稳定性冠心病伴抑郁焦虑患者的精神压力诱发心肌缺血临床研究

A clinical study of mental stress-induced myocardial ischemia in patients with stable coronary artery disease and depression/anxiety

目的探索抑郁焦虑状态与稳定性冠心病患者精神压力诱发心肌缺血（MSIMI）的关系。方法根据纳排标准纳入178例门诊/住院患者，男88例，女90例，年龄（54±12）岁。根据患者冠状动脉（冠脉）情况及PHQ-9（Patient Health Questionnaire 9-item）、GAD-7（Generalized Anxiety Disorder 7-item）评分分为冠心病抑郁焦虑组、冠心病无抑郁焦虑组、非冠心病抑郁焦虑组，正常组4组。通过心脏超声检查评估患者在精神压力测试前后心功能的变化，判断MSIMI的发生情况。用SPSS19.0对数据进行统计分析。结果冠心病患者MSIMI发生率为17.24%，冠心病抑郁焦虑组MSIMI发生率为35.00%，冠心病无抑郁焦虑组MSIMI发生率为2.13%，非冠心病抑郁焦虑组MSIMI发生率为14.29%，正常组发生率为2.38%。非冠心病抑郁焦虑组MSIMI的发生风险为正常组的6.83倍（P〉0.05），冠心病抑郁焦虑组MSIMI的发生风险为正常组的22.08倍（P〈0.05）。多因素logistic回归分析显示，调整性别、年龄等因素后，GAD-7评分毎增加1分，冠心病患者MSIMI的发生风险增加1.22倍[95%CI（1.07~1.38）, P=0.00]，PHQ-9评分增加均没有增加冠心病患者MSIMI的发生风险[OR=0.95, 95%CI（0.77~1.17）, P=0.63]。结论冠心病合并抑郁焦虑患者的MSIMI发生率明显高于冠心病无焦虑抑郁患者，焦虑是冠心病患者MSIMI发生的危险因素；尚不能认为抑郁是冠心病患者MSIMI发生的危险因素。

ObjectivesExploring the association between depression/anxiety and mental stress-induced myocardial ischemia （MSIMI） in patients with stable coronary artery disease （CAD）.MethodsA total of 178 subjects was enrolled according to the inclusion and exclusion criterion with 88 men and 90 women at age of （54±12）years. The subjects were divided into four groups including CAD with depression/anxiety, CAD without depression/anxiety, depression/anxiety without CAD, and control group based on the state of coronary artery, the scores of Patient Health Questionnaire 9-item （PHQ-9） and Generalized Anxiety Disorder 7-item （GAD-7） . MSIMI was diagnosed by echocardiography. Data were analyzed by SPSS19.0.ResultsThe incidence of MSIMI in all CAD patients was 17.24%. Within each group, 35.00% patients were MSIMI in CAD with depression/anxiety, 2.13% were in CAD without depression/anxiety, 14.29% were in depression/anxiety without CAD, and 2.38% were in control group. The risks of MSIMI in depression/anxiety without CAD and with CAD groups were 6.83 （P〉0.05） and 22.08 times （P〈0.05） higher than that in control group, respectively. Logistic regression showed that a 1-point increment in the GAD-7 score, but not PHQ-9 score [OR=0.95, 95% CI （0.77-1.17）, P=0.63], was associated with 1.22-fold increase in the likehood of MSIMI [95% CI （1.07-1.38）, P=0.00].ConclusionsThe MSIMI rate is much higher in patients with CAD comorbid depression/anxiety compared with CAD without depression/anxiety. Anxiety, but not depression, is an independent risk factor of MSIMI in CAD patients.