应激性生活事件和社会支持缺陷对急性冠脉综合征患者后期功能恢复的影响

The effect of stressful life events and social support deficits on later function recovery in patients with acute coronary syndrome

目的探讨应激性生活事件(SLE)和社会支持缺陷(SSD)对急性冠脉综合征(ACS)患者后期功能恢复的影响。方法以2016年9月至2019年6月在浙江医院接受治疗的ACS患者为研究对象,根据威胁事件列表及社会支持量表评估结果分为A组(无SLE无SSD)、B组(有SLE无SSD)、C组(无SLE有SSD)和D组(有SLE有SSD)。1年后采用社会和职业功能评定量表(SOFAS)、WHO残疾评定量表检查者12项(WHODAS-12)、WHO生活质量简表(WHOQOL-BREF)评估并比较患者的功能状态及生活质量。结果共纳入652例ACS患者,其中398例完成1年随访。4组患者在性别、独居、Montgomery Asberg抑郁评定量表(MADRS)评分、焦虑症方面比较,差异均有统计学意义(均P<0.05)。校正这4个协变量后,经协方差重复测量分析发现4组患者SOFAS、WHODAS-12评分以及WHOQOL-BREF的生理因素、社会关系、环境背景评分均存在组间及时间的交叉反应(均P<0.05)。结论ACS早期阶段存在SLE和SSD,预示患者后期功能恢复差和生活质量低下。

Objective To investigate the influence of stressful life events(SLE)and social support deficit(SSD)on later function recovery of patients with acute coronary syndrome(ACS).Methods Patients treated for ACS in Zhejiang Hospital from September 2016 to June 2019 were recruited and divided into group A without SLE and SSD,group B with only SLE,group C with only SSD and group D with both SLE and SSD based on survey of list of threatening events and social support scale.The social and occupational functioning assessment scale(SOFAS),the world health organization disability assessment schedule-12(WHODAS-12)and world health organization quality of life-abbreviated form(WHOQOL-BREF)were performed at baseline and 1 year later.Results A total of 652 patients with ACS were enrolled,of them,398 patients finished 1 year follow-up.There were significant differences of gender,living alone,montgomery-asberg depression rating scale(MADRS)scores and anxiety among the 4 groups(all P<0.05).After adjustment of 4 covariates,repeated measures analysis of variance showed there were significant cross-interactions between groups and time on SOFAS,WHODAS-12 and three domains(physical factors,social relationships,environmental context)of WHOQOL-BREF(P<0.05).Conclusion SLE and SSD at an early phase of ACS may predict poorer later function recovery and quality of life.