冠状动脉旁路移植术患者术前炎症标志物与术后抑郁障碍的相关性研究

Pre-Operative Inflammatory Marker Predicting the Post-Operative Depression Occurrence in Patients With Coronary Artery Bypass Grafting

目的:探讨冠状动脉旁路移植术(CABG)患者术前炎症标志物与术后抑郁障碍的关系。方法:收集2010-03至2010-09间在我院接受CABG患者的临床资料,同时术前采集患者血样,以检测血清中高敏C反应蛋白等炎症因子的水平。本研究应用PHQ-9抑郁量表,对患者术前、术后1个月、6个月的心理状况进行评估。以PHQ-9抑郁量表评分结果为观察终点,运用Logistic多因素回归分析的方法,确定CABG患者术前炎症标志物与术后抑郁障碍发生的关系。结果:研究共收集234例CABG患者,共计232例完成了随访,另外2例为院内死亡患者;平均年龄为(60.8±8.6)岁,其中女性比例为18.5%(43/232),CABG患者术前抑郁障碍者发生率为18.1%(42/232),术后1个月抑郁障碍者的发生率为14.7%(34/232),患者6个月抑郁障碍者发生率为18.1%(42/232)高于前者,且差异无统计学意义(P>0.05)。女性患者术后抑郁障碍者发生率明显高于男性患者(术后1个月随访结果:20.9%:13.2%,P=0.197;术后6个月随访结果:20.9%:17.5%,P=0.594)。术后抑郁障碍者血液中高敏C反应蛋白的水平显著高于非抑郁障碍者[术后1个月:(5.4±5.1)mg/L vs(3.0±2.9)mg/L,P<0.01;术后6个月:(4.9±4.7)mg/L vs(3.0±3.0)mg/L,P<0.05)]。Logis-tic回归分析显示:高敏C反应蛋白是术后1个月、6个月抑郁发生的独立危险因素。结论:本研究通过Logistic回归分析进行多因素调整,得出术前高敏C反应蛋白水平为影响CABG患者术后早中期抑郁障碍发生的独立危险因素。

Objective： To explore the relationship between pre-operative inflammatory marker and the post-operative depression occurrence in patients with coronary artery bypass grafting（CABG）. Methods： We studied 234 patients undergoing CABG in our hospital from March to September 2010.2 patients died during hospitalization,and 232 patiewts finished 6 months follow-up study.The patients with the mean age of（60.8±8.6）years,the female ratio was 18.5%（43/232）.We measured blood high sensitivity C-reactive protein（hs-CRP）in all patients at least 3 days before the operation.The depressive disorders at pre-operation,1 month and 6 months after the operation were accessed with patient health questionnaire（PHQ）by telephone visit.Taking PHQ-9 score as the end point,multivariable logistic regression was used to analyze the relationship between pre-operative hs-CRP level and the post-operative depression occurrence. Results： Pre-operative depressive disorder occurred in 18.1%（42/232）of patients.While 1 month post-operative depression was found in 14.7%（34/232）,6 months post operation was 18.1%（42/232）,P0.05.Depressive symptoms occurred more in female patieuls than male as 1 month post operation was 20.9% vs.13.2%,P=0.197,6 months post operation was 20.9% vs.17.5%,P=0.594.The hs-CRP level in patients with post-operative depression was significantly higher than those without it as 1 month post operation was（5.4±5.1）mg/L vs.（3.0±2.9）mg/L,P0.01,and 6 months post operation was（4.9±4.7）mg/L vs.（3.0±3.0）mg/L,P0.05.Logistic regression analysis indicated that circulating hs-CRP level was the independent risk factor for 1 month and 6 months post operative depression occurrence after CABG. Conclusion： With the adjusted multi-factors,pre-operative hs-CRP level is the indedepent risk factor for post-operative depression in CABG patients.