职业紧张与心肌梗死的相关性研究

Job stress and myocardial infarction:a clinical investigation

目的探讨职业紧张与心肌梗死的相关性。方法共调查260例患者,其中心肌梗死164例,非冠心病96例。利用付出-回报失衡问卷评价患者的职业紧张水平,同时收集患者其他冠心病危险因素,结合临床表现和冠状动脉造影结果明确患者冠心病的诊断。采用病例对照研究方法,进行多因素分析。结果高外在付出、高付出-回报失衡、高内在投入均增加心肌梗死的患病危险,调整年龄、性别、高血压病、高脂血症、糖尿病、早发冠心病家族史、吸烟、体质量指数、教育程度和婚姻等混杂因素后的OR值分别为2.4（95%CI 1.2~5.2）、2.8（95%CI 1.3~6.1）2、.7（95%CI 1.2~5.8）,若高付出-回报失衡和高内在投入同时存在时,调整后OR为4.9（95%CI 1.7~14.2）。职业紧张对心肌梗死的影响存在剂量反应关系,职业紧张程度越高,心肌梗死的患病危险越高。结论职业紧张增加心肌梗死的患病危险,很可能是冠心病一个潜在的重要危险因素。

Objective To explore the association between job stress and myocardial infarction.Methods A total of 260 subjects were investigated,including 164 cases of myocardial infarction and 96 controls.In this case-control study,job stress in the past career was measured by effort-reward imbalance（ERI） model,and coronary heart disease was diagnosed by combination of clinical manifestation and angiography.The association between job stress and myocardial infarction was explored by the multivariate analysis.Results Compared with the baseline,high effort,high ERI or high overcommitment increased the risk of myocardial infarction.The odds ratio（OR） was 2.4（95%CI 1.2-5.2）,2.8（95%CI 1.3-6.1）,and 2.7（95%CI 1.2-5.8）,respectively,after adjustment for age,gender,primary hypertension,hyperlipidemia,diabetes mellitus,family history of coronary heart disease,smoking,body mass index,education and marriage.The combination of high ERI and high overcommitment led to the highest risk of coronary heart disease with adjusted OR 4.9（95%CI 1.7-14.2）.Job stress affected the risk of myocardial infarction in a dose-dependent manner.Conclusion Job stress increases the risk of myocardial infarction,and it is probably a new potential important risk factor of myocardial infarction.