-HT were decreased,and CRP level was elevated,AS incidence was increased,and the time of AS onset was shortened(P<0.01).CPSS and HAMA scores of CAT patients in the group with anxiety and depressive symptoms were positively correlated with anxiety,depression,anger,anger introversion,and anger extrover

关 键 词：冠状动脉迂曲 精神压力 神经递质 冠状动脉粥样硬化 炎症 

分 类 号：R543.3[医药卫生—心血管疾病]