早发冠状动脉粥样硬化性心脏病患者焦虑状态危险因素的分析

Screening of risk factors for anxiety patients with premature coronary artery disease

摘要:

目的 探讨早发冠状动脉粥样硬化性心脏病（CHD）患者焦虑状态发生的危险因素，了解焦虑状 态对其短期预后的影响。方法 连续筛选诊断为早发CHD 患者120 例，根据汉密尔顿焦虑量表（HAMA）评分 分为焦虑组65 例和非焦虑组55 例，记录基本临床资料，并检测超敏C- 反应蛋白（hs-CRP）等生化指标，行 心脏彩超、冠状动脉造影或支架植入治疗（PCI）。对入选者随访180 d，记录其临床事件。结果 ①焦虑组女 性、高血压、吸烟史、心肌梗死（陈旧和急性）、双支或双支以上血管病变、PCI 治疗、高中以上文化程度其 所占比例及hs-CRP 水平高于非焦虑组（P <0.05）；随着焦虑程度的增加，hs-CRP 水平、高血压、双支及以 上血管病变及PCI 例数递增（P <0.05）；②高血压[O^R=2.352（95%CI ：1.090，5.044），P =0.004]、心肌梗死 [O^R=2.195（95%CI ：1.862，5.577），P =0.018]、PCI 治疗[O^R=3.680（95%CI ：1.743，7.772），P =0.000]、双支或 双支以上血管病变[O^R=3.96（95%CI ：1.895，8.304），P =0.011] 是早发冠心病患者焦虑状态发生的危险因素； ③焦虑组180 d 无事件生存率低于非焦虑组（P =0.049）。结论 高血压、心肌梗死、PCI 治疗、双支或双支 以上血管病变为早发CHD 患者发生焦虑的危险因素，焦虑状态影响早发CHD 患者短期预后。

Abstract:

Objective To investigate the risk factors for anxiety status in patients with premature coronary artery disease. Methods A total of 120 cases admitted with premature coronary artery disease were involved in this study and were subjected to 2 groups based on Hamilton anxiety scale: anxious group (n = 65) and non-anxious group (n = 55). Demographic data, hypersensitive C-reactive protein (hs-CRP) were recorded. Echocardiography and coronary angiography or percutaneous coronary intervention (PCI) were performed if necessary. Patients were followed up for 180 days. Results Ratio of female to male, blood pressure, smoking, myocardiac infarction (chronic or acute), double or multiple blood vessel lesion, high education background, history of PCI andlevel of hs-CRP were all significantly higher in anxious group compared with those in non-anxious group. Level of hs-CRP, blood pressure and incidence of multiple blood vessel lesion and PCI were positively correlated with the higher level of anxiety (P < 0.05). Risk factors for anxiety includes high blood pressure [O^R = 2.35, (95% CI: 1.09, 5.04), P = 0.018] myocardiac infaction [O^R= 2.19, (95%CI: 1.86, 5.57), P = 0.018], PCI [O^R = 3.68, (95% CI: 1.74, 7.77), P = 0.000] and double or multiple blood vessel lesion [O^R= 3.96, (95%CI: 1.89, 8.30), P = 0.011]. Patients in anxious group experienced lower survival rate compared with non-anxious group. Conclusions High blood pressure, history of myocardiac infarction, PCI and double or multiple blood vessel lesion are independent risk factors for anxiety status in patients with premature coronary artery disease. Anxiety status is closely associated with poor short-term prognosis.