急性心肌梗死合并焦虑抑郁中医证素分布及相关临床特征回顾性研究  

Retrospective Study on the Distribution of Chinese Medicine Syndrome Elements and Related Clinical Characteristics in Patients with Acute Myocardial Infarction Combined with Anxiety and Depression

作　　者：徐嘉唯 刘剑刚[1] 陈露莹 张京春[1] 蒋跃绒[1] XU Jia-wei;LIU Jian-gang;CHEN Lu-ying;ZHANG Jing-chun;JIANG Yue-rong(National Clinical Research Center for Chinese Medicine Cardiology/State Key Laboratory of Traditional Chinese Medicine Syndrome,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091)

机构地区：[1]国家中医心血管病临床医学研究中心/中医证候全国重点实验室,中国中医科学院西苑医院心血管中心,北京100091

出　　处：《中国中西医结合杂志》2025年第2期162-168,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：中国中医科学院科技创新工程重大攻关项目(No.CI2021A00908);全国中医临床优秀人才项目(No.国中医药人教函[2022]1号)。

摘　　要：目的 观察急性心肌梗死(AMI)合并焦虑抑郁患者的中医证素分布及相关临床特征,探讨其相关危险因素。方法 采用回顾性研究,纳入2019年9月-2022年9月中国中医科学院西苑医院住院的AMI患者1 392例,按是否合并焦虑抑郁分为单纯AMI组(1 300例)和AMI合并焦虑抑郁组(92例),并根据AMI类型进一步分为急性ST段抬高型心梗(STEMI)和急性非ST段抬高型心梗(NSTEMI)亚组。收集一般资料、中医证候要素、心脏超声指标及血清生物学指标。通过单因素分析筛选AMI是否合并焦虑抑郁两组间存在显著差异的临床特征,采用二元Logistic回归分析差异性临床特征是否为焦虑抑郁发生的危险因素。结果 中医证素方面,单纯AMI组以血瘀、痰浊为主,AMI合并焦虑抑郁组以血瘀、气虚为主。单因素分析结果显示性别、婚姻状况、吸烟史、合并失眠、心功能不全、心律失常、NTproBNP水平及Killip分级在单纯AMI组与AMI合并焦虑抑郁组间差异有统计学意义(P<0.05);Logistic回归显示婚姻异常[OR 2.949,95%CI (1.514~5.741),P=0.001]和合并失眠[OR 2.934,95%CI(1.788~4.816),P=0.000]是AMI合并焦虑抑郁的独立危险因素。亚组分析显示,女性、婚姻异常、合并失眠及心律失常是NSTEMI合并焦虑抑郁的独立危险因素(P<0.05)。结论 婚姻异常及失眠是AMI患者合并焦虑抑郁的独立危险因素。此外,女性和合并心律失常也是NSTEMI患者合并焦虑抑郁的独立危险因素。Objective To observe the distribution of Chinese medicine(CM)syndrome elements and related clinical characteristics in patients with acute myocardial infraction(AMI)combined with anxiety and depression, and to explore the related risk factors. Methods A retrospective study was conducted on patients with AMI hospitalized from September 2019 to September 2022 at Xiyuan Hospital, China Academy of Chinese Medical Sciences. And 1 392 patients met the inclusion criteria and were assigned to the AMI-alone group(1 300 cases)and the AMI combined with anxiety and depression group(92 cases) based on the presence or absence of anxiety and depression. Furthermore, the patients were assigned to subgroups according to the type of AMI: acute ST-segment elevation myocardial infarction(STEMI)and acute non-ST-segment elevation myocardial infarction(NSTEMI). General information, CM syndrome elements, cardiac ultrasound indicators, and serum biomarkers were collected. Univariate analysis was performed to identify significant differences in clinical characteristics between AMI patients with and without anxiety and depression. Binary Logistic regression was then employed to analyze whether these differential clinical characteristics served as risk factors for anxiety and depression. Results In terms of CM syndrome elements, the AMI-alone group was mainly characterized by blood stasis and phlegm turbidity, while the AMI with anxiety and depression group primarily exhibited blood stasis and qi deficiency. Univariate analysis showed statistically significant differences in gender, marital status, smoking history, insomnia, heart failure, arrhythmia, NT-proBNP levels, and Killip classification between the two groups(P<0.05). Logistic regression identified abnormal marital status [OR 2.949, 95%CI(1.514~5.741), P=0.001] and insomnia [OR 2.934, 95%CI(1.788~4.816), P=0.000] as independent risk factors for anxiety and depression in AMI patients. Subgroup analysis showed that female, abnormal marital status, insomnia, and arrhythmia were indepen

关 键 词：急性心肌梗死 焦虑 抑郁 中医证素 中西医结合 回归分析 回顾性研究 

分 类 号：R259[医药卫生—中西医结合] R277.7[医药卫生—中医内科学]