急性心肌梗死患者与冠状动脉造影阴性患者躯体化症状、焦虑及抑郁状态的调查分析

目的调查分析急性心肌梗死患者与冠状动脉(冠脉)造影阴性患者躯体化症状、焦虑及抑郁状态。方法连续调查2016年6月至12月于上海市某三甲医院心内科住院行冠脉造影患者1353例,选取冠脉造影结果阴性者为冠脉阴性组(676例),同期选取急性心肌梗死(AMI)患者为心梗组(150例)。采用躯体化症状自评量表(SSS)、广泛性焦虑障碍量表(GAD-7)及患者健康问卷抑郁自评量表(PHQ-9)对患者进行心理测评,比较心梗组及冠脉造影阴性组躯体化症状及焦虑抑郁状态的患病情况。结果与急性心梗组相比,冠脉阴性组躯体化症状阳性率高(32.8%vs.22.7%,P=0.014),躯体化症状量表分值高(32.7±8.45 vs.30.29±8.03,P=0.0015);冠脉造影阴性患者焦虑状态阳性率高于AMI患者(18.3%vs.9.3%,P=0.0074);冠脉造影阴性患者抑郁及焦虑评分分值高于AMI患者(P<0.05);冠脉造影阴性患者非特异性躯体化症状均高于AMI(P<0.05)。结论冠脉造影阴性患者的躯体化症状及焦虑状态的阳性率高于AMI患者,特别是对于伴非特异躯体症状的冠脉造影阴性患者,及早识别此类患者的躯体化症状可能对临床上进一步治疗提供帮助。

Investigation and analysis of somatic symptoms disorder,anxiety and depression in patients with acute myocardial infarction and patients with negative coronary angiography

Objective To investigate and analyze somatic symptom disorder,anxiety and depression in patients with acute myocardial infarction and normal coronary angiography.Methods A total of 1353 patients undergoing coronary angiography(CAG)in the Department of Cardiology of a tertiary hospital in Shanghai from June to December in 2016 were continuously investigated.Based on the results of coronary angiography,we selected 676 patients with negative coronary angiography(stenosis of main coronary arteries and their branches<50%)as the coronary negative group.Meanwhile,150 patients diagnosed with acute myocardial infarction(AMI)patients(acute myocardial injury and evidence of myocardial ischemia)were selected as AMI group.Self-Rating Somatic Symptom Scale(SSS),Generalized Anxiety Disorder(GAD-7)and The Patient Health Questionnaire-9(PHQ-9)were used.Psychological evaluation was performed on patients to compare the prevalence of somatic symptom disorder,anxiety,and depression between the AMI group and the coronary negative group.Results The prevalence of somatic symptom disorder in the coronary negative group is higher than that in the AMI group(32.8%vs.22.7%,P=0.014).The prevalence of anxiety status of the coronary negative group is higher than that of the AMI group(18.3%vs.9.3%,P=0.0074).Depression and anxiety scores in the coronary negative group are higher than those in the AMI group(P<0.05).Non-specific somatic symptom disorder such as fatigue,loss of interest,and health excessive concerns in the coronary negative group are worse than those in the AMI group(25.74%vs.16.67%,P=0.0187),(16.62%vs.10.00%,P=0.0479),(11.54%vs.5.30%,P=0.0244),respectively.Conclusion The prevalence of somatic symptom disorder and anxiety status in patients with normal coronary angiography is higher than that in patients with acute myocardial infarction,especially in patients with negative coronary angiography with non-specific somatic symptoms.Early identification and treatment of somatic symptom disorder may be benefit for these patients.