抑郁症状对慢性病共病患者全因死亡、心脑血管疾病死亡风险影响的前瞻性队列研究  

A prospective cohort study on the impact of depressive symptoms on all-cause mortality and cardiovascular mortality risk in patients with chronic comorbidity

作　　者：安芹彧 周婕[2] 张福艳 詹清清 张畑霖 李小雪 尹丽华 刘涛 AN Qin-yu;ZHOU Jie;ZHANG Fu-yan;ZHAN Qing-qing;ZHANG Tian-lin;LI Xiao-xue;YIN Li-hua;LIU Tao(School of medicine,Guizhou University,Guiyang,Guizhou 550025,China;不详)

机构地区：[1]贵州大学医学院,贵州贵阳550025 [2]贵州省疾病预防控制中心慢性病防治研究所 [3]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室

出　　处：《现代预防医学》2025年第6期1144-1152,共9页Modern Preventive Medicine

基　　金：贵州省科技计划项目(黔科合支撑[2018]2819);贵州省卫生健康委省级重点建设学科项目。

摘　　要：目的探索抑郁症状与慢性病共病患者全因死亡和心脑血管疾病死亡的关系。方法本研究采用χ2检验进行单因素分析,运用COX比例风险回归模型分别分析PHQ-9得分、抑郁症状与共病患者全因死亡和心脑血管疾病死亡的关系。结果多因素COX回归结果显示,与无抑郁症状人群相比,抑郁症状人群的全因死亡、心脑血管死亡分别为HR=1.665(95%CI:1.135~2.444)、HR=2.090(95%CI:1.216~3.594),随着PHQ-9得分增加,全因死亡(HR=1.060,95%CI:1.014~1.107)(P_(趋势)<0.01)和心脑血管死亡(HR=1.072,95%CI:1.005~1.144)(P_(趋势)<0.01)风险逐渐增大。城乡亚组分析结果显示,不同城乡抑郁症状对共病患者全因死亡风险存在交互作用(P interaction<0.05),在农村地区,抑郁症状人群的全因死亡、心脑血管死亡风险分别是无抑郁症状人群的2.637倍(95%CI:1.639~4.243)、3.207倍(95%CI:1.686~6.101),且随着PHQ-9得分的增加,全因死亡(P趋势<0.001)和心脑血管死亡(P趋势<0.001)风险也随之增大,然而在城市地区这些关联无统计学意义。结论抑郁症状是共病患者全因死亡和心脑血管疾病死亡的危险因素,应更加注重农村地区共病患者心理健康教育与干预,降低共病患者死亡风险。Objective To explore the association between depressive symptoms and all-cause mortality and cardiovascular disease mortality in patients with chronic comorbidity.Methods Single-factor analysis was performed using chi-square test,and the relationship between PHQ-9 scores,depressive symptoms,and all-cause mortality as well as cardiovascular disease mortality in patients of multimorbidity were analyzed using COX proportional hazards regression model.Results The results of the multivariable COX regression showed that as compared to those without depressive symptoms,patients of multimorbidity with depressive symptoms had HR=1.665(95%CI:1.135-2.444)for all-cause mortality and HR=2.090(95%CI:1.216-3.594)for cardiovascular mortality.With an increase in PHQ-9 score,the risks of all-cause mortality(HR=1.060,95%CI:1.014-1.107)(P_(trend)<0.010)and cardiovascular mortality(HR=1.072,95%CI:1.005-1.144)(P_(trend)<0.010)gradually increased.Subgroup analysis by urban and rural areas showed that there was an interaction between different urban and rural depressive symptoms on the risk of all-cause mortality in patients of multimorbidity(P interaction<0.05).In rural areas,patients of multimorbidity with depressive symptoms had 2.637 times(95%CI:1.639-4.243)higher risk of all-cause mortality and 3.207 times(95%CI:1.686-6.101)higher risk of cardiovascular mortality compared to those without depressive symptoms.With an increase in PHQ-9 score,the risks of all-cause mortality(Ptrend<0.001)and cardiovascular mortality(Ptrend<0.001)also increased.However,these associations were not significant in urban areas.Conclusion Depressive symptoms is a risk factor for all-cause mortality and cardiovascular disease mortality in patients of multimorbidity,and more attention should be paid to psychological interventions for patients of multimorbidity in rural areas to reduce the risk of mortality in patients of multimorbidity.

关 键 词：抑郁症状 共病 全因死亡 心脑血管疾病死亡 前瞻性队列研究 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R54[医药卫生—临床医学]