冠心病患者PCI后合并抑郁状态的调查研究

A survey on depression in patient with coronary heart disease after percutaneous coronary intervention

目的探讨冠状动脉粥样硬化性心脏病(冠心病,CHD)经皮冠状动脉介入治疗(PCI)后患者抑郁状态的发生率及相关影响因素。方法选取2017年7月至2017年12月于西安交通大学第一附属医院心血管内科接受PCI的438例冠心病患者为研究对象,完成基本人口社会学信息调查及疾病相关状况调查,收集相关资料并由患者本人完成中文版PHQ-9抑郁自评量表以评估患者心理状态。结果119例(27.2%)患者存在不同程度的抑郁问题(轻度20.5%,中度5.9%,重度0.7%),其中女性患者抑郁发生率明显高于男性(35.5%vs.24.4%,P=0.019);CHD诊断分型中的不稳定型心绞痛(UAP)患者较ST段抬高型心肌梗死(STEMI)患者及非ST段抬高型心肌梗死(NSTEMI)患者抑郁发生率高(31.0%vs.17.1%vs.12.1%,P=0.006);合并短暂性脑缺血发作(TIA)/脑卒中患者较非脑卒中患者抑郁发生率高(39.6%vs.25.6%,P=0.040)。术后1月抑郁状态有明显改善,术后6月抑郁状态较1个月随访时加重;急性心肌梗死(AMI)患者术后抑郁状态的改善明显低于UAP患者(9.2%vs.21.3%,P=0.015)。结论冠心病行PCI患者抑郁状态发生与性别、疾病状况有关。术后1月抑郁状态可改善,但随病程延长,抑郁状态又呈恶化趋势。CHD诊断分型中AMI患者术后抑郁状态改善较差,应关注术后远期心理状况。

Objective To discuss the incidence rate of depression and relevant influence factors in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods CHD patients(n=438)undergone PCI were chosen from Department of Cardiovascular Medicine in the First Affiliated Hospital of Xi’an Jiaotong University from July 2017 to Dec.2017.The basic sociodemographic information and investigation about disease-related status were carried out,and relevant materials were collected.The Patient Health Questionnaire-9 Items(PHQ-9)was filled by patients themselves for reviewing patients’psychological status.Results There were 119 patients(27.2%)with depression problems in varying degrees(mild=20.5%,moderate=5.9%,severe=0.7%),and incidence rate of depression was significantly higher in female patients than that in male ones(35.5%vs.24.4%,P=0.019).The incidence rate of depression was higher in patients with unstable angina pectoris(UAP)than that in patients with STEMI and NSTEMI(31.0%vs.17.1%vs.12.1%,P=0.006).The incidence rate of depression was higher in patients complicated by transient ischemic attack(TIA)or stroke than that in patient without stroke(39.6%vs.25.6%,P=0.040).The depression status was significantly relieved after PCI for 1 month,and depression status exacerbated in patients after PCI for 6 months.The recovery rate of depression after PCI was significantly lower in patients with acute myocardial infarction(AMI)than that in UAP patients(9.2%vs.21.3%,P=0.015).Conclusion The incidence of depression is related to gender and disease states in CHD patients undergone PCI.The depression status can be relieved after PCI for 1 month,but shows a worse trend along with the disease course prolongs.The improvement of depression is poor in AMI patients and the attention should be paid to their long-term psychological status after PCI.