情绪障碍对ACS患者NLR水平和GRACE评分危险分层的影响
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摘要
目的:研究情绪障碍对急性冠脉综合征(ACS)患者自身炎症反应及病情严重程度的影响。方法:收集190例ACS患者的临床资料,采用GRACE评分标准对所有患者进行危险分层。所有入选患者住院期间接受ACS标准化治疗,患者出院前7 d内完成患者健康问卷(PHQ-9)和广泛性焦虑量表(GAD-7)以评估患者情绪状态,分析情绪障碍对患者炎症指标中性粒细胞-淋巴细胞比值(NLR)及GRACE评分危险分层的影响。结果:(1)ACS患者中有抑郁障碍者占34.2%(65例),焦虑障碍者占28.9%(55例),其中抑郁合并焦虑者占9.5%(18例)。(2)GRACE危险分层高危组PHQ-9评分、GAD-7评分及NLR水平均高于中危组和低危组(9.10±4.13 vs. 7.29±3.79 vs. 5.90±4.27,9.51±3.77 vs. 7.83±4.79 vs. 4.98±4.55,4.61±5.38 vs. 3.72±2.47 vs. 2.86±1.92,P<0.05),有抑郁、焦虑症状组GRACE评分、NLR水平均高于无抑郁、焦虑症状组(119.89±30.20 vs.98.00±23.49,121.43±28.46 vs. 97.96±24.65,4.51±4.75 vs.3.25±2.54,4.62±5.27 vs. 3.23±2.03,P <0.01)。(3)以GRACE评分为因变量行多因素回归分析显示,PHQ-9评分、GAD-7评分及NLR水平与GRACE评分呈正相关关系。结论:情绪障碍可使ACS患者炎症反应指标NLR升高,病情加重,及时发现ACS患者情绪障碍及关注NLR水平可优化患者预后评估。
Objective: To study the effects of mood disorders on the inflammatory response and severity of acute coronary syndrome.Methods: Clinical data of 190 patients with ACS were collected and risk assessment and risk stratification were conducted for all patients with GRACE score. All selected patients received ACS routine treatment, patients were discharged from hospital within 7 days before com pleting patient health questionnaire(PHQ-9) and anxiety scale(GAD-7)in the evaluation of patients' emotional state, mood disorder, and whether NLR and GRACE score is related to the risk stratification was generalized. Results:(1)The proportion of patients with depressive disorder were 34.2%(65 cases), 28.9%(55 cases) and 9.5%(18 cases) with depression and anxiety.(2)The levels of PHQ-9, GAD-7 and NLR in the high-risk groups of parliamentary GRACE hazard stratification were higher than those in the middle and low risk groups(9.10±4.13 vs. 7.29±3.79 vs. 5.90±4.27, 9.51±3.77 vs. 7.83±4.79 vs. 4.98±4.55,4.61±5.38 vs. 3.72±2.47 vs. 2.86±1.92, P <0.05),and GRACE scores and NLR levels in the emotionally impaired group were higher than those in the non-mood disorder group(119.89±30.20 vs. 98.00±23.49, 121.43±28.46 vs. 97.96±24.65, 4.51±4.75 vs. 3.25±2.54, 4.62±5.27 vs. 3.23±2.03, P <0.01).(3)Multivariate regression analysis with GRACE score as the dependent variable showed that phq-9 score, GAD-7 score and NLR level were positively correlated with GRACE score. Conclusion: Emotional disorder, NLR and GRACE score of ACS patients are correlated. Timely detection of emotional disorder of ACS patients and attention to NLR level may optimize prognosis assessment of patients.
Objective: To study the effects of mood disorders on the inflammatory response and severity of acute coronary syndrome.Methods: Clinical data of 190 patients with ACS were collected and risk assessment and risk stratification were conducted for all patients with GRACE score. All selected patients received ACS routine treatment, patients were discharged from hospital within 7 days before com pleting patient health questionnaire(PHQ-9) and anxiety scale(GAD-7)in the evaluation of patients' emotional state, mood disorder, and whether NLR and GRACE score is related to the risk stratification was generalized. Results:(1)The proportion of patients with depressive disorder were 34.2%(65 cases), 28.9%(55 cases) and 9.5%(18 cases) with depression and anxiety.(2)The levels of PHQ-9, GAD-7 and NLR in the high-risk groups of parliamentary GRACE hazard stratification were higher than those in the middle and low risk groups(9.10±4.13 vs. 7.29±3.79 vs. 5.90±4.27, 9.51±3.77 vs. 7.83±4.79 vs. 4.98±4.55,4.61±5.38 vs. 3.72±2.47 vs. 2.86±1.92, P <0.05),and GRACE scores and NLR levels in the emotionally impaired group were higher than those in the non-mood disorder group(119.89±30.20 vs. 98.00±23.49, 121.43±28.46 vs. 97.96±24.65, 4.51±4.75 vs. 3.25±2.54, 4.62±5.27 vs. 3.23±2.03, P <0.01).(3)Multivariate regression analysis with GRACE score as the dependent variable showed that phq-9 score, GAD-7 score and NLR level were positively correlated with GRACE score. Conclusion: Emotional disorder, NLR and GRACE score of ACS patients are correlated. Timely detection of emotional disorder of ACS patients and attention to NLR level may optimize prognosis assessment of patients.
引文
[1]中国医师协会急诊医师分会,中华医学会心血管病学分会,中华医学会检验医学分会.急性冠脉综合征急诊快速诊疗指南[J].中华危重症医学杂志(电子版),2016(2):73
[2] Pardaens S, De Smedt D, De Bacquer D, et al. Comorbidities and psychosocial characteristics as determinants of dropout in outpatient cardiac rehabilitation[J]. J Cardiovasc Nurs, 2017, 32(1):14
[3] Eagle K A, Lim M J, Dabbous O H, et al. A validated prediction model for all forms of acute coronary syndrome:estimating the risk of 6-month postdischarge death in an international registry[J].JAMA, 2004, 291(22):2727
[4] Tahto E, Jadric R, Pojskic L, et al. Neutrophil-to-lymphocyte ratio and its relation with markers of inflammation and myocardial necrosis in patients with acute coronary syndrome[J]. Med Arch,2017, 71(5):312
[5] Lotrakul M S. Validity of the Thai Version of the PHQ-9[Z].BMC Psychiatry, 2008:46
[6] Sousa T V, Viveiros V, Chai M V, et al. Reliability and validity of the portuguese version of the generalized anxiety disorder(GAD-7)scale[Z]. Health Qual Life Outcomes, 2015:50
[7]中国康复学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.在心血管科就诊患者的心理处方中国专家共识[J].中华心血管病杂志, 2014,42(1):6
[8] Huffman J C, Celano C M, Januzzi J L. The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes[J]. Neuropsychiatr Dis Treat, 2010, 6:123
[9] Pragle A S, Salahshor S. Identifying and managing depression in patients with coronary artery disease[J]. JAAPA,2018,31(5):12
[10] Farquhar J M, Stonerock G L, Blumenthal J A. Treatment of anxiety in patients with coronary heart disease:a systematic review[J].Psychosomatics, 2018, 59(4):318
[11] Rutledge T, Linke S E, Krantz D S, et al. Comorbid depression and anxiety symptoms as predictors of cardiovascular events:results from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation(WISE)study[J]. Psychosom Med, 2009, 71(9):958
[12] Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease[J]. Arch Gen Psychiatry,2008,65(1):62
[13] Sabatine M S, Morrow D A, Cannon C P, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes:a TACTICS-TIMI 18(treat angina with aggrastat and determine cost of therapy with an invasive or conservative strategy-thrombolysis in myocardial infarction 18 trial)substudy[J]. J Am Coll Cardiol, 2002,40(10):1761
[14] Turak O, Ozcan F, Isleyen A, et al. Usefulness of neutrophil to lymphocyte ratio to predict in-hospital outcomes in infective endocarditis[J]. Eur Heart J, 2013, 34(1):691
[15] Dentali F, Nigro O, Squizzato A, et al. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes:A systematic review and meta-analysis of the literature[J]. Int J Cardiol, 2018, 266:31
[16] Gundogdu Meydaneri G, Meydaneri S. Can neutrophil lymphocyte ratio predict the likelihood of suicide in patients with major depression[J]. Cureus, 2018, 10(4):e2510
[2] Pardaens S, De Smedt D, De Bacquer D, et al. Comorbidities and psychosocial characteristics as determinants of dropout in outpatient cardiac rehabilitation[J]. J Cardiovasc Nurs, 2017, 32(1):14
[3] Eagle K A, Lim M J, Dabbous O H, et al. A validated prediction model for all forms of acute coronary syndrome:estimating the risk of 6-month postdischarge death in an international registry[J].JAMA, 2004, 291(22):2727
[4] Tahto E, Jadric R, Pojskic L, et al. Neutrophil-to-lymphocyte ratio and its relation with markers of inflammation and myocardial necrosis in patients with acute coronary syndrome[J]. Med Arch,2017, 71(5):312
[5] Lotrakul M S. Validity of the Thai Version of the PHQ-9[Z].BMC Psychiatry, 2008:46
[6] Sousa T V, Viveiros V, Chai M V, et al. Reliability and validity of the portuguese version of the generalized anxiety disorder(GAD-7)scale[Z]. Health Qual Life Outcomes, 2015:50
[7]中国康复学会心血管病专业委员会,中国老年学学会心脑血管病专业委员会.在心血管科就诊患者的心理处方中国专家共识[J].中华心血管病杂志, 2014,42(1):6
[8] Huffman J C, Celano C M, Januzzi J L. The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes[J]. Neuropsychiatr Dis Treat, 2010, 6:123
[9] Pragle A S, Salahshor S. Identifying and managing depression in patients with coronary artery disease[J]. JAAPA,2018,31(5):12
[10] Farquhar J M, Stonerock G L, Blumenthal J A. Treatment of anxiety in patients with coronary heart disease:a systematic review[J].Psychosomatics, 2018, 59(4):318
[11] Rutledge T, Linke S E, Krantz D S, et al. Comorbid depression and anxiety symptoms as predictors of cardiovascular events:results from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation(WISE)study[J]. Psychosom Med, 2009, 71(9):958
[12] Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease[J]. Arch Gen Psychiatry,2008,65(1):62
[13] Sabatine M S, Morrow D A, Cannon C P, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes:a TACTICS-TIMI 18(treat angina with aggrastat and determine cost of therapy with an invasive or conservative strategy-thrombolysis in myocardial infarction 18 trial)substudy[J]. J Am Coll Cardiol, 2002,40(10):1761
[14] Turak O, Ozcan F, Isleyen A, et al. Usefulness of neutrophil to lymphocyte ratio to predict in-hospital outcomes in infective endocarditis[J]. Eur Heart J, 2013, 34(1):691
[15] Dentali F, Nigro O, Squizzato A, et al. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes:A systematic review and meta-analysis of the literature[J]. Int J Cardiol, 2018, 266:31
[16] Gundogdu Meydaneri G, Meydaneri S. Can neutrophil lymphocyte ratio predict the likelihood of suicide in patients with major depression[J]. Cureus, 2018, 10(4):e2510