认知行为治疗联合SSRI对冠状动脉粥样硬化性心脏病合并焦虑障碍患者心率变异性和血管内皮细胞功能影响的临床研究

Clinical study of the effect of cognitive behavioral therapy combined with SSRI on heart rate variability and vascular endothelial cell function in patients with coronary heart disease complicated with anxiety disorder

目的探讨认知行为治疗(CBT)联合5-羟色胺再摄取抑制剂(SSRI)对冠状动脉粥样硬化性心脏病(CHD)合并焦虑障碍患者心率变异性和血管内皮细胞功能的影响。方法选取90例已确诊为CHD合并焦虑障碍患者,随机分为观察组(CBT联合SSRI治疗)和对照组(SSRI治疗)。比较两组治疗前后17项汉密尔顿抑郁量表(HAMD-17)评分、汉密尔顿焦虑量表(HAMA)评分、心率变异性及血管内皮细胞功能变化情况。结果两组治疗后HAMD-17、HAMA均较治疗前降低,而治疗后观察组的HAMD-17、HAMA低于对照组(P<0.05)。两组治疗后内皮素-1(ET-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和血管性血友病因子(vWF)较治疗前降低,而一氧化氮(NO)升高(P<0.05)。观察组治疗后ET-1、vWF低于对照组,而NO高于对照组(P<0.05)。观察组治疗后全部窦性心搏RR间期(SNDD)、相邻RR间期差值的均方根(RMSSD)、正常RR间期的标准差(SDANN)和相邻RR间期差值>50 ms的个数占总窦性心搏个数的百分比(PNN50)较治疗前升高(P<0.05),而对照组的各项指标也均有升高趋势,但差异无统计学意义;治疗后观察组SNDD和RMSSD高于对照组(P<0.05)。结论CBT联合SSRI能改善CHD患者的焦虑症状,并改善自主神经功能和血管内皮细胞功能。

Objective To investigate the effects of cognitive behavioral therapy(CBT)combined with SSRI on heart rate variability and vascular endothelial cell function in patients with coronary heart disease(CHD)complicated with anxiety disorder.Methods Ninety patients with CHD combined with anxiety disorder were randomly divided into observation group(CBT combined with SSRI treatment)and control group(SSRI treatment).The changes of 17 items of Hamilton Depression Scale(HAMD-17)score,Hamilton Anxiety Scale(HAMA)score,heart rate variability and vascular endothelial cell function were compared between the two groups before and after treatment.Results After treatment,HAMD-17 and HAMA in both groups were lower than those before treatment,while HAMD-17 and HAMA in observation group were lower than those in control group(P<0.05).After treatment,ET-1,IL-6,TNF-αand vWF decreased in the two groups,while NO increased(P<0.05).After treatment,ET-1 and vWF in the observation group were lower than those in the control group,while NO was higher than that in the control group(P<0.05).After treatment,SNDD,RMSSD,SDANN and PNN50 in the observation group were higher than those before treatment(P<0.05),and all indexes in the control group also showed an increasing trend,but the differences were not statistically significant.After treatment,SNDD and RMSSD in observation group were higher than those in control group(P<0.05).Conclusion CBT combined with SSRI can improve anxiety symptoms,autonomic nerve function and endothelial cell function in CHD patients.