Assessing myocardial indices and inflammatory factors to determine anxiety and depression severity in patients with chronic heart failure

BACKGROUND Patients with chronic heart failure(CHF)have a progressive disease that is associated with poor quality of life and high mortality.Many patients experience anxiety and depression(A&D)symptoms,which can further accelerate disease progression.We hypothesized that indicators of myocardial function and inflammatory stress may reflect the severity of A&D symptoms in patients with CHF.Changes in these biomarkers could potentially predict whether A&D symptoms will deteriorate further in these individuals.AIM To measure changes in cardiac and inflammatory markers in patients with CHF to determine A&D severity and predict outcomes.METHODS We retrospectively analyzed 233 patients with CHF treated at the Jingzhou Hospital,Yangtze University between 2018-2022 and grouped them according to Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores.We compared clinical data in the no-A&D,mild-A&D,moderate-A&D,and severe-A&D groups,the SAS and SDS scores with the New York Heart Association(NYHA)functional classification,and cardiac markers and inflammatory factors between the no/mild-A&D and moderate/severe-A&D groups.Regression analysis was performed on the markers with P<0.05 to determine their ability to predict A&D severity in patients and the area under the receiver operating characteristic curve(AUROC)was used to evaluate their accuracy.RESULTS In the inter-group comparison,the following variables had an effect on A&D severity in patients with CHF:NYHA class,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,N-terminal pro-brain natriuretic peptide(NT-proBNP),interleukin-6(IL-6),and tumor necrosis factor-alpha(P<0.05).Other variables did not differ significantly between the A&D groups(P>0.05).In addition,we found that higher NYHA classes were associated with higher the SAS and SDS scores(P<0.05).Regression analysis showed that LVEF,NTproBNP,and IL-6 were independent risk factors for A&D severity(P<0.05).Among them,NT-proBNP had the best predictive ability as a single indicator(AUROC=0.781).Furthermore,the combination of these three indicators exhibited a good predictive effect toward discriminating the extent of A&D severity among patients(AUROC=0.875).CONCLUSION Cardiac and inflammatory biomarkers,such as LVEF,NT-proBNP,and IL-6,are correlated with A&D severity in patients with CHF and have predictive value.

Clinical intervention effect of Xuefu Zhuyu decoction on chronic heart failure complicated with depression

BACKGROUND The diagnosis and treatment of depression in patients with chronic heart failure(CHF)is challenging,with no ideal treatment at present.AIM To analyze the clinical intervention effect of Xuefu Zhuyu decoction(XFZYD)on CHF complicated with depression.METHODS The study cohort comprised 116 patients with CHF complicated with depression who received treatment from July 2020 to July 2023,of which 55 received Western medicine(control group)and 61 received XFZYD(research group).Data on clinical effectiveness,traditional Chinese medicine(TCM)syndrome score,cardiac function,negative emotions,and serum inflammatory factors,were collected for comparative analyses.RESULTS Compared with the control group,the research group had an evidently higher total effective rate.Furthermore,there were marked reductions in TCM symptom score,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,Self-Rating Depression Scale,Hamilton Depression Scale,high-sensitivity C-reactive protein,monocyte chemoattractant protein-1,and matrix metalloproteinase-9 in the research group after treatment,and these were lower than the corresponding values in the control group.Left ventricular ejection fraction was increased and higher in the research group compared with the control group after treatment.CONCLUSION Our findings conclusively proved that XFZYD was considerably superior to Western medicine for treating CHF complicated with depression because it significantly alleviated patients’symptoms,improved cardiac function,relieved negative emotions,and reduced the levels of serum inflammatory factors.

Analysis of the Status and Factors Influencing Anxiety and Depression in Patients with Chronic Heart Failure and Their Primary Caregivers: Empirical Quantitative Research

Objective: This study examined the associations between anxiety, depression, and quality of life among hospitalized patients with chronic heart failure and their primary caregivers. Patients and Methods: Between May and September 2018, the data were collected from 61 patients and their caregivers. Demographic information of CHF patients was collected by questionnaires; the Hospital Anxiety and Depression Scale (HADS) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used to assess CHF patient’s anxiety, depression and quality of life (QOL); the HADS, the Family Caregiver Quality of Life (FAMQOL) were used to assess primary caregivers’ anxiety, depression and QOL. Descriptive statistics, correlation analysis, independent-sample t-test, one-way analysis of variance and multiple stepwise regression were used in the statistical analysis. SPSS 17.0 was used to manage and perform statistical analyses. Results: Quality of life, anxiety, and depression of the patients and caregivers had significant positive correlations. Gender, quality of life, number of hospitalizations, duration of patients’ heart failure, and the quality of life of caregivers influenced patients’ anxiety. Gender, quality of life, relationship with the patient, and depression of caregivers influenced their anxiety. The quality of life and anxiety of patients influenced their depression. Daily caregiving time, anxiety, relationship with patients, and the patients’ heart function influenced caregivers’ depression. Conclusion: The patients and caregivers experienced anxiety and depression, which interacts and decreases their quality of life. It is important to regularly assess anxiety, depression, and quality of life in patients with chronic heart failure and their primary caregivers.

Treatment of Chronic Heart Failure Complicated with Anxiety and Depression Using Traditional Chinese and Western Medicine

Chronic heart failure(CHF)is the terminal stage of various heart diseases,and is the main cause of death from cardiovascular disease.In recent years,the prevalence of CHF combined with anxiety and depressive state has shown an upward trend,and this paper was aimed to provide a reference for the diagnosis and treatment of CHF combined with anxiety and depression using Traditional Chinese medicine(TCM)and Western medicine.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Effects of Digoxin and Tongxinluo capsule combination treatment on oxidative stress, cytokines and vascular endothelial function in patients with chronic heart failure

Objective:To explore the effect of digoxin and Tongxin capsule combined therapy on oxidative stress, cytokines and vascular endothelial function in patients with chronic heart failure, and provide help for clinical treatment of patients with chronic heart failure.Methods:95 cases of chronic heart failure in our hospital were randomly divided into observation group (47 cases) and control group (48 cases). Control group patients were given basic treatment, and observation group received combination therapy of digoxin and Tongxinluo capsule, to detect and to investigate the changes of oxidative stress, cytokines and vascular endothelial function in two groups of patients before and after treatment.Results:There was no significant difference in oxidative stress, cytokines and vascular endothelial function between the two groups of chronic heart failure patients before treatment (P>0.05). Compared with before treatment, the malondialdehyde (MDA) and cytokines [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6) and brain natriuretic peptide (BNP)] in two groups of patients with chronic heart failure after treatment decreased significantly (P<0.05), while indexes related to endothelial function [hyperemic brachial artery diameter after reactive hyperemia, brachial artery diameter change rate, brachial artery endothelial dependent diastolic function (FMD), and brachial artery endothelium dependent diastolic function (NMD)] and related indexes of oxidative stress [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT)] were significantly increased (P<0.05). The related indexes and oxidative stress indexes (GSH-Px, CAT and SOD) of observation group after the combined treatment in patients with endothelial function were significantly higher than the control group after treatment (P<0.05). After treatment, cytokines and MDA levels were significantly lower than the control group (P<0.05).Conclusions:Tongxinluo capsule combined with digoxin treatment significantly improved the oxidative stress, cytokines and vascular endothelial function levels in patients with chronic heart failure, and has important clinical significance for the treatment of patients with chronic heart failure.

达格列净结合标准抗心衰及降糖方案治疗老年慢性心力衰竭合并T2DM及高尿酸血症的临床分析

目的探究对老年慢性心力衰竭合并2型糖尿病(Diabetes Mellitus Type 2,T2DM)及高尿酸血症患者采用达格列净和标准抗心衰及降糖方案结合治疗后效果。方法随机选取2021年6月—2022年6月广州市花都区人民医院收治的心力衰竭合并T2DM及高尿酸血症患者120例为研究对象,采用随机数表法分成对照组(60例)、观察组(60例)。对照组采取标准抗心衰及降糖方案,观察组在对照组基础上采取达格列净,对比临床效果。结果观察组氨基末端脑钠肽前体(N Terminal Pro B Type Natriuretic Peptide,NT-proBNP)为(519.36±107.52)ng/L、血尿酸为(346.17±42.15)μmol/L低于对照组,差异有统计学意义(t=2.020、4.245,P<0.05)。观察组血脂改善更好,左室舒张末容积、左室收缩末容积、舒张早期二尖瓣血流速度/二尖瓣环运动速度(the Ratio of Early Diastolic Transmitral Flow Velocity to Mitral Annular Velocity,E/e’)低于对照组,左室射血分数高于对照组,差异有统计学意义(P<0.05)。观察组主要终点事件、次要终点事件、痛风发作率低于对照组,差异有统计学意义(P<0.05)。两组药物不良反应率对比,差异无统计学意义(P>0.05)。结论针对老年慢性心力衰竭合并T2DM及高尿酸血症患者,采用达格列净联合标准抗心衰及降糖方案,能改善血脂、心功能等指标水平,预后效果以及安全性较高。

心理干预联合人文关怀对慢性心力衰竭患者心理状态、治疗依从性及睡眠质量的影响

目的:分析心理干预与人文关怀在慢性心力衰竭(CHF)患者中的应用效果。方法:选取2023年3月至2024年2月泉州市第一医院收治的CHF患者150例作为研究对象,按照随机数字表法分为观察组和对照组,每组75例。2组均接受常规治疗与护理,观察组在常规治疗、护理基础上接受心理干预与人文关怀。比较2组干预后焦虑与抑郁情绪、服药依从性、睡眠质量与生命质量。焦虑采用焦虑自评量表(SAS)评价,抑郁采用抑郁自评量表(SDS)评价,睡眠质量采用匹兹堡睡眠质量指数(PSQI)评价,生命质量采用明尼苏达心力衰竭生命质量量表(MLHFQ)评价。结果:观察组在干预后SAS、SDS评分低于对照组,服药依从率高,PSQI评分与睡眠障碍发生率较低,差异有统计学意义(P<0.05)。观察组在干预后MLHFQ评分显著低于对照组,差异有统计学意义(P<0.05)。结论:心理干预与人文关怀可改善CHF患者心理障碍与睡眠障碍,提升治疗依从性,改善生命质量。

慢性心力衰竭患者衰弱变化轨迹及其影响因素

目的探索慢性心力衰竭患者衰弱变化轨迹及其影响因素,为针对性干预提供参考。方法采用方便抽样法选取住院治疗的105例慢性心力衰竭患者,对其入院至出院后6个月期间分为4个时间点进行衰弱评估,了解衰弱变化轨迹,分析影响因素。结果4个时间点患者衰弱评分分别为2(1,3)分、2(0.3)分、1(0,3)分、1(0,3)分;衰弱轨迹分为低水平缓降组(47.6%)、中水平下降组(18.1%)、中水平上升组(34.3%)3个潜类别;多分类logistic回归分析结果显示,年龄、身体质量指数、共病种数、血红蛋白、心功能分级、抑郁和体力活动是患者衰弱轨迹的影响因素(均P<0.05)。结论慢性心力衰竭患者经住院治疗护理,衰弱水平总体呈好转趋势,衰弱轨迹分为3个潜类别,轨迹具有异质性;护理人员可针对不同类别、不同阶段及影响因素制定干预计划,实现精准护理。

陈晓虎从“气、郁、瘀”论治慢性心力衰竭伴焦虑抑郁经验

本文介绍陈晓虎教授从“气、郁、瘀”论治慢性心力衰竭(慢性心衰)伴焦虑抑郁经验。陈晓虎教授认为,心气不足、肝气郁结、血脉瘀阻为该病核心病机。其主张从益气健脾、疏肝解郁、活血通脉等方面进行辨证论治,并认为其属于“双心疾病”范畴,将安神作为主要治疗大法,形神同治,且不忘心理疏导,动静结合,实现“双心同治”,从而获得更佳的疗效。附验案1则,以资佐证。

基于数据挖掘探析中医药治疗慢性心力衰竭合并抑郁的用药规律

目的:基于数据挖掘探析中医药治疗慢性心力衰竭合并抑郁的用药规律。方法:收集并整理中国知网、维普、万方数据及中国生物医学文献数据库建库至2023年5月发表的关于中医药治疗慢性心力衰竭合并抑郁的文献,将方剂录入Excel表格,然后导入中医传承辅助平台(V2.5)软件,采用基本信息统计、频次分析、关联规则分析、层次聚类等数据挖掘技术,对医案进行分析并探究其用药规律、挖掘新方。结果:共纳入处方42首,涉及单味中药88味。频次分析结果显示,茯苓、白术、柴胡、白芍、炮附子、炙甘草、丹参、人参、黄芪、川芎居于用药频次前10位。药性以温、寒、平为主;药味以甘味为主,苦、辛次之;归经以心、肝、脾经为主。得到50组常用药物组合,31条药物关联规则和5个潜在新方。结论:中医药治疗慢性心力衰竭合并抑郁以益气温阳、疏肝解郁为基本治法,兼以活血化瘀、利水渗湿。

保元汤合血府逐瘀汤治疗气虚血瘀型慢性心力衰竭患者的穴位温度变化规律探析

目的探讨保元汤合血府逐瘀汤对气虚血瘀型慢性心力衰竭(CHF)治疗疗效及穴位的温度变化规律。方法选取东莞市中医院在2020年12月-2021年12月收治的31例CHF患者,均给予保元汤合血府逐瘀汤治疗。在治疗前后,比较血清B型钠尿肽前体(NT-ProBNP)、超声心动图相关指标[左心室舒张末期内径(LVEDd)、心脏彩超射血分数(LVEF)]、膻中与跗阳24 h的温度变化(平均温度、昼夜温度)。结果治疗后,BNP水平低于治疗前(P<0.05);治疗后,超声心动图LVEDd参数值低于治疗前,LVEF参数值高于治疗前(P<0.05);治疗后,患者的膻中与跗阳的24 h平均温度均高于治疗前的平均温度(P<0.05)。结论气虚血瘀型CHF患者近心端及远心端不同穴位具有温度差异,心功能不同患者也具有穴位温度差异,通过穴温变化可评估心衰的病情变化和用药疗效。

越鞠丸类方治疗气滞水停型慢性心衰合并抑郁的临床疗效

目的探讨越鞠丸类方治疗气滞水停型慢性心衰合并抑郁的临床疗效。方法选取气滞水停型慢性心衰合并抑郁患者76例,随机均分为观察组(越鞠丸类方+常规治疗)和对照组(常规治疗)。比较两组治疗前后心功能、中医症候积分、抑郁评分、生活质量和血清胃饥饿素(Ghrelin)等指标的差异。结果与治疗前比较,治疗后两组左室射血分数、6 min总步行距离、Ghrelin升高(P<0.05),而左心室舒张期末内径、左心室舒张期末容积、中医症候积分、抑郁自评量表评分、明尼苏达生活质量评分、N末端B型脑钠肽前体和可溶性生长刺激表达基因2水平降低(P<0.05);且观察组较对照组更为显著(P<0.05)。结论越鞠丸类方治疗气滞水停型慢性心衰合并抑郁有较好的效果,可明显改善患者临床症状和心功能。

真武汤联合补心气方加味治疗心肾阳虚型慢性心力衰竭患者的疗效及对其氧化应激反应、血管内皮功能的影响

目的观察真武汤联合补心气方加味治疗心肾阳虚型慢性心力衰竭(Chronic heart failure,CHF)患者的临床疗效及对其氧化应激反应、血管内皮功能的影响。方法选取2020年5月—2022年5月期间唐山市中医医院心血管二科收治的CHF患者110例作为研究对象,按随机数字表法分为对照组和观察组,每组各55例。对照组予以常规对症治疗,观察组在对照组基础上予以真武汤合补心气方加味治疗。两组患者均以4周为1个疗程,治疗3个疗程。观察比较两组患者临床疗效,治疗前后中医证候积分、心功能[左心室射血分数(Left ventricular ejection fraction,LVEF)、左心室舒张末期内径(Left ventricular end-diastolic diameter,LVEDD)及每搏输出量(Stroke volume,SV)]、氧化应激反应[血清超氧化物歧化酶(Superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(Glutathione peroxidase,GSH-Px)、丙二醛(Malondialdehyde,MDA)]、血管内皮功能[血清内皮素-1(Eendothelin-1,ET-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、一氧化氮(Nitric oxide,NO)]水平。结果治疗后观察组总有效率92.73%(51/55)明显高于对照组77.36%(41/53),差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分较治疗前降低,差异有统计学意义(P<0.05);且观察组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者心功能LVEF、SV水平均较治疗前升高,LVEDD水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组LVEF、SV水平明显高于对照组,LVEDD水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清SOD、GSH-Px水平均较治疗前升高,血清MDA水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组血清SOD、GSH-Px水平明显高于对照组,血清MDA水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清ET-1、NO水平均较治疗前降低,血清VEGF水平均较治疗前升高,差异有统计学意义(P<0.05);且观察组血清ET-1、NO水平明显低于对照组,血清VEGF水平明显高于对照组,差异有统计学意义(P<0.05)。结论真武汤合补心气方加味治疗心肾阳虚型CHF患者,可改善患者氧化应激反应,提高血管内皮功能,促进心功能恢复,整体提高患者治疗有效率。

刍议慢性心力衰竭的气血津液辨治

气血津液皆中焦脾胃所化生,功能上互生互济,故而气虚、气滞、血虚、血瘀、水饮等气血津液的病理过程也常相继发生。“血不利则为水”阐明了气分、血分、水分的病理因果关系,可用以解释慢性心力衰竭(慢性心衰)的病变过程,认为慢性心衰常见病因皆可导致气的化生及气的功能障碍,进而引起“血不利”,所化之水饮停聚肌肤、脏腑组织间隙导致“水不利”,水饮、瘀血互结日久化热酿毒,则蚀脉伤肌,变证丛生。治疗应补气兼顾理气,活血利水不忘养血,恰当配伍清热解毒药,希冀在减少慢性心衰心血管事件方面获得较好的疗效。

《慢性心力衰竭伴利尿剂抵抗中西医结合诊疗专家共识》解读

在中国中西医结合学会的指导下,湖南中医药大学第一附属医院与中南大学湘雅医院共同牵头,组织心血管领域中西医结合专业专家,于2021年8月制定了《慢性心力衰竭伴利尿剂抵抗中西医结合诊疗专家共识》(以下简称《共识》)。为更好地帮助读者对《共识》进行理解,系统地解读和介绍《共识》中的重点、难点,以期读者更全面、准确地理解和临床运用《共识》,从而提高慢性心力衰竭伴利尿剂抵抗中西医结合治疗的临床疗效。

慢性心力衰竭伴发焦虑抑郁对患者血清5-HT、尿酸、胱抑素C和AngⅡ水平的影响

目的研究慢性心力衰竭伴发焦虑抑郁对患者血清5-羟色胺(5-HT)、尿酸、胱抑素C和血管紧张素Ⅱ(AngⅡ)水平的影响。方法回顾性选取2020年9月至2022年9月右江民族医学院附属医院收治的120例CHF患者作为研究对象。根据汉密尔顿焦虑量表(HAMA)(大于7分为焦虑)、汉密尔顿抑郁量表(HAMD)(≥7分为抑郁)分数将患者分为焦虑抑郁组(n=42)和非焦虑抑郁组(n=78)。焦虑抑郁组患者42例,非焦虑抑郁组患者78例。比较两组患者的5-HT、尿酸、胱抑素C、AngⅡ、血肌酐、一般自我效能感量表(GSES)评分、纽芬兰纪念大学幸福度量表(MUNSH)评分、并发症情况、生活质量。结果焦虑抑郁组患者5-HT低于非焦虑抑郁组,尿酸、胱抑素C、血肌酐水平均高于非焦虑抑郁组,差异均有统计学意义(P<0.05);两组患者AngⅡ比较,差异无统计学意义(P>0.05)。焦虑抑郁组患者GSES评分、MUNSH评分均低于非焦虑抑郁组,差异均有统计学意义(P<0.05)。焦虑抑郁组并发症总发生率为42.86%,明显高于非焦虑抑郁组(16.67%),差异有统计学意义(P<0.05)。焦虑抑郁组患者躯体供能、社会功能、心理功能、物质功能、生存质量总评分均显著低于非焦虑抑郁组,差异均有统计学意义(P<0.05)。结论慢性心力衰竭伴发焦虑抑郁患者5-HT更低,尿酸、胱抑素C、并发症总发生率更高,幸福感和生活质量更低,在慢性心力衰竭患者治疗中应注意减少焦虑抑郁的发生。

压力接种训练对慢性心力衰竭患者焦虑、抑郁及运动能力的影响研究

目的:探讨压力接种训练(Stress Inoculation Training,SIT)对慢性心力衰竭(Chronic Heart Failure,CHF)患者焦虑、抑郁及运动能力的影响。方法:选取2020年3月—2021年10月郑州大学第一附属医院心内科收治的74例CHF患者作为研究对象,采用抽签法分为对照组和干预组,每组各37例。对照组给予常规护理干预,干预组在对照组的基础上给予8周SIT。比较两组患者干预前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分情况及6 min步行试验(6 MWT)的距离。结果:干预后,干预组SAS、SDS评分均明显低于对照组,差异有统计学意义(t=5.673、5.549,P<0.05)。干预后,干预组6 MWT的距离明显短于对照组,差异有统计学意义(t=-2.753,P<0.05)。结论:SIT能够缓解CHF患者焦虑、抑郁等负性情绪,提高CHF患者的活动能力,增强其战胜疾病的信心,改善其预后。

慢性心力衰竭患者躯体化症状、焦虑、抑郁对临床结局的影响

目的·探讨慢性心力衰竭(心衰)患者躯体化症状、焦虑、抑郁与临床结局的关系。方法·纳入2018年1月—2021年12月上海交通大学医学院附属仁济医院心内科门诊就诊的心衰患者。收集患者人口学资料及临床特征,采用躯体化症状评估量表(Self-reported Somatic Symptom Scale of China,SSS-CN)、9项患者健康问卷(The Patient Health Questionnaire-9,PHQ-9)及7项广泛性焦虑障碍量表(Generalized Anxiety Disorder-7,GAD-7)对患者进行评估。在初次就诊后的第12个月进行电话随访,收集患者终点事件具体信息(包括是否死亡、是否再住院、死亡原因及再住院原因)。采用生存曲线及Cox回归分析评价患者的临床预后。结果·共纳入患者195例。慢性心衰患者SSS-CN得分在不同性别、心率分组、美国纽约心脏病学会(New York Heart Association,NYHA)心功能分级,以及是否焦虑、抑郁人群间的差异具有统计学意义(均P<0.05)。生存曲线分析显示,中-重度躯体化症状组患者的总体生存率低于正常-轻度组(Log rank P=0.020)。Cox回归分析显示,与正常-轻度组相比,中-重度躯体化症状组患者的全因死亡风险更高[风险比(HR)=2.797,95%CI 1.135~6.890];存在抑郁症状的心衰患者全因死亡风险更高(HR=2.883,95%CI 1.150~6.984);与正常-轻度组相比,中-重度躯体化症状组患者心血管死亡风险更高(HR=2.784,95%CI 1.073~7.226);存在抑郁症状的心衰患者心血管死亡的风险更高(HR=2.823,95%CI 1.087~7.330)。心衰患者有无焦虑、抑郁,有无躯体化症状及其不同严重程度在全因住院和因心衰住院中的差异无统计学意义。结论·中-重度的躯体化症状及抑郁状态是慢性心衰患者全因死亡及心血管死亡的危险因素。

社区老年慢性心力衰竭患者焦虑抑郁现状的流行病学研究

目的研究社区老年慢性心力衰竭患者焦虑抑郁情绪,找出焦虑抑郁情绪严重程度和患者病情严重程度的关系,提出有效的情绪管理方案。方法纳入老年慢性心力衰竭患者450例,均为2019年5月至2021年5月广州市越秀区某社区接受家庭医生签约服务人群,将其组建为观察组,另外将同一时间在该社区体检的65岁≥健康老年人450例组建为对照组,焦虑抑郁情绪采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)。分析2组抑郁率、焦虑率及程度,并分析患者的HAMD、HAMA评分结构,找出患者在情绪方面的特征,分析患者病情指标、对疾病认识水平和HAMD评分、HAMA评分的关联关系。结果观察组焦虑率、抑郁率高于对照组(P<0.05);受试者HAMA评分特点上,对照组躯体性焦虑因子评分较高(P<0.01),观察组精神性焦虑因子评分较低(P<0.05);受试者HAMD评分特点上,观察组焦虑躯体化、阻滞、睡眠障碍、全身症状因子分数较高(P<0.05),2组体重、认知障碍差异无统计学意义(P>0.05)。老年慢性心力衰竭患者HAMD评分、HAMA评分和患者NYHA心功能分级之间有一定关联性,和患者6 min步行试验及患者对慢性心力衰竭疾病相关知识的认知水平存在关联关系,体现出负相关性。结论心力衰竭患者身体感受以及心力衰竭病情严重程度会影响患者情绪,为有效预防,首先要改善患者的不良感受,进行有效的心理疏导,才能确保患者积极面对疾病。