支架内再狭窄冠心病患者焦虑和抑郁的影响因素分析及预测模型构建

Influencing factors and prediction model construction of anxiety and depression in coronary heart disease patients with in-stent restenosis

目的探讨支架内再狭窄(ISR)冠心病(CHD)患者焦虑和抑郁的影响因素,并建立评价预测模型,提供快速识别焦虑和抑郁患者方法。方法选取2020年1月至2021年12月在郑州大学第一附属医院进行冠状动脉造影(CAG)检查并确诊为ISR的260例CHD住院患者为研究对象,通过焦虑自评量表、抑郁自评量表和一般状况调查表对患者焦虑和抑郁状况进行调查评估。然后,采用χ2检验分析发生率,运用二元Logistic回归分析焦虑和抑郁的影响因素。最后,使用R软件构建列线图预测模型和校准曲线,并采用受试者工作特征曲线(ROC)和校准图评价模型的准确性。结果最终纳入252例患者,其中焦虑102例(40.48%),抑郁118例(46.83%),其余患者均无焦虑或抑郁;ISR冠心病患者焦虑的危险因素分别为女性(OR=2.66,95%CI:1.33~5.32,P=0.005)、离婚或丧偶(OR=2.56,95%CI:1.09~6.04,P=0.031)、植入支架数量≥3枚(OR=4.41,95%CI:1.67~11.62,P=0.003)、MehranⅢ型(OR=5.01,95%CI:2~12.5,P=0.001)、MehranⅣ型(OR=7.35,95%CI:2.64~20.42,P<0.001);ISR冠心病患者抑郁的危险因素分别为女性(OR=3.29,95%CI:1.53~7.09,P=0.002)、文化程度为中学以下(OR=7.19,95%CI:1.75~29.46,P=0.006)、离婚或丧偶(OR=4.8,95%CI:1.7~13.53,P=0.003)、植入支架数量≥3枚(OR=13.77,95%CI:4.34~43.71,P=0.000)、MehranⅢ型(OR=5.22,95%CI:1.87~14.58,P=0.002)、MehranⅣ型(OR=9,95%CI:2.76~29.27,P<0.001);所构建模型预测患者焦虑和抑郁的ROC曲线下面积(AUC)值分别为0.820和0.883。结论ISR冠心病患者焦虑和抑郁的患病率较高,女性、离婚或丧偶、支架数量≥3枚、MehranⅢ型或Ⅳ型是ISR冠心病患者发生焦虑或抑郁的独立危险因素,支架数量和血管狭窄程度是主要影响因素,所构建列线图在识别焦虑和抑郁特异性群体方面具有良好的性能。

Objective To explore the influencing factors of anxiety and depression in coronary heart disease patients with in-stent restenosis(ISR),establish and evaluate the prediction model,and provide a method for rapid identification of the patients with anxiety and depression.Methods A total of 260 inpatients diagnosed with ISR who underwent coronary angiography in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were selected as research objects.Self-rating Anxiety Scale,Self-rating Depression Scale,and general status questionnaire were used to evaluate the patients'situations of anxiety and depression.Chi-square test was used to analyze the incidence rate,and binary logistic regression was employed to investigate the influencing factors of anxiety and depression.R software was used to construct the prediction model and calibration curve of the line graph,and the accuracy of the model was examined through receiver operating characteristic(ROC)curve and calibration chart.Results A total of 252 cases were included in the study,among which 102 cases were with anxiety(40.48%)and 118 cases were with depression(46.83%),and the remaining had no anxiety or depression.The risk factors for anxiety in coronary heart disease patients with ISR were female(OR=2.66,95%CI:1.33-5.32,P=0.005),divorce or widowhood(OR=2.56,95%CI:1.09-6.04,P=0.031),the number of implanted stents≥3(OR=4.41,95%CI:1.67-11.62,P=0.003),MehranⅢ(OR=5.01,95%CI:2-12.5,P=0.001),and MehranⅣ(OR=7.35,95%CI:2.64-20.42,P<0.001).The risk factors for depression in coronary heart disease patients with ISR were female(OR=3.29,95%CI:1.53-7.09,P=0.002),education level below secondary school(OR=7.19,95%CI:1.75-29.46,P=0.006),divorce or widowhood(OR=4.8,95%CI:1.7-13.53,P=0.003),number of implanted stents≥3(OR=13.77,95%CI:4.34-43.71,P=0.000),MehranⅢ(OR=5.22,95%CI:1.87-14.58,P=0.002),and MehranⅣ(OR=9,95%CI:2.76-29.27,P<0.001).The area under the ROC curve(AUC)values of the constructed moddoiel to predict anxiety and depression of patients were 0.820 and 0.883,respectively.Conclusion The prevalence of anxiety and depression in coronary heart disease patients with ISR is higher.Female,divorce or widowhood,number of stents≥3,MehranⅢorⅣare independent risk factors for anxiety or depression in coronary heart disease patients with ISR,in which the number of stents and the severity of stenosis have the greatest weight.The constructed nomogram has a good performance in the identification of anxiety and depression among specific groups.