冠心病患者的抑郁和焦虑

Depression and Anxiety in Patients with Coronary Heart Disease

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状(如抑郁或/和焦虑)者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面:对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。

A number of clinical trial results show that depressive and anxiety disorders are more common in coronary heart disease （CHD） .The very high prevalence of CHD is found among those with the most severe psychiatric symptoms ,such as those persons with depression or /and anxiety . There are several factors that seem to link depression with the development of CHD and with a worse outcome in patients with established CAD ： worse adherence to prescribed medication and life style modifications in depressive patients , as well as higher rates in abnormal platelet function , endothelial dysfunction and lowered heart rate variability .Selective serotonin reuptake inhibitors seem to be preferable for treatment of depressive and anxiety patients with co-morbid CAD because of their good tolerability and absence of significant cardiovascular side effects .Treatment of depression and anxiety disorders has been shown to improve patients ＆#39;quality of life .Large scale clinical trials are needed to answer this question of influence on cardiovascular prognosis in depressed or/and anxiety patients with CHD . Anxiety as possible risk factor for CHD needs to be more elaborately investigated in future research ,and deserves more attention in clinical care as well .