冠脉血运重建后不稳定型心绞痛伴抑郁客观指标及特定中医证候的相关性研究

Correlation study of unstable angina pectoris with depression and objective indicators and specific TCM syndromes after coronary revascularization

目的 探讨冠脉血运重建后不稳定型心绞痛患者发生抑郁与血小板水平(PLT)、淋巴细胞计数(TLC)、血小板淋巴细胞比率(PLR)、胆红素(TBIL)及特定证候的相关性。方法 2020年11月—2021年7月,纳入冠脉血运重建后不稳定型心绞痛患者87例。入院后检测PLT、TLC及TBIL,计算PLR。同日对患者进行汉密尔顿抑郁量表(HAMD)评分,8~24分者纳入抑郁组(42例),低于8分者纳入对照组(45例)。将PLT、TLC、TBIL、PLR与是否抑郁进行双变量Spearman相关性分析。然后将是否抑郁作为因变量,PLT、TLC、TBIL、PLR作为自变量,进行二元Logistic回归分析,确定影响因素。对气滞血瘀证、气滞痰郁证、气郁化火证以1、0赋值进行数字化处理,并进行Spearman相关性分析,然后将研究对象依不同中医证候分为符合与不符合,对Spearman相关性分析中有统计学意义的实验室检查指标进行独立样本t检验。结果 PLT(r=0.312,P=0.003)、PLR(r=0.486,P<0.001)与抑郁的发生正相关,TLC(r=-0.296,P=0.005)、TBIL(r=-0.424,P<0.001)与抑郁情绪的发生负相关。PLT与气滞血瘀证正相关(r=0.354,P=0.001),PLR与气郁化火证正相关(r=0.293,P=0.006),TLC(r=-0.229,P=0.033)与气郁化火证负相关。结论 PLR为冠脉血运重建后不稳定型心绞痛患者发生抑郁的独立危险因素,TBIL为其保护因素。高水平的PLT与气滞血瘀证的发生密切相关,高水平的TLC、PLR与气郁化火证的发生相关。

Objective We aimed to explore the correlation between depression in patients with unstable angina pectoris after coronary revascularization and the levels of platelet(PLT), total lymphocyte count(TLC), platelet-lmphocyte ratio(PLR), and total bilirubin(TBIL) and specific TCM syndromes. Methods Altogether 87 patients with unstable angina pectoris after coronary revascularization from November 2020 to July 2021 were selected. Laboratory examination was conducted after admission, including PLT, TLC, and TBIL values. The PLR was obtained by calculating the ratio of PLT and TLC. On the same day, the patient’s Hamilton Depression Scale(HAMD) score was collected. Patients with a score between 8 and 24 were included in the depression group(42 cases);patients with a score below 8 were included in the control group(45 cases). Bivariate Spearman correlation analysis was conducted to investigate the relationship between each laboratory examination indices(PLT, TLC, TBIL, and PLR) and depression. Then, depression was taken as a dependent variable and each above laboratory examination index was taken as an independent variable to conduct binary Logistic regression analysis to determine the influencing factors. TCM syndromes(qi stagnation and blood stasis syndrome, qi stagnation and phlegm stagnation syndrome, and syndrome of qi depression transforming into fire) were classified by assigning values of 1 and 0, and Spearman correlation analysis was conducted. Then, the subjects were divided into compliance and non-compliance subgroups according to different TCM syndromes, and the independent sample t-test was conducted for laboratory examination indices with statistical significance in Spearman correlation analysis. Results PLT(r=0.312, P=0.003) and PLR(r=0.486, P<0.001) were positively correlated with the occurrence of depression, while TLC(r=-0.296, P=0.005) and TBIL(r=-0.424, P<0.001) were negatively correlated with the occurrence of depression. PLT was positively correlated with the occurrence of qi stagnation and blood stasis syndrome(r=0.354, P=0.001), and TLC(r=-0.229, P=0.033) and PLR(r=0.293, P = 0.006) were negatively or positively correlated with the occurrence of syndrome of qi depression transforming into fire, respectively. Conclusion PLR is an independent risk factor for depression in patients with unstable angina pectoris after coronary revascularization, and TBIL is a protective factor. High levels of PLT are closely related to the occurrence of qi stagnation and blood stasis syndrome, and high levels of TLC and PLR are related to the occurrence of syndrome of qi depression transforming into fire.