影响冠状动脉病变程度的危险因素与抑郁状态分析

Risk factors correlated with severity of coronary artery lesion and depression status in patients with coronary heart disease

目的研究冠状动脉病变程度不同的冠心病(CHD)患者糖脂代谢异常的情况及抑郁状态。方法选择2008年4月—2009年6月初次行冠状动脉造影的患者117例,根据造影检查结果分为冠状动脉正常组(Control),冠状动脉狭窄组(AS)及经皮冠状动脉支架置入术组(PCI)。所有研究对象均测量简易体脂参数,空腹血糖(FPG),餐后2 h血糖(2hPG),糖化血红蛋白(HbA1c),糖化白蛋白水平(GA),血脂谱,并使用Zung自评抑郁量表(SDS)测定抑郁程度。结果①冠脉病变程度与年龄及GA水平正相关,而与高密度脂蛋白(HDL-c)水平负相关。②校正年龄性别后,AS组与PCI组的抑郁评分与Control组差异有统计学意义(P<0.05)。③多因素分析显示,年龄、HDL-c是冠状动脉病变的独立危险因素。结论冠心病患者抑郁程度高于正常人,护理工作需兼顾心理疏导。

Objective To analyze the glucose and lipid metabolic dysfunction and depression in coronary heart disease（CHD） patients with different degrees of coronary artery lesion.Methods A total of 117 patients underwent the first coronary arteriography in our hospital from April,2008 to June,2009 were divided into 3 groups,including non-CHD（control） group,coronary atherosclerosis（AS） group and percutaneous coronary intervention（PCI） group.The body mass index（BMI）,waist（W）,fasting plasma glucose（FPG）,2-hour postprandial glucose（2hPG）,glycosylated hemoglobin（HbA1c）,glycosylated albumin（GA） and lipid profile（total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol） were evaluated in all patients.Depression was assessed with Self-rating Depression Scale（SDS）.Results The severity of coronary artery lesion was positively correlated with age and GA,but negatively correlated with HDL cholesterol.After adjustment for age and sex,compared with that in the control group,depression scores were significantly higher in AS group and PCI group（27.53±1.39 vs 33.48±1.16,P=0.004 and 27.53±1.39 vs 32.17±1.86,P=0.024,respectively）.Multivariate logistic regression analysis showed that age and HDL cholesterol were independently associated with CHD.Conclusion The CHD patients with coronary artery lesion have glucose and lipid metabolic dysfunction.Meanwhile their depression rates are higher than the control patients.The nurses should pay more attention to the patients＇ depressive symptoms to relieve their psychological problems.