抑郁对冠状动脉非阻塞性心肌梗死患者预后影响的研究

The effect of depression on prognosis of patients with coronary non obstructive myocardial infarction

目的探讨抑郁对冠状动脉非阻塞性心肌梗死(MINOCA)患者临床预后的影响。方法选取2015年12月至2019年4月杭州市第三人民医院MINOCA患者318例,诊断为抑郁85例(抑郁组),非抑郁233例(非抑郁组),随访3年观察两组患者的主要和次要终点事件发生情况。主要终点为全因死亡;次要终点为发生心血管事件,包括心肌梗死复发、心力衰竭和缺血性脑卒中。采用Kaplan-Meier法计算并比较两组患者的生存率;采用log-rank检验和Cox比例风险模型对患者预后影响因素进行单因素和多因素分析。结果随访期间,发生全因死亡47例,发生心血管事件86例。抑郁与全因死亡率和心血管事件显著相关(均P<0.05),抑郁是全因死亡和心血管事件发生的独立危险因素(HR=2.13,95%CI:1.74~2.72,P<0.05;HR=2.48;95%CI:2.11~2.78,P<0.05)。结论抑郁与MINOCA患者临床预后的不良风险增加有关,积极治疗抑郁症状可能改善MINOCA患者的临床预后。

Objective To investigate the effect of depression on the prognosis of patients with myocardial infarction with nonobstructive coronary arteries(MINOCA).Methods A total of 318 patients with MINOCA were enrolled,including 85 cases with depression(depression group)and 233 cases without depression(non-depression group).In the study,all-cause death was defined as the primary end point,and the occurrence of cardiovascular events,including recurrence of myocardial infarction,heart failure and ischemic stroke was defined as the secondary end point.Patients were followed up for 3 years,and the occurrence of primary and secondary end points were observed in two groups.The survival rates were analyzed with Kaplan Meier method,and comprared between two groups.Log rank test and Cox proportional hazards model were used to analyze the influencing factors of prognosis.Results During the follow-up period,there were 47 all-cause deaths and 86 cardiovascular events.Univariate analysis showed that depression was significantly correlated with all-cause mortality and cardiovascular eventsall(P<0.05),and multivariate logistic regression showed that depression was an independent risk factor for all-cause mortality and cardiovascular events(HR=2.13,95%CI:1.74-2.72,P<0.05,HR=2.48,95%CI:2.11-2.78,P<0.05).Conclusion Depression is related to the increased risk of adverse clinical prognosis in patients with MINOCA,suggesting that active treatment of depressive symptoms may improve the clinical prognosis of patients with MINOCA.