上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (9): 1038-.doi: 10.3969/j.issn.1674-8115.2019.09.016

• 论著·临床研究 • 上一篇    下一篇

冠状动脉造影患者躯体化症状、焦虑及抑郁状况研究

陈柄旭 1，廖嘉愉 1，胡佳宇 1，苏璇 1，姜萌 2，毛家亮 2，卜军 2   

  1. 1.上海交通大学医学院，上海 200025；2.上海交通大学医学院附属仁济医院心内科，上海 200127
  • 出版日期:2019-09-28 发布日期:2019-11-02
  • 通讯作者: 卜军，电子信箱：pujun310@hotmail.com。毛家亮，电子信箱：maojl@aliyun.com。姜萌，电子信箱：jiangmeng0919@163.com。为共同通信作者。
  • 作者简介:陈柄旭 (1994—)，男，硕士生；电子信箱：forvan@foxmail.com。
  • 基金资助:
    国家自然科学基金（81470391）；促进市级医院临床技能与临床创新能力三年行动计划（（（16CR3020A）；上海市教育委员会高峰高原学科建设计划（20172014）；上海市浦东新区卫生健康委员会联合攻关项目（PW2018D-03）

A preliminary study on the association between psychological problems and chest pain in patients undergoing coronary angiography

CHEN Bing-xu1, LIO Ka U1, HU Jia-yu1, SU Xuan1, JIANG Meng2, MAO Jia-liang2, BU Jun2   

  1. 1. Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 2. Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2019-09-28 Published:2019-11-02
  • Supported by:
    National Natural Science Foundation of China, 81470391; Three-year Action Plan to Promote Clinical Skills and Clinical Innovation Capabilities in Municipal Hospitals, Shanghai ShenKang Hospital Development Center, 16CR3020A; Shanghai Municipal Education Commission— Gaofeng Clinical Medicine Support, 20172014；Shanghai Pudong Health Commission Joint Research Project, PW2018D-03）。

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摘要： 目的 ·调查因胸痛而行冠状动脉（冠脉）造影（coronary angiography，CAG）患者的躯体化症状、焦虑及抑郁状态，探讨分析心理障碍对胸痛的影响。方法 ·连续入选 2016年 6月—12月上海交通大学医学院附属仁济医院心内科因胸痛行 CAG患者，共入组 908例。根据 CAG结果分为冠脉阴性组（冠脉血管狭窄 <30%）、冠脉轻中度狭窄组（冠脉血管狭窄≥ 30%且<75%）及冠脉重度狭窄组（冠脉单支或多支血管狭窄≥ 75%），采用躯体化症状自评量表（Self-Rating Somatic Symptom Scale，SSS）、广泛性焦虑障碍量表（Generalized Anxiety Disorder，GAD-7）及患者健康问卷抑郁自评量表（Patient Health Questionnaire，PHQ-9）对患者进行心理测评，比较 3组患者躯体化症状及焦虑抑郁状态的发生率。结果 ·男性患者中，冠脉轻中度狭窄组躯体化症状阳性率高于冠脉重度狭窄组（20.6% vs 18.5%，P0.014），抑郁状态阳性率高于冠脉重度狭窄组（20.6% vs 10.6%，P0.008），焦虑状态阳性率高于冠脉重度狭窄组（13.4% vs 6.6%，P0.028）。女性患者中，冠脉轻中度狭窄组躯体化症状阳性率高于冠脉重度狭窄组（57.6% vs 39.4%， P0.008）。结论 ·冠脉轻中度狭窄患者的躯体化症状阳性率高于冠脉重度狭窄患者，其胸痛症状可能与心理障碍有关。对这类患者进行早期的心理干预可缓解患者胸痛症状，减少不必要的医疗资源浪费。

关键词: 胸痛, 冠状动脉造影, 躯体化症状, 焦虑状态, 抑郁状态

Abstract:

Objective · To explore the role of psychological problems of somatization, anxiety, and depression in patients presenting chest pain who underwent coronary angiography (CAG). Methods · Altogether, 908 patients with chest pain referred to the cardiology inpatient department were enrolled in the present study. The enrolled patients underwent CAG and coronary angiographic results were classified into negative (<30% diameter stenosis in all vessels), mild to moderate coronary stenosis ( ≥ 30% and <75% diameter stenosis in all vessels) and severe coronary stenosis group ( ≥ 75% diameter stenosis in at least a single vessel). Patients also completed a battery of self-reported inventories before the CAG: the Self-Rating Somatic Symptom Scale (SSS), the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Results · Compared with severe coronary stenosis group, male patients in the mild to moderate coronary stenosis group (n189) seemed to have higher rate of somatization (20.6% vs 18.5%, P0.014), higher rate of depression (20.6% vs 10.6%, P0.008), and higher rate of anxiety (13.4% vs 6.6%, P0.028). Compared with severe coronary stenosis group, female patients in the mild to moderate coronary stenosis group seemed to have higher rate of somatization (57.6% vs 39.4%, P0.008). Conclusion · The positive rate of somatization symptoms in patients with mild to moderate coronary stenosis was higher than that in patients with severe coronary stenosis. These findings suggest that psychological problems may contribute in part to the development of chest pain and other physical symptoms. It is also needed to evaluate the clinical and economic benefits of early psychological interventions, especially in mild to moderate coronary stenosis patients who are presenting chest pain.

Key words: chest pain, coronary angiography, somatization disorder, anxiety, depression

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