[A clinical study of mental stress-induced myocardial ischemia in patients with stable coronary artery disease and depression/anxiety].

Objectives: Exploring the association between depression/anxiety and mental stress-induced myocardial ischemia (MSIMI) in patients with stable coronary artery disease (CAD). Methods: A total of 178 subjects was enrolled according to the inclusion and exclusion criterion with 88 men and 90 women at age of (54±12)years. The subjects were divided into four groups including CAD with depression/anxiety, CAD without depression/anxiety, depression/anxiety without CAD, and control group based on the state of coronary artery, the scores of Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) . MSIMI was diagnosed by echocardiography. Data were analyzed by SPSS19.0. Results: The incidence of MSIMI in all CAD patients was 17.24%. Within each group, 35.00% patients were MSIMI in CAD with depression/anxiety, 2.13% were in CAD without depression/anxiety, 14.29% were in depression/anxiety without CAD, and 2.38% were in control group. The risks of MSIMI in depression/anxiety without CAD and with CAD groups were 6.83 (P>0.05) and 22.08 times (P<0.05) higher than that in control group, respectively. Logistic regression showed that a 1-point increment in the GAD-7 score, but not PHQ-9 score [OR=0.95, 95% CI (0.77-1.17), P=0.63], was associated with 1.22-fold increase in the likehood of MSIMI [95% CI (1.07-1.38), P=0.00]. Conclusions: The MSIMI rate is much higher in patients with CAD comorbid depression/anxiety compared with CAD without depression/anxiety. Anxiety, but not depression, is an independent risk factor of MSIMI in CAD patients.目的： 探索抑郁焦虑状态与稳定性冠心病患者精神压力诱发心肌缺血（MSIMI）的关系。 方法： 根据纳排标准纳入178例门诊/住院患者，男88例，女90例，年龄（54±12）岁。根据患者冠状动脉（冠脉）情况及PHQ-9（Patient Health Questionnaire 9-item）、GAD-7（Generalized Anxiety Disorder 7-item）评分分为冠心病抑郁焦虑组、冠心病无抑郁焦虑组、非冠心病抑郁焦虑组，正常组4组。通过心脏超声检查评估患者在精神压力测试前后心功能的变化，判断MSIMI的发生情况。用SPSS19.0对数据进行统计分析。 结果： 冠心病患者MSIMI发生率为17.24%，冠心病抑郁焦虑组MSIMI发生率为35.00%，冠心病无抑郁焦虑组MSIMI发生率为2.13%，非冠心病抑郁焦虑组MSIMI发生率为14.29%，正常组发生率为2.38%。非冠心病抑郁焦虑组MSIMI的发生风险为正常组的6.83倍（P>0.05），冠心病抑郁焦虑组MSIMI的发生风险为正常组的22.08倍（P<0.05）。多因素logistic回归分析显示，调整性别、年龄等因素后，GAD-7评分毎增加1分，冠心病患者MSIMI的发生风险增加1.22倍[95%CI(1.07~1.38), P=0.00]，PHQ-9评分增加均没有增加冠心病患者MSIMI的发生风险[OR=0.95, 95%CI(0.77~1.17), P=0.63]。 结论： 冠心病合并抑郁焦虑患者的MSIMI发生率明显高于冠心病无焦虑抑郁患者，焦虑是冠心病患者MSIMI发生的危险因素；尚不能认为抑郁是冠心病患者MSIMI发生的危险因素。.