摘要
目的 探讨抑郁对冠心病患者行再血管化治疗包括冠状动脉旁路移植术（CABG）和冠状动脉介入治疗（PCI）预后的影响.方法 采用ZUNG抑郁自评量表（SDS）分别对345例CABG和308例PCI患者术前及术后进行抑郁评分,根据评定结果分为抑郁组和非抑郁组,其中CABG患者抑郁组84例、非抑郁组261例,PCI患者抑郁组88例、非抑郁组220例.随访12个月,观察抑郁状态分别对2种治疗方式主要不良心血管事件（MACE）发生率及再住院率的影响.结果 345例行CABG的患者,术后抑郁患病率明显高于术前（40.9％比24.3％,P＜0.01）；术后抑郁患者12个月内MACE的发生率高于无抑郁患者[8.5％（ 12/141）比2.9％ （6/204）,P＜0.05]；其中,抑郁组再次血运重建率和12个月累积再住院率均高于非抑郁组[4.9％（ 7/141）比1.0％（ 2/204）和12.8％（ 18/141）比6.4％ （13/204）,P均＜0.05].308例行PCI患者,术后抑郁患病率亦高于术前（36.4％比28.6％,P＜0.05）；术后抑郁患者12个月MACE发生率和再住院率均高于无抑郁患者[8.0％ （9/112）比2.0％ （4/196）和12.5％ （14/112）比4.6％ （9/196）,P均＜0.05].对同期行PCI和CABG的两组患者手术前后抑郁评分进行比较,PCI与CABG术前两组患者SDS评分比较差异无统计学意义（P＞0.05）.CABG术后患者SDS评分明显高于PCI组（48.9±9.8比45.7±10.5,P=0.01）.166例行PCI患者测定血清IL-6水平,抑郁患者IL-6水平高于非抑郁者,差异有统计学意义（P＜0.05）.结论 再血管化治疗术后有较高比例的患者存在不同程度的抑郁.术后抑郁状态与患者再缺血事件相关,并可能影响预后.
Objective To investigate the impact of depression on clinical outcome of patients undergoing revascularization.Methods Self-rating depression scale （SDS） assessment was made before and after coronary artery bypass grafting （CABG,n =345 ） and percutaneous coronary intervention（ PCI,n =308 ）procedure.Patients were divided into depression and non-depression group.All patients were followed up for 12 months after procedure for the occurrence of rehospitalization and major adverse cardiovascular events （MACE） including all-cause mortality,nonfatal myocardial infarction or target lesion revascularization.Results Depression was present in 40.9% （ n =141 ） of patients after CABG,which was significantly higher than before procedure （24.3%,P 〈 0.01 ）.The MACE rate was significantly higher in patients with post-procedure depression[ 8.5% （ 12/141 ） ] than in patients without depression [ 2.9% （6/204）,P 〈0.05 ] and the incidences of target lesion revascularization and rehospitalization were also significantly higher in depression patients than in non-depression patients during the 12 months follow-up （ all P 〈 0.05 ）.Depression was present in 36.4% （n =112） of patients after PCI,which was significantly higher than that before procedure （28.6%,P 〈0.05）.The MACE rate [8.0% （9/112） vs.2.0% （4/196）]and rehospitalization rate [ 12.5% （ 14/112 ） vs.4.6% （ 9/196 ） ] were significantly higher in depression patients than in patients without depression during the 12 months follow-up （ P 〈 0.05 ）.There was no significant difference on SDS score between the PCI and CABG before the procedure.However,after the procedure,the SDS score for patients undergoing CABG was significantly higher than in patients undergoing PCI （48.9 ± 9.8 vs.45.7 ± 10.5 P =0.01 ）.The level of serum IL-6 was significantly higher in depression patients than in patients without depression （ P 〈 0.05 ）.Conclusion Prevalence of depression is high in patients treated with revascularization procedures and is linked with poor post-procedure prognosis.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第2期99-103,共5页
Chinese Journal of Cardiology
关键词
冠状动脉疾病
抑郁症
心肌血管重建术
预后
Coronary disease
Depression
Myocardial revascularization
Prognosis
