急性心肌梗死患者PCI治疗后抑郁对心率变异性、内皮功能及不良心血管事件发生率的影响

Influence of Depressive on Heart Rate Variability, Endothelial Function and Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction after PCI

目的:探讨急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)治疗后抑郁对心率变异性(HRV)、内皮功能及不良心血管事件(MACE)发生率的影响。方法:选择2017年1月-2018年12月期间在本院接受PCI治疗的AMI患者117例作为研究对象,根据PCI术后出院当日的抑郁自评量表(SDS)评分值将其分为抑郁组(评分值≥53分)41例、非抑郁组(评分值<53分)76例。对比两组患者HRV相关指标[正常RR间期标准差(SDNN)、5 min内正常RR间期平均值标准差(SDANN)、相邻正常RR间期差值均方的平方根(RMSSD)、总功率(TP)、低频功率(LF)、高频功率(HF)、低频功率与高频功率比值(LF/HF)]、内皮功能指标[内皮依赖性血管舒张功能(FMD)、非内皮依赖性血管舒张功能(NMD)]水平差异,记录两组随访期内MACE发生情况。结果:PCI术后出院当日,抑郁组患者的HRV时域指标SDNN、SDANN、RMSSD水平低于非抑郁组患者;频域指标中LF、LF/HF的水平高于非抑郁组,HF的水平低于非抑郁组(P<0.05),两组患者TP水平的差异无统计学意义(P>0.05)。抑郁组患者的FMD、NMD水平均低于非抑郁组患者,差异有统计学意义(P<0.05)。随访期内,抑郁组患者的MACE总发生率、再发心肌梗死发生率高于非抑郁组,差异有统计学意义(P<0.05)。两组患者顽固性心绞痛、新发心肌梗死、心力衰竭、心源性死亡发生率的差异无统计学意义(P>0.05)。结论:AMI患者PCI后合并抑郁可能对心血管系统造成负面影响并最终增加MACE的发生风险。

Objective: To investigate the influence of depressive on heart rate variability(HRV), endothelial function and major adverse cardiovascular events(MACE) in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI).Methods: 117 AMI patients underwent PCI treatment in our hospital during January 2017 to December 2018 were selected as study subjects. According to the self-rating depression scale(SDS) score on discharge day after PCI, all patients were divided into depression group(score≥53, n=41) and non-depression group(score<53, n=76). Two groups related parameters[standard diviation of NN intervals(SDNN), standard deviation of average NN intervals(SDANN), root mean square successive difference(RMSSD), total power(TP), low frequency power(LF), high frequency power(HF), LF/HF], endothelial function indexes[flow mediated dilation(FMD), nitroglycerin-mediated dilatio(NMD)] levels difference were compared, the occurrence of MACE was recorded during the follow-up period between the two groups. Results: On discharge day after PCI, SDNN, SDANN and RMSSD levels in the depression group were lower than those in the non-depression group, LF and LF/HF were higher than those in the non-depression group, HF levelwas lower than that in the non-depression group(P<0.05), there was no significant difference in TP between two groups(P>0.05). The levels of FMD, NMD in depression group were lower than those in the non-depression group, the difference were statistically significant(P<0.05). During the follow-up period,the total incidence of MACE and recurrent myocardial infarction in depression group were higher than those in the non-depression group,the difference were statistically significant(P<0.05). There were no significant difference in the incidence of refractory angina pectoris,new myocardial infarction, heart failure and cardiac death between the two groups(P>0.05). Conclusion: Depressive in AMI patients after PCI may negatively affect the cardiovascular system and eventually increase the incidence risk of MACE.