抑郁状态患者的心血管功能变化

Impairments of cardiovascular function in depressive state

目的 探讨抑郁发作时患者的心血管功能改变及其与抑郁症状和伴随的焦虑症状的关系。方法 对65例抑郁症患者(其中单纯抑郁组34例,抑郁合并焦虑组31例)和31名健康志愿者分别评定汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA),测定左心搏指数(LSI)、射血分数(EF)、心率、平均舒张压(DPM)、平均收缩压(SPM)、左室舒张末期血量(LVDV)、有效循环容量(ECV)、总阻抗、血流平滑度(BFSD)等,将HAMD总分和因子分与心功能各指标进行相关分析。结果 (1)与对照组比较,单纯抑郁组的LSI、EF、DPM、SPM、LVDV、ECV和BFSD低,总阻抗高(均P<0 01和<0 05);抑郁合并焦虑组的LVDV、ECV和BFSD低,心率快(均P<0 05和<0 01),余组间差异无统计学意义。两患者组间比较,单纯抑郁组的LSI、EF、SPM和LVDV均低于抑郁合并焦虑组,而总阻抗高于抑郁合并焦虑组(均P<0 05和<0 01)。(2)焦虑/躯体化因子分与LSI(r=0 397)、EF(r=0 447)、LVDV(r=0 410 )呈正相关,与总阻抗呈负相关(r=-0 370 );抑郁/迟滞因子分与DPM(r=-0 353)、SPM(r=-0 401)、LVDV(r=-0 331)呈负相关(均P<0 01和<0 05);总分和其他因子分与各指标均无相关性(均P>0 05)。结论 抑郁发作对心脏前后负荷、心搏出量、血压、心率、微循环、周围血管阻抗等指标均有明显影响。

Objective The aim of this study was to explore the relationship between the cardiac function changes and depressive and anxiety symptom in depression patients.Methods The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were determined in 65 patients with major depressive disorders and 31 healthy normal controls. The clinical symptoms were assessed with the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA).Results In patients with depression without anxiety, ECV, SPM, DPM was significantly lower than that in controls, while RTM higher than that in controls. The indexes of LVDV, LSI, EF, which represented left cardiac function, were decreased significantly in patients. The patients with comorbidity of depression and anxiety showed decreased ECV, LVDV, BFSD, and increased HR in comparison with the controls. The HAMD anxiety/somatization factor score was positively correlated with the LSI, RSI, EF, LVDV, whereas negatively correlated to RTM. There was negative correlation between retardation factor score and DPM, SPM, LVDV.Conclusions The study indicates that there are noticeable changes of left ventricle preload and afterlord, blood pressure, microcirculation, peripheral resistance in patients with depressive episode,and the accompanying anxiety would make it more complex.