急性冠脉综合征患者抑郁程度与冠脉狭窄及内皮功能障碍的关系

The relationship between depression,severity of coronary artery lesion and endothelial dysfunction in patients with acute coronary syndrome

目的 了解急性冠脉综合征(acute coronary syndrome,ACS)患者抑郁程度与冠脉狭窄程度及内皮功能障碍的关系,评价ACS合并抑郁患者的短期预后。方法 选取确诊为ACS的患者108例。根据抑郁自评量表(self-rating depression scale,SDS)评分(临界值为53分)将入选患者分为无抑郁组和抑郁组。统计冠脉造影结果及Gensini积分。统一检测血清不对称二甲基精氨酸(asymmetric dimethylarginine,ADMA)值。统计出院3个月主要不良心血管事件(因冠心病再次入院、死亡及心肌梗死)的情况。结果 两组患者在超敏-C反应蛋白、天门冬氨酸氨基转移酶、SDS得分、Gensini积分及血清ADMA水平差异有统计学意义(P <0.05)。将抑郁组分为轻、中、重度抑郁3个亚组,3个亚组间SDS得分、Gensini积分及ADMA浓度水平差异有统计学意义(P <0.05)。SDS得分与超敏-C反应蛋白、天门冬氨酸氨基转移酶、Gensini积分、ADMA浓度水平均成正相关。出院后3个月随访结果,显示两组在再次入院、心肌梗死及因冠心病死亡的主要不良心血管事件之间比较,差异无统计学意义(P> 0.05)。3亚组间在出院后3个月在再次入院事件、心肌梗死事件及因冠心病死亡事件的差异均有统计学意义(P <0.05)。结论 ACS患者合并抑郁障碍可加重冠脉狭窄程度,且抑郁障碍程度与冠脉狭窄程度呈正相关。ACS患者合并抑郁障碍影响患者内皮功能,且抑郁程度越重,内皮功能损害程度越重。抑郁影响ACS患者短期预后。

Objective:To investigate the relationship among the severity of depression,the severity of coronary artery lesion and endothelial dysfunction in patients with acute coronary syndrome,and evaluate the short term prognosis of ACS with depression patients. Methods:108 patients who were diagnosed of acute coronary syndrome were selected. According to the score of SDS scale(the critical value of 53),patients were divided into No depression group and Depression group.the severity of coronary artery lesion of two groups patients was evaluate according to Gensini score. The serum ADMA was detected to evaluate endothelial function. Major adverse cardiac events at 3 months after discharge were follow up and recorded. Results:The level of hs-CRP and AST,the number of medication of glycoprotein Ⅱb/Ⅲa receptor antagonist in Depression group were significantly greater compared with those in the No depression group. There were significant differences in Gensini score and serum ADMA level between the No depression group and Depression group. Based on the degree of depression,the Depression group was divided into the mild,moderate and severe sub-groups. The difference of Gensini score and ADMA level in three sub-groups was statistically significant. There was significant difference in the rate of mortality,readmission,myocardial infarction reoccurring after three months of discharge among the mild,moderate and severe sub-groups. Conclusion:Depression in patients with acute coronary syndrome can aggravate the severity of coronary artery lesion,and the degree of depression is positively correlated with the severity of coronary artery lesion. The endothelial function will be affected in the ACS with depression patients,and the more severe the degree of depression is,the more serious the degree of endothelial dysfunction is. Depression affects short-term prognosis in ACS patients.