心理应激与急性冠状动脉综合征

Psycbological stress status in patients with acute coronary syndrome and stable angina pectoris

目的分析心理应激与急性冠状动脉综合征（ACS）的关系，探讨心理应激是否为诱发ACS发生的危险因素。方法100例经冠状动脉造影检查及临床表现确诊为冠心病的中青年男性患者，分为ACS组（67例）和稳定性心绞痛（SA）组（33例），进行社会心理应激调查，测定其血清白介素（IL）-6、可溶性细胞间黏附分子（sICAM）-1及C-反应蛋白（CRP）的水平，并对其结果进行对照性分析。结果（1）心理应激组52例，ACS患者和SA患者分别占78．8％（41例）和21．2％（11例，P=0．009）；ACS组有心理应激者明显高于SA组[61．2％（41／67）比33．3％（11／33），P=0．009]。（2）心理应激组的血清CRP[（14．82±5、07）g／L比（8、78±4．34）g／L]、IL-6[（101．7±22．2）ng／L比（71．1±23．5）ng／L]及sICAM-1（1．41±0.47）mg／L比（0．82±0．37）mg／L]明显高于非心理应激组（均P〈0.01）；ACS组血清CRP[（18.91±3.12）g／L比（6.20±2.46）g／L]、IL-6[（114.6±15．2）ng／L比（56、4±15．8）ng／L]及sICAM-1[（1．67±0．39）mg／L比（0．63±0.28）mg／L]水平明显高于SA组（P〈0.01）。结论心理应激可使体内炎症因子分泌增加，从而使动脉粥样硬化斑块由稳定变成不稳定，并通过炎症反应参与了ACS发生、发展。

Objective To observe the psychological stress status in patients with acute coronary syndrome （ACS） and stable angina pectoris （SA）. Methods The intensity of social psychological stress and the serum levels of IL-6, CRP and ICAM-1 were determined in patients with ACS （ n = 67） and SA （ n = 33 ）. Results （ 1 ） The percentage of patients with psychological stress was significantly higher in ACS than that in SA group （78.8% vs. 21.2%, P〈0.01）. （2） The serum levels of CRP [ （14.82 ±5.07）g/L vs.（8.78±4.34）g/L], IL-6[（101.7±22.2）ng/Lvs. （71.1 ±23.5） ng/L] and sICAM-1[（1.41 ± 0.47） mg/L vs. （0.82 ±0.37 ） mg/L] were significantly higher in psychological stress group than those in non-psychological stress group （all P 〈0.05）, Serm CRP [ （18.91 ±3.12）g/L vs. （6.20 ±2.46） g/L] , IL-6 [ （ 114.6 ± 15.2） ng/L vs, （56.4 ± 15.8） ng/L] and slCAM-1 [ （ 1.67 ± 0.39） mg/L vs. （0. 63 ± 0.28）mg/L] levels in ACS group were significantly higher than those in SA group （all P 〈 0. 01 ）. Conclusion Higher psychological stress was associated with higher risk of ACS and increased serum inflammatory cytokines.