老年慢性心力衰竭患者情绪障碍与免疫功能的相关性研究

Correlation between emotional disorders and immune function in elderly patients with chronic heart failure

目的探索老年慢性心力衰竭(心衰)患者情绪障碍与免疫功能紊乱之间的相关性。方法选择2020年1月至2021年12月于河南省人民医院老年医学科住院的慢性心衰合并情绪障碍的老年患者145例为研究对象,另选取老年心衰患者90例作为对照组。收集两组患者基线资料,均行常规诊治,检测两组入院时及4周时血生化、超敏C反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-proBNP)、细胞免疫与体液免疫等指标,采用汉密尔顿焦虑抑郁量表评估患者的情绪障碍程度,并进行统计学分析。结果两组分别有3例和2例患者中途退出。两组患者的IgA水平、NK细胞数在治疗前无显著差异(P>0.05),情绪障碍组患者CD8^(+)T水平较高,CD4^(+)T、CD4^(+)/CD8^(+)、IgM、IgG水平降低,差异有统计学意义(P<0.05)。治疗4周后,两组患者的hs-CRP、NT-proBNP、CD8^(+)T水平均显著降低、CD4^(+)T、CD4^(+)/CD8^(+)、IgM、IgG水平升高,与对照组比较,情绪障碍组患者的变化均更为显著(P<0.05)。两组的HAMD-24、HAMA-14评分与CD4^(+)T、CD4^(+)/CD8^(+)、IgG等呈负相关,与CD8^(+)T呈正相关(分别为r=-0.559、r=-0.418、r=-0.656、r=0.639;r=-0.485、r=-0.471、r=-0.630、r=0.537,P均<0.001);但与NK细胞数、IgA、IgM、hs-CRP、NT-proBNP等指标比较,均无相关性(P均>0.05)。结论合并情绪障碍的老年心衰患者存在免疫功能的紊乱,两者之间具有显著相关性,积极的治疗干预有助于患者免疫功能的恢复。

Objective To investigate the correlation between emotional disorders and immune dysfunction in elderly patients with chronic heart failure.Methods A total of 145 elderly patients with chronic heart failure complicated with emotional disorders who were hospitalized in Our Hospital from January 2020 to December 2021 were selected as the research objects,and another 90 elderly patients with heart failure were selected as controls.At admission and 4 weeks later,blood biochemical,hs-CRP,NT-proBNP,cellular immunity,humoral immunity,and other indicators were measured,and the Hamilton Anxiety and Depression Scale was used to assess the degree of emotional disturbance in patients,which was statistically analyzed.Results In the two groups,3 and 2 patients dropped out.There was no significant difference in the levels of IgA and NK cells between the two groups before treatment(P>0.05).The patients in the emotional disorders group had higher levels of CD8^(+)T,and CD4^(+)T,CD4^(+)/CD8^(+),and lower level of IgM and IgG,with statistical significance(P<0.05).After 4 weeks of treatment,the levels of hs-CRP,NT-proBNP,and CD8^(+)T cells in both groups significantly decreased,while CD4^(+)T,CD4^(+)/CD8^(+),IgM,and IgG levels increased.Compared with the control group,the changes in the patients with mood disorders were more significant(P<0.05).The scores of HAMD-24 and HAMA-14 in both groups were negatively correlated with CD4^(+),CD4^(+)/CD8^(+),IgG,and positively correlated with CD8^(+)T(r=-0.559,r=-0.418,r=-0.656,r=0.639;r=-0.485,r=-0.471,r=-0.630,r=0.537,respectively,P<0.001);but there was no correlation with NK cell count,IgA,IgM,hs-CRP,NT-proBNP and other indicators(P>0.05).Conclusion There is a significant correlation between emotional disorders and immune dysfunction in elderly patients with chronic heart failure.Active therapeutic intervention will contribute to the recovery of immune function.