抑郁与慢性缺血性心力衰竭患者心室重构相关性分析-correlation between depression and ventricular remodeling in patients with chronic ischemic heart failure.docxVIP

抑郁与慢性缺血性心力衰竭患者心室重构相关性研究硕士研究生王勇导师耿庆山摘要目的比较单纯慢性缺血性心衰患者、抑郁慢性缺血性心衰患者心室重构程度，探讨抑郁与慢性缺血性心力衰竭患者心室重构的相关性。方法选取2010年1月-2010年9月广东省心血管病研究所心内科符合慢性缺血性心力衰竭、纽约心脏协会心功能Ⅰ～Ⅲ级住院患者117名，根据抑郁自评量表(SDS)标准分，分为单纯心衰组（80名）、抑郁心衰组（37名）。采用经胸心脏超声，测量以下指标：左室舒张末期心室内径指数（LVEDDI）、左室收缩末期心室内径指数（LVSDDI）、相对室壁厚度（RWT）、左室质量指数（LVMI）、左室射血分数（EF）,以LVEDDI为主要研究指标。两组间心室重构指标比较，确定抑郁单变量相关心室重构指标，并对抑郁单变量相关心室重构指标进行逐步多元线性回归分析，从而确定抑郁是否是该指标的独立相关因素。结果1.慢性缺血性性心力衰竭患者抑郁患病率为31.62%（95%CI23.19%～50.05%）。2.单纯心衰组、抑郁心衰组两组间比较，LVEDDI具有显著统计学意义差异，p=0.011；LVSDD、RWT、LVMI、EF值两组间无显著统计学差异，p=0.075、0.968、0.067、0.209。3．LVEDDI独立相关性分析，空腹血糖、总胆固醇、脑钠肽与LVEDDI独立相关，Beta=-0.2111、0.238、0.232，p=0.046、0025、0.029;未发现抑郁与LVEDDI具有显著统计学意义独立相关性。结论慢性缺血性心力衰竭患者抑郁发病率高于普通人群；抑郁慢性缺血性心力衰竭患者LVEDDI较无抑郁患者高，但未发现抑郁与LVEDDI之间存在独立相关性。关键词：抑郁；缺血性心力衰竭，慢性；心室重构RelationshipofDepressiontoVentricularRemodinginPatientswithChronicIschemicHeartFailurePostgraduateYongWangSupervisorQing-shanGengABSTRACTObjective:TocomparethemagnitudeofventricularremodingbetweenChronicIschemicHeartFailure(CIHF)-onlygroupandCIHFpulsdepressiongroup,anddeterminetherelationshipofdepressiontoventricularremodinginpatientswithchronicischemicheartfailure.Methods:Wescreened117patientswithCIHF,havingNewYorkHeartAssociationClassⅠ～Ⅲ,admittedbetweenJanuary2010andSeptember2010,tothevasculocardiologydepartmentofGuangdongprovincialcardiovasculardiseaseinstitute.ThepatientsweredividedintoCIHF-onlygroup(n=80)anddepressionpulsCIHFgroup(n=37)accordingtothestanardsoreontheSelf-RatingDepressionScale,thecutpointwas≥53.TransthoracicEchocardiographicassessmentsofleftventricularend-diastolicdimensionindex(LVEDDI),end-systolicdimensionindex(LVESDI),relativewallthickness(LVRWT),massindex(LVMI),ejectionfraction(LVEF)wereperformedin117patients.leftventricularend-diastolicdimensionindexwastheprimaryendpoint.Echocardiographiccharacteriticsbetweentwogroupswerecomparedtodeterminethecharacteriticscorrelatedwithdepression.Stepwisemultiplelinearregressionanalysiswasusedtoconfirmewhetherdepressionwasdependentlyassociatedwiththeechocardiographiccharacte