心理干预对冠心病合并抑郁患者的血管内皮功能的影响

Effect of Mental Intervention on Endothelial Function of Patients with Coronary Heart Disease Accompanied by Depression

目的研究心理干预对冠心病合并抑郁患者的血管内皮功能的影响。方法 252例冠心病合并抑郁组患者,随机分为心理干预组和对照组各126例,两组患者均给予常规调节血脂、抑制血小板聚集等治疗,心理干预组在常规治疗的同时实施支持性心理干预,所有患者治疗前后均行汉密尔顿抑郁量表(HAMD)评分和接受肱动脉超声检查和血清一氧化氮(NO)、内皮素(ET)浓度测定。结果心理干预组治疗后与治疗前HAMD评分比较明显下降,差异有统计学意义(t=14.7±3.9,18.7±5.3;P<0.001);对照组治疗后与治疗前HAMD评分比较差异无统计学意义(t=18.2±5.2,19.1±4.3;P>0.05)。组间比较,治疗前两组HAMD评分比较差异无统计学意义(t=18.7±5.3,19.1±4.3;P>0.05)。治疗后心理干预组与对照组HAMD评分比较明显下降,差异有统计学意义(t=14.7±3.9,18.2±5.2;P<0.001)。心理干预组治疗后与治疗前FMD%、NMD%、血浆NO、ET水平比较差异有统计学意义(t=4.65±0.49,12.11±1.93,70.37±19.24,70.65±16.48,4.16±0.38,8.52±1.48,54.13±9.88,90.16±14.31;P<0.001),对照组治疗后与治疗前FMD%、NMD%、血浆NO、ET水平比较差异有统计学意义(t=4.47±0.36,9.70±1.56,65.70±17.23,82.35±16.57,4.17±0.42,8.63±1.45,53.78±10.12,89.43±15.36;P<0.001)。组间比较,治疗前两组FMD%、NMD%、血浆NO、ET水平比较差异无统计学意义(t=4.16±0.38,8.52±1.48,54.13±9.88,90.16±14.31,4.17±0.42,8.63±1.45,53.78±10.12,89.43±15.36;P>0.05),治疗后两组FMD%、NMD%、血浆NO、ET水平比较差异有统计学意义(t=4.65±0.49,12.11±1.93,70.37±19.24,70.65±16.48,4.47±0.36,9.70±1.56,65.70±17.23,82.35±16.57;P<0.001)。结论心理干预治疗能明显改善冠心病合并抑郁患者的抑郁程度和血管内皮功能。

Objective To investigate the effect of mental intervention on endothelial function of patients with coronary heart disease（CHD） accompanied by depression.Methods A total of 252 patients with CHD accompanied by depression were randomly divided into following the two groups including 126 in the mental intervention group and 126 in the control group.Routine treatments such as regulating blood-fat,restraining platelet aggregation and so on were adopted in the both groups.Meanwhile,mental intervention was performed in the mental intervention group.Then,the results of Hamilton Rating Scale for Depression（HAMD） and the levels of nitric oxide（NO） and endothelins（ET） were observed before and after the therapy.Ultrasonic inspection was employed to evaluate the function of brachial artery before and after therapy.Results The HAMD score of the mental intervention group significantly decreased after psychological intervention（P〈0.001）.There was no difference in the HAMD score of the control group before and after treatment（P〈0.05）.Before treatment,there was no significantly difference in the scores of HAMD between two groups（P〈0.05）.After treatment,the scores of HAMD in the intervention group were significantly lower than that of controls（P〈0.001）.There was significantly diference in the values of FMD%,NMD%,NO and ET in the mental invention group before and after treatment（P〈0.001）.There was significantly diference in the values of FMD%,NMD%,NO and ET in the control group before and after treatment（P〈0.001）.Before the treatment,there was no significantly difference in the values of FMD%,NMD%,NO and ET between two groups（P〈0.05）.After the treatment,there was significantly difference in the values of FMD%,NMD%,NO and ET between two groups（P〈0.001）.Conclusion Mental intervention can significantly improve depression and endothelial function in patients with CHD accompanied by depression.