急性冠脉综合征病人生活质量的多因素分析

Multi-factor model of quality of life in patients with acute coronary syndrome

目的探讨影响急性冠脉综合征（ACS）病人生活质量（QOL）的危险因素，从而为早期识别QOL较差的高危病人提供理论依据。方法对403例ACS病人进行QOL测评，同时进行焦虑抑郁情绪测量及其他可能相关因素的收集。以QOL为因变量进行多重线性回归分析。结果心肌梗死172例（42．6％），不稳定性心绞痛74例（57．3％）。其中84例（20．8％）有焦虑情绪，43例（10．7％）有抑郁情绪，144例（35．7％）同时有焦虑和抑郁情绪。年龄（r=-0．237，P〈0．001），女性（r=-0．183，P〈0．001），焦虑情绪（r=-0．211，P〈0．001），抑郁情绪（r=-0．180，P〈0．001）与躯体健康呈独立负相关。年龄（r=-0．117，P=0．01）、焦虑情绪（r=-0．215，P〈0．001）、抑郁情绪（r=-0．169，P=0．004）与精神健康呈独立负相关，吸烟（r=0．157，P=0．001）与精神健康呈独立正相关。结论高龄、女性、焦虑和／或抑郁情绪为ACS病人QOL差的危险因素。

Objective To detect the risk factors of quality of life （QOL） in patients with acute coronary syndrome （ACS）, so as to help doctors to recognize the risk population with impaired QOL. Methods 403 hospitalized ACS patients, 252 males and 151 females, aged 67 ± 12, 168 with ST-segment elevation myocardial infarction （STEMI）, 4 with non-ST-segment elevation myocardial infarction （NSTEMI） , and 74 with unstable angina pectoris （UAP） , were surveyed with short-form-36 （SF-36） scale （Chinese version） , including physical component summary （PCS） and mental component summary （MCS） so as to analyze the QOL, hospital anxiety depression scales （HADS） so as to detect the anxiety status. Multiple linear regression analysis was conducted to identify the variables associated with QOL. Results Of the 403 patients 84 （ 20.8% ） suffered from anxiety, 43 （ 10.7% ） suffered from depression, and 144 （35.7%） suffered from depression combined with anxiety symptoms . Age（ r = -0. 237, P 〈 0. 001 ）, being female （r = -0. 183,P 〈0.001）, depression （r = -0. 180; P 〈0.001）, and anxiety （r = -0.211, P〈0. 001 ） were independent risk factors of physical QOL. Age （ r = - 0. l17,P = 0.01 ） , depression （ r = - 0. 169,P = 0. 004）, and anxiety （ r = - 0. 215, P 〈 0. 001 ） were independendy negatively correlated with mental QOL. Smoking was unexpectedly a protective factor for MCS （ r = 0. 157 ,P = 0. 001 ）. Conclusion Depression and anxiety are common in patients diagnosed as with ACS, and appear to be related to significant worsening of QOL. The patients being female, with elder age, and suffering from depression and/or anxiety may be with impaired QOL, and need more care and effective intervention.