广泛性焦虑障碍对冠心病的影响:基于冠状动脉计算机断层扫描血管造影的初步研究

Influence of generalized anxiety disorder on coronary artery disease:a preliminary study based on coronary computed tomography angiography

目的基于冠状动脉计算机断层扫描血管造影(CCTA)评估冠状动脉狭窄程度,探讨广泛性焦虑障碍(GAD)对冠心病的影响,并探索冠心病危险因素和临床特征的性别差异。方法对2018年4月至2019年6月就诊于天津医科大学总医院并行CCTA检查的1117例患者进行杜克冠心病指数评分,同时对患者进行广泛性焦虑障碍7项(GAD-7)量表测评,采用二分类logistic回归方法分析GAD、性别与高危冠心病的关系。结果最终入组1099例患者,其中男460例(41.9%),女639例(58.1%)。GAD是高危冠心病的危险因素(OR=1.071,95%CI 1.013~1.134,P=0.017)。女性患者的GAD患病率高于男性[20.3%(130/639)vs 7.0%(32/460),P<0.01],但在女性中GAD并非高危冠心病的危险因素(OR=1.037,95%CI 0.954~1.129,P=0.392)。年龄、GAD、糖尿病、高脂血症、吸烟是男性高危冠心病的危险因素(P均<0.05),而在女性中仅年龄、高血压是高危冠心病的危险因素(P均<0.05)。结论GAD在女性中更为常见,但不是女性发生高危冠心病的危险因素,对有冠心病疑似症状的女性患者,其症状可能是GAD躯体症状而非冠心病症状,因此临床上更应关注其心理因素;对于存在GAD的男性患者,临床上更应注意其高危冠心病的筛查。

Objective To evaluate coronary artery stenosis based on coronary computed tomography angiograpy(CCTA),and to explore the influence of generalized anxiety disorder(GAD)on coronary artery disease(CAD)and the influence of gender on CAD risk factors and clinical characteristics.Methods Altogether 1117 patients who underwent CCTA in Tianjin Medical University General Hospital from Apr.2018 to Jun.2019 were evaluated with Duke CAD index and generalized anxiety disorder 7(GAD-7).The relationships between GAD,gender and high-risk CAD were analyzed by binary logistic regression.Results A total of 1099 patients were enrolled,including 460 males(41.9%)and 639 females(58.1%).GAD was a risk factor for high-risk CAD(odds ratio[OR]=1.071,95%confidence interval[CI]1.013-1.134,P=0.017).Compared with men,women had higher prevalence of GAD(20.3%[130/639]vs 7.0%[32/460],P<0.01),but GAD was not a risk factor of high-risk CAD in women(OR=1.037,95%CI 0.954-1.129,P=0.392).Age,GAD,diabetes mellitus,hyperlipidemia and smoking were the risk factors of high-risk CAD in men(all P<0.05),while only age and hypertension were risk factors in women(both P<0.05).Conclusion Women are more likely to suffer from GAD,but it is not a risk factor of high-risk CAD in women.For women with suspected CAD symptoms,the symptoms may be caused by GAD rather than CAD,so more attention should be paid to the influence of psychological factors;for men with GAD,we should focus on screening of high-risk CAD in clinic.