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

doi:10.3969/j.issn.1674-8115.2023.09.009

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (9): 1153-1161.doi: 10.3969/j.issn.1674-8115.2023.09.009

• 论著 · 临床研究 • 上一篇

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

卢启帆(), 刘启明, 周红梅, 柴烨子, 姜萌(), 卜军()

上海交通大学医学院附属仁济医院心内科，上海 200127

收稿日期:2023-03-27 接受日期:2023-05-24 出版日期:2023-09-28 发布日期:2023-09-28
通讯作者: 姜萌,卜军 E-mail:czzx_2012_505@126.com;jiangmeng0919@163.com;pujun310@hotmail.com
作者简介:卢启帆（1997—），女，博士生；电子信箱：czzx_2012_505@126.com。
基金资助:
国家自然科学基金(81971570);中华心血管病发展专项基金“心脏健康科研基金”项目(Z-2019-42-1908-2);上海申康医院发展中心临床三年行动计划项目(SHDC2020CR2025B);上海市科学技术委员会优秀技术带头人计划(21XD143210);上海市科学技术委员会医学创新研究专项(20Y11910500);上海市浦东新区卫生和计划生育委员会联合攻关项目(PW2018D-03);上海交通大学“交大之星”计划医工交叉研究基金(YG2019ZDA13);上海交通大学医学院“双百人”项目(20172014)

Effect of somatic symptoms, anxiety and depression on clinical prognosis in patients with chronic heart failure

LU Qifan(), LIU Qiming, ZHOU Hongmei, CHAI Yezi, JIANG Meng(), PU Jun()

Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2023-03-27 Accepted:2023-05-24 Online:2023-09-28 Published:2023-09-28
Contact: JIANG Meng,PU Jun E-mail:czzx_2012_505@126.com;jiangmeng0919@163.com;pujun310@hotmail.com
Supported by:
National Natural Science Foundation of China(81971570);China International Medical Foundation(Z-2019-42-1908-2);Three-year Clinical Research Plan of Shanghai Hospital Development Center(SHDC2020CR2025B);Advanced Technology Leader of Shanghai Science and Technology Committee(21XD143210);Innovation Research Project of Shanghai Science and Technology Commission(20Y11910500);Shanghai Pudong New Area Health Commission Joint Research Project(PW2018D-03);Medical-Engineering Cross Research of Shanghai Jiao Tong University(YG2019ZDA13);“Two-hundred Talents” Program of Shanghai Jiao Tong University School of Medicine(20172014)

摘要/Abstract

摘要：

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。

关键词: 慢性心力衰竭, 躯体化症状, 抑郁, 焦虑

Abstract:

Objective ·To explore the association of somatizatic symptoms, anxiety and depression with clinical prognosis in the patients with chronic heart failure (CHF). Methods ·The patients with CHF who visited the Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 were included. Demographic data and clinical features of the patients were collected. The Self-reported Somatic Symptom Scale of China (SSS-CN), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were used to evaluate the patients′ conditions. Telephone follow-up was conducted at the 12th month after the first visit, and the specific information of the patients′ end-point events (including death, re-hospitalization, causes of death and re-hospitalization) was collected. Survival curve and Cox regression analysis were used to evaluate the clinical prognosis of the patients. Results ·A total of 195 patients were included. The SSS-CN scores in CHF patients were different between the two genders, among the different heart rate groups and the different cardiac function grades of New York Heart Association (NYHA), also between the patients with anxiety/depression or not (all P<0.05). Survival curve analysis showed that overall survival rate of patients in the moderate-severe somatic symptoms group was lower than that of the patients in the normal-mild group (Log rank P=0.020). Cox regression analysis showed that compared with the normal-mild group, the patients in the moderate-severe somatic symptoms group had a higher risk of all-cause death [hazard ratio (HR)=2.797, 95%CI 1.135－6.890]; the CHF patients with depressive symptoms had a higher risk of all-cause death (HR=2.883, 95%CI 1.150－6.984). Compared with the normal-mild group, the patients with moderate-severe somatic symptoms had a higher risk of cardiovascular death (HR=2.784, 95%CI 1.073－7.226). The CHF patients with depressive symptoms had a higher risk of cardiovascular death (HR=2.823, 95%CI 1.087－7.330). There were no statistically differences in anxiety, depression, somatization symptoms and their severity between all-cause hospitalization and hospitalization due to CHF. Conclusion ·The moderate-severe somatic symptoms and depression are the risk factors of all-cause death and cardiovascular death in the patients with CHF.

Key words: chronic heart failure, somatic symptom, depression, anxiety

中图分类号:

R546.1⁺1

卢启帆, 刘启明, 周红梅, 柴烨子, 姜萌, 卜军. 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[J]. 上海交通大学学报（医学版）, 2023, 43(9): 1153-1161.

LU Qifan, LIU Qiming, ZHOU Hongmei, CHAI Yezi, JIANG Meng, PU Jun. Effect of somatic symptoms, anxiety and depression on clinical prognosis in patients with chronic heart failure[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(9): 1153-1161.

图/表 5

参考文献 28

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Item	Participant/n(%)	SSS-CN
Item	Participant/n(%)	Score/point	P value
Gender			0.017
Male	132 (67.69)	32.0 (27.0, 39.0)
Female	63 (32.31)	34.0 (30.0, 42.0)
Age			0.141
<60 years	88 (45.13)	31.0 (26.0, 39.0)
≥60 years	107 (54.87)	34.0 (28.8, 41.1)
Marriage status			0.992
Married	189 (96.92)	32.5 (28.5, 46.0)
Not married	4 (2.05)	33.0 (28.5, 40.0)
Divorced	2 (1.03)	36.5 (33.0, 37.5)
Job			0.401
Retired or unemployment	121 (62.05)	34.0 (29.0, 41.0)
In service	74 (37.95)	32.5 (27.5, 38.5)
Education			0.881
Middle school and below	68 (34.87)	33.5 (28.4, 40.1)
High school	63 (32.31)	33.5 (29.0, 40.2)
College	59 (30.26)	29.5 (25.6, 36.2)
Master and above	5 (2.56)	33.0 (28.0, 40.0)
PHQ-9			0.000
>4 points	51 (26.15)	41.0 (36.0, 49.0)
≤4 points	144 (83.75)	30.0 (26.0, 36.0)
GAD-7			0.000
>4 points	34 (17.43)	41.0 (37.9, 41.5)
≤4 points	161 (82.57)	31.0 (27.0, 37.0)
NYHA classification			0.013
Ⅰ－Ⅱ	144 (73.85)	30.0 (26.0, 37.0)
Ⅲ－Ⅳ	51 (26.15)	37.0 (30.5, 45.5)
Heart rate			0.016
<68 bpm	51 (26.15)	36.0 (30.0, 45.3)
≥68 and <75 bpm	42 (21.54)	28.0 (26.0, 32.8)
≥75 and <81 bpm	53 (27.18)	31.0 (27.0, 37.0)
≥81 bpm	49 (25.13)	33.0 (29.0, 42.0)
Blood pressure			0.710
SBP>140 mmHg or DBP>90 mmHg	44 (22.56)	32.5 (28.0, 40.0)
SBP≤140 mmHg and DBP≤90 mmHg	151 (77.44)	33.0 (28.2, 40.8)
BMI			0.902
≥25 kg·m^-2	57 (29.23)	31.5 (27.2, 38.8)
<25 kg·m^-2	138 (70.77)	32.0 (27.0, 41.0)
LVEF			0.674
≤40%	84 (43.08)	31.0 (28.0, 38.0)
40%<LVEF<50%	52 (26.67)	33.0 (29.0, 41.8)
≥50%	59 (30.25)	34.0 (26.0, 40.0)

Item	Participant/n(%)	SSS-CN
Item	Participant/n(%)	Score/point	P value
Gender			0.017
Male	132 (67.69)	32.0 (27.0, 39.0)
Female	63 (32.31)	34.0 (30.0, 42.0)
Age			0.141
<60 years	88 (45.13)	31.0 (26.0, 39.0)
≥60 years	107 (54.87)	34.0 (28.8, 41.1)
Marriage status			0.992
Married	189 (96.92)	32.5 (28.5, 46.0)
Not married	4 (2.05)	33.0 (28.5, 40.0)
Divorced	2 (1.03)	36.5 (33.0, 37.5)
Job			0.401
Retired or unemployment	121 (62.05)	34.0 (29.0, 41.0)
In service	74 (37.95)	32.5 (27.5, 38.5)
Education			0.881
Middle school and below	68 (34.87)	33.5 (28.4, 40.1)
High school	63 (32.31)	33.5 (29.0, 40.2)
College	59 (30.26)	29.5 (25.6, 36.2)
Master and above	5 (2.56)	33.0 (28.0, 40.0)
PHQ-9			0.000
>4 points	51 (26.15)	41.0 (36.0, 49.0)
≤4 points	144 (83.75)	30.0 (26.0, 36.0)
GAD-7			0.000
>4 points	34 (17.43)	41.0 (37.9, 41.5)
≤4 points	161 (82.57)	31.0 (27.0, 37.0)
NYHA classification			0.013
Ⅰ－Ⅱ	144 (73.85)	30.0 (26.0, 37.0)
Ⅲ－Ⅳ	51 (26.15)	37.0 (30.5, 45.5)
Heart rate			0.016
<68 bpm	51 (26.15)	36.0 (30.0, 45.3)
≥68 and <75 bpm	42 (21.54)	28.0 (26.0, 32.8)
≥75 and <81 bpm	53 (27.18)	31.0 (27.0, 37.0)
≥81 bpm	49 (25.13)	33.0 (29.0, 42.0)
Blood pressure			0.710
SBP>140 mmHg or DBP>90 mmHg	44 (22.56)	32.5 (28.0, 40.0)
SBP≤140 mmHg and DBP≤90 mmHg	151 (77.44)	33.0 (28.2, 40.8)
BMI			0.902
≥25 kg·m^-2	57 (29.23)	31.5 (27.2, 38.8)
<25 kg·m^-2	138 (70.77)	32.0 (27.0, 41.0)
LVEF			0.674
≤40%	84 (43.08)	31.0 (28.0, 38.0)
40%<LVEF<50%	52 (26.67)	33.0 (29.0, 41.8)
≥50%	59 (30.25)	34.0 (26.0, 40.0)

Item	All-cause hospitalization			Heart failure induced hospitalization
Item	None (n=174)	Yes (n=21)	P value	None (n=187)	Yes (n=8)	P value
Gender/n(%)			0.915			0.139
Female	56 (32.18)	7 (33.33)		58 (31.02)	5 (62.50)
Male	118 (67.82)	14 (66.67)		129 (68.98)	3 (37.50)
Age/year	57.0±14.4	65.8±14.6	0.000	57.5±14.4	68.1±16.5	0.043
SSS-CN/n(%)			0.589			0.874
≤29 points	60 (34.48)	6 (28.57)		64 (34.22)	2 (25.00)
>29 points	114 (65.52)	15 (71.43)		123 (65.78)	6 (75.00)
SSS-CN/n(%)			0.428			0.738
≤39 points	130 (74.71)	14 (66.67)		139 (74.33)	5 (62.50)
>39 points	44 (25.29)	7 (33.33)		48 (25.67)	3 (37.50)
PHQ-9/n(%)			0.240			0.247
>4 points	131 (75.29)	13 (61.90)		140 (74.87)	4 (50.00)
≤4 points	43 (24.71)	8 (38.10)		47 (25.13)	4 (50.00)
GAD-7/n(%)			0.965			0.957
>4 points	139 (79.89)	18 (85.71)		150 (80.21)	7 (87.50)
≤4 points	35 (20.11)	3 (14.29)		37 (19.79)	1 (12.50)
NYHA classification/n(%)			0.037			0.039
Ⅰ－Ⅱ	133 (76.4)	11 (52.63)		141 (75.41)	3 (37.50)
Ⅲ－Ⅳ	41 (23.5)	10 (47.37)		46 (24.59)	5 (62.50)
Heart rate/bpm	76.1±12.0	76.4±12.4	0.562	76.4±12.1	72.4±10.2	0.365
SBP/mmHg	127.06±19.11	127.39±19.81	0.606	127.23±19.47	124.25±12.19	0.670
DBP/mmHg	79.38±13.23	80.18±13.17	0.073	79.89±13.13	71.00±12.80	0.065
Height/cm	168.62±8.09	168.19±8.42	0.843	168.63±7.97	167.57±10.61	0.740
Weight/kg	72.38±16.61	66.31±11.35	0.163	72.17±16.21	61.71±9.88	0.096
BMI/(kg·m^-2)	25.36±4.99	23.31±2.63	0.112	25.28±4.83	21.86±1.80	0.066
TNI/(ng·mL^-1)	0.03 (0.01, 0.16)	0.01 (0.01, 0.03)	0.174	0.04 (0, 0.07)	0.04 (0, 0.07)	0.750
BNP/(pg·mL^-1)	214.0 (100.0, 573.5)	225.5 (49.0, 510.7)	0.736	205.0 (49.0, 491.0)	508.0 (241.0, 980.0)	0.467
LVEF/n(%)			0.531			0.195
≤40%	71 (40.80)	13 (61.90)		79 (42.25)	5 (62.50)
40%<LVEF<50%	47 (27.01)	5 (23.81)		50 (26.73)	2 (25.00)
≥50%	56 (32.19)	3 (14.29)		58 (31.02)	1 (12.50)

Item	All-cause hospitalization			Heart failure induced hospitalization
Item	None (n=174)	Yes (n=21)	P value	None (n=187)	Yes (n=8)	P value
Gender/n(%)			0.915			0.139
Female	56 (32.18)	7 (33.33)		58 (31.02)	5 (62.50)
Male	118 (67.82)	14 (66.67)		129 (68.98)	3 (37.50)
Age/year	57.0±14.4	65.8±14.6	0.000	57.5±14.4	68.1±16.5	0.043
SSS-CN/n(%)			0.589			0.874
≤29 points	60 (34.48)	6 (28.57)		64 (34.22)	2 (25.00)
>29 points	114 (65.52)	15 (71.43)		123 (65.78)	6 (75.00)
SSS-CN/n(%)			0.428			0.738
≤39 points	130 (74.71)	14 (66.67)		139 (74.33)	5 (62.50)
>39 points	44 (25.29)	7 (33.33)		48 (25.67)	3 (37.50)
PHQ-9/n(%)			0.240			0.247
>4 points	131 (75.29)	13 (61.90)		140 (74.87)	4 (50.00)
≤4 points	43 (24.71)	8 (38.10)		47 (25.13)	4 (50.00)
GAD-7/n(%)			0.965			0.957
>4 points	139 (79.89)	18 (85.71)		150 (80.21)	7 (87.50)
≤4 points	35 (20.11)	3 (14.29)		37 (19.79)	1 (12.50)
NYHA classification/n(%)			0.037			0.039
Ⅰ－Ⅱ	133 (76.4)	11 (52.63)		141 (75.41)	3 (37.50)
Ⅲ－Ⅳ	41 (23.5)	10 (47.37)		46 (24.59)	5 (62.50)
Heart rate/bpm	76.1±12.0	76.4±12.4	0.562	76.4±12.1	72.4±10.2	0.365
SBP/mmHg	127.06±19.11	127.39±19.81	0.606	127.23±19.47	124.25±12.19	0.670
DBP/mmHg	79.38±13.23	80.18±13.17	0.073	79.89±13.13	71.00±12.80	0.065
Height/cm	168.62±8.09	168.19±8.42	0.843	168.63±7.97	167.57±10.61	0.740
Weight/kg	72.38±16.61	66.31±11.35	0.163	72.17±16.21	61.71±9.88	0.096
BMI/(kg·m^-2)	25.36±4.99	23.31±2.63	0.112	25.28±4.83	21.86±1.80	0.066
TNI/(ng·mL^-1)	0.03 (0.01, 0.16)	0.01 (0.01, 0.03)	0.174	0.04 (0, 0.07)	0.04 (0, 0.07)	0.750
BNP/(pg·mL^-1)	214.0 (100.0, 573.5)	225.5 (49.0, 510.7)	0.736	205.0 (49.0, 491.0)	508.0 (241.0, 980.0)	0.467
LVEF/n(%)			0.531			0.195
≤40%	71 (40.80)	13 (61.90)		79 (42.25)	5 (62.50)
40%<LVEF<50%	47 (27.01)	5 (23.81)		50 (26.73)	2 (25.00)
≥50%	56 (32.19)	3 (14.29)		58 (31.02)	1 (12.50)

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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

Effect of somatic symptoms, anxiety and depression on clinical prognosis in patients with chronic heart failure

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