焦虑抑郁对缺血伴非阻塞性冠状动脉疾病患者冠脉血流储备的影响

Effect of Anxiety and Depression on Coronary Flow Reserve in Patients with Ischemia with Non-obstructive Coronary Artery Disease

目的焦虑抑郁对缺血伴非阻塞性冠状动脉疾病(INOCA)患者冠脉血流储备(CFR)的影响。方法连续入选2020年6月至2021年月6因胸痛、胸闷症状来郑州大学第一附属医院住院但是行冠状动脉造影显示心外膜大血管未见明显狭窄(狭窄<50%)的患者198例,行CFR检查,按照CFR结果分为两组,CFR<2为冠脉微血管疾病(CMD)组115例,CFR≥2为对照组83例。使用医院焦虑和抑郁量表(HADs)对患者进行焦虑抑郁症状测定,焦虑量表评分(HADs-A)≥8分和/或抑郁量表评分(HADs-D)≥8分为有焦虑抑郁,两量表均<8分为无焦虑抑郁。比较两组焦虑抑郁状态是否有差异,采用多因素logistic回归分析患者低CFR的危险因素。结果相比对照组,CMD组患者的年龄、体质量指数(BMI)、吸烟者的占比、糖尿病史、高血压病史、Ca通道阻滞剂使用、血沉(ESR)、降钙素原(PCT)、C反应蛋白(CRP)、平均心率、正常窦性R-R间期总体标准差(SDNN)、正常相邻窦性R-R间期差值均方根(MSD)、焦虑抑郁的占比差异有统计学意义(P<0.05)。经过多因素logistic回归分析显示,焦虑抑郁(OR=5.36,95%CI:2.03~14.16,P=0.001)、吸烟、糖尿病、BMI、ESR、MSD是低CFR值的独立危险因素,平均心率稍增高对CFR有较弱保护作用。结论焦虑抑郁与低CFR相关,且焦虑抑郁是低CFR值的独立危险因素。

Objective To explore the effect of anxiety and depression on coronary flow reserve(CFR)in patients with ischemia with non-obstructive coronary arteries(INOCA).Methods A total of 198 patients with angina symptoms and normal coronary angiography or without obvious coronary stenosis were enrolled in the First Affiliated Hospital of Zhengzhou University from June 2020 to June 2021.All the patients were divided into coronary microvascular dysfunction(CMD)group(CFR<2,115 cases)and control group(CFR≥2,83 cases)according to the result of CFR.Anxiety and depression symptoms were measured by hospital anxiety and depression scale(HADs).Anxiety scale score(HADs-A)≥8 and/or depression scale score(HADs-D)≥8 were classified as anxiety and depression,and both scales<8 were classified as no anxiety and depression.The differences in anxiety and depression symptoms between the two groups were compared.The significative influencing factors of CMD were analyzed by multivariate logistic regression.Results Compared to the control group,there were significant differences in age,body mass index(BMI),proportion of smokers,history of diabetes,history of hypertension,use of Calcium channel blocker,erythrocyte sedimentation rate(ESR),procalcitonin(PCT),C-reactive protein(CRP),mean heart rate,standard deviation of NN intervals(SDNN),square root of the mean difference of successive RR intervals(MSD)and the proportion of anxiety and depression in CMD group(P<0.05).From multivariate logistic regression analysis,the independent risk factors of low CFR were anxiety and depression(OR=5.36,95%CI:2.03-14.16,P=0.001),smoking,diabetes,BMI,ESR and MSD.Mean heart rate increased slightly was protective factors for CFR.Conclusion Anxiety depression is associated with low CFR,and anxiety depression is an independent risk factor for low CFR.