应用DCPR评估老年冠心病患者感染SARS-Cov-2后的心身相关障碍

何欢; 孙中华; 翁阳阳; 贾坚; 曲晨

doi:10.16766/j.cnki.issn.1674-4152.003445

应用DCPR评估老年冠心病患者感染SARS-Cov-2后的心身相关障碍

doi: 10.16766/j.cnki.issn.1674-4152.003445

何欢¹,
孙中华¹,
翁阳阳¹,
贾坚²,
曲晨^1, ,

1.
南京医科大学第二附属医院老年医学科，江苏南京 210000
2.
江苏省人民医院全科医学科，江苏南京 210000

基金项目:

江苏省老年医学临床技术应用研究项目 LR2021005

详细信息

通讯作者:
曲晨，E-mail: quchen@njmu.edu.cn

中图分类号: R541.4
计量
- 文章访问数: 109
- HTML全文浏览量: 36
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-16
- 网络出版日期: 2024-05-29

DCPR was used to assess psychosomatic disorders after SARS-Cov-2 in elderly patients with coronary heart disease

1.
Department of Geriatrics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, China

摘要

摘要: 目的为改善老年冠心病患者的生活质量提供个性化的干预措施，采用心身研究的诊断标准(DCPR)评估老年冠心病患者在感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)后产生的心身相关障碍程度。方法采用简单随机抽样的方法，选取南京医科大学第二附属医院2022年9月—2023年6月收治的101例老年冠心病患者作为研究对象，根据是否感染SARS-CoV-2分组，分为感染组(69例)和未感染组(32例)。采用DCPR量表评估患者目前的心身状态，并使用成组t检验、Wilcoxon秩和检验、χ²检验和logistic回归分析等统计学方法进行分析。结果感染组更容易产生抑郁情绪[轻度抑郁：27(39.10%) vs. 5(15.60%)；中重度抑郁：9(13.10%) vs. 1(3.10%)]和心身症状[37(53.60%) vs. 25(78.10%)，χ²=5.537，P＜0.05]；2组幸福感总分、睡眠困扰总分、心理困扰总分、异常疾病行为总分比较差异均有统计学意义(P＜0.05)。结论感染SARS-CoV-2是老年冠心病患者产生心身相关障碍的影响因素之一，利用DCPR可以更全面地评估并有助于及时提出合理、具有针对性的干预措施。
- 老年人 /
- 冠心病 /
- 严重急性呼吸综合征冠状病毒2 /
- 心身相关障碍 /
- 量表评估
Abstract: Objective To provide individualized interventions aimed at improving the quality of life of elderly patients, the diagnostic criteria for psychosomatic research (DCPR) was used to evaluate the psychosomatic related disorders in elderly patients with coronary atherosclerotic heart disease after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods Using random sampling, 101 elderly patients with coronary heart disease admitted to the Second Affiliated Hospital of Nanjing Medical University from September 2022 to June 2023 were selected as the research subjects. According to whether they were infected with SARS-CoV-2, 69 cases were in the infected group and 32 cases were in the uninfected group. The DCPR scale was used to evaluate the current psychosomatic status of the patients, and statistical methods such as group t-test, Wilcoxon rank-sum test, χ² test, and logistic regression analysis were used to analyze the impact of psychosomatic symptoms on the elderly patients with coronary heart disease after infection with COVID-19. Results The infected group was more likely to develop depressed moods [Mild depression: 27 (39.10%) vs. 5 (15.60%); Moderate to severe depression: 9 (13.10%) vs. 1 (3.10%)]and psychosomatic symptoms [(37 (53.60%) vs. 25 (78.10%), χ²=5.537, P < 0.05]. The differences in the scores of happiness total score, sleep disturbance, psychological distress, and abnormal disorder behavior between the two groups were all statistically significant(P < 0.05). Conclusion Infection with SARS-CoV-2 is one of the influencing factors of psychosomatic disorders in elderly patients with coronary heart disease, DCPR can make a more comprehensive assessment and help to propose reasonable and targeted interventions in time.
- The aged /
- Coronary heart disease /
- Severe acute respiratory syndrome coronavirus-2 /
- Psychosomatic disorders /
- Scale evaluation

HTML全文

图 1 感染SARS-CoV-2预测老年冠心病患者产生心身相关障碍的ROC曲线

Figure 1. ROC curve of SARS-CoV-2 infection predicting psychosomatic disorders in elderly patients with coronary heart disease

下载: 全尺寸图片幻灯片

表 1 2组老年冠心病患者基本资料及心身相关障碍各量表比较

Table 1. Comparison of basic situation and various scales of psychosomatic disorders in 2 two groups of elderly patients with coronary heart disease

项目	类别	未感染组(n=32)	感染组(n=69)	统计量	P值
年龄(x±s，岁)		73.28±9.48	71.20±9.53	1.021^a	0.310
性别[例(%)]	男性	15(46.88)	31(44.93)	0.033^b	0.855
	女性	17(53.12)	38(55.07)
婚姻状况[例(%)]	已婚	32(100.00)	63(91.30)	1.607^b	0.205
	未婚、丧偶或离异	0	6(8.70)
职业[例(%)]	退休	25(78.10)	59(85.50)	0.851^b	0.356
	在职	7(21.90)	10(14.50)
文化程度[例(%)]	文盲	2(6.30)	2(2.90)	-0.595^c	0.552
	小学	1(3.10)	9(13.00)
	初中	5(15.60)	12(17.40)
	高中(包括职高和中专)	18(56.30)	33(47.80)
	本科(包括大专和高职)	6(18.80)	13(18.80)
GAD-7[例(%)]	正常	31(96.90)	56(81.20)	-2.147^c	0.032
	轻度焦虑	1(3.10)	7(10.10)
	中度焦虑	0	0
	中重度焦虑	0	6(8.70)
	重度焦虑	0	0
PHQ-9[例(%)]	正常	26(81.30)	33(47.80)	-3.149^c	0.002
	轻度抑郁	5(15.60)	27(39.10)
	中度抑郁	0	0
	中重度抑郁	1(3.10)	9(13.10)
	重度抑郁	0	0
PSSS[例(%)]	正常	7(21.90)	32(46.40)	5.537^b	0.019
	存在心身相关障碍	25(78.10)	37(53.60)
PSI[M(P₂₅, P₇₅)，分]	压力总分	0.00(0.00，1.00)	0.00(0.00，1.00)	-0.700^c	0.484
	幸福感总分	6.00(6.00，6.00)	6.00(5.00，6.00)	-2.233^c	0.026
	睡眠困扰总分	2.00(0.25，3.75)	3.00(1.00，5.00)	-2.251^c	0.024
	心理困扰总分	4.00(2.00，5.00)	6.00(4.00，10.00)	-3.928^c	＜0.001
	异常的疾病行为总分	0.00(0.00，0.00)	0.00(0.00，2.00)	-2.622^c	0.009
	生活质量总分	3.00(2.25，4.00)	3.00(2.50，3.00)	-1.089^c	0.276
	总体幸福评分	9.00(8.00，10.00)	8.00(8.00，9.00)	-1.900^c	0.057
注：^a为t值，^b为χ²值，^c为Z值。

下载: 导出CSV

表 2 因变量赋值情况

Table 2. Assignment of the dependent variable

因变量	赋值方法
GAD-7	正常=0，轻度焦虑=1，中度焦虑=2，中重度焦虑=3，重度焦虑=4
PHQ-9	正常=0，轻度抑郁=1，中度抑郁=2，中重度抑郁=3，重度抑郁=4
PSSS	正常=0，存在心身相关障碍=1

下载: 导出CSV

表 3 是否感染SARS-CoV-2对老年冠心病患者产生心身相关障碍的logistic回归分析

Table 3. Logistic regression analysis of psychosomatic disorders in elderly patients with coronary heart disease caused by SARS-CoV-2 infection

因变量	B	SE	Waldχ²	P值	OR值	95% CI
GAD-7	-1.993	1.067	3.490	0.062	0.136	0.017~1.103
PHQ-9	-1.552	0.510	9.279	0.002	0.212	0.078~0.575
PSSS	1.128	0.491	5.275	0.022	3.089	1.180~8.087

下载: 导出CSV

参考文献(20)

[1]	CHEN Y, KLEIN S L, GARIBALDI B T, et al. Aging in COVID-19: vulnerability, immunity and intervention[J]. Ageing Res Rev, 2021, 65: 101205. DOI: 10.1016/j.arr.2020.101205.
[2]	NAPOLI C, TRITTO I, BENINCASA G, et al. Cardiovascular involvement during COVID-19 and clinical implications in elderly patients[J]. Ann Med Surg (Lond), 2020, 57: 236-243. DOI: 10.1016/j.amsu.2020.07.054.
[3]	刘洋, 王新芳, 吴京凤, 等. 老年综合评估对高龄冠心病合并焦虑患者生活质量的影响[J]. 中国社区医师, 2022, 38(25): 145-147. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202225049.htm LIU Y, WANG X F, WU J F, et al. Effect of geriatric comprehensive assessment on the quality of life of elderly patients with coronary heart disease complicated with anxiety[J]. Chinese Community Doctors, 2022, 38(25): 145-147. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202225049.htm
[4]	包海童, 谈萍, 俞沛文, 等. 基于老年综合评估的2型糖尿病病人衰弱影响因素分析[J]. 实用老年医学, 2022, 36(12): 1264-1268. doi: 10.3969/j.issn.1003-9198.2022.12.019 BAO H T, TAN P, YU P W, et al. Analysis of influencing factors of frailty in patients with type 2 diabetes mellitus based on comprehensive assessment of geriatrics[J]. Practical Geriatrics, 2022, 36(12): 1264-1268. doi: 10.3969/j.issn.1003-9198.2022.12.019
[5]	王小娇, 王宁, 崔宏, 等. 应用老年综合评估技术分析老年脑卒中恢复期病人营养状态的影响因素[J]. 实用老年医学, 2022, 36(8): 809-812. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA202208014.htm WANG X J, WANG N, CUI H, et al. The comprehensive geriatric assessment technique was used to analyze the influencing factors of nutritional status of elderly patients recovering from stroke[J]. Practical Geriatrics, 2022, 36(8): 809-812. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA202208014.htm
[6]	FAVA G A, SONINO N. The clinical domains of psychosomatic medicine[J]. J Clin Psychiatry, 2005, 66(7): 849-858. doi: 10.4088/JCP.v66n0707
[7]	SPITZER R L, KROENKE K, WILLIAMS J B, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7[J]. Arch Intern Med, 2006, 166(10): 1092-1097. doi: 10.1001/archinte.166.10.1092
[8]	KROENKE K, SPITZER R L, WILLIAMS J B. The PHQ-9: validity of a brief depression severity measure[J]. J Gen Intern Med, 2001, 16(9): 606-613. doi: 10.1046/j.1525-1497.2001.016009606.x
[9]	LI L, PENG T, LIU R, et al. Development of the psychosomatic symptom scale (PSSS) and assessment of its reliability and validity in general hospital patients in China[J]. Gen Hosp Psychiatry, 2020, 64: 1-8. doi: 10.1016/j.genhosppsych.2020.01.008
[10]	PIOLANTI A, OFFIDANI E, GUIDI J, et al. Use of the Psychosocial Index: a sensitive tool in research and practice[J]. Psychother Psychosom, 2016, 85(6): 337-345. doi: 10.1159/000447760
[11]	LEE K, JEONG G C, YIM J. Consideration of the psychological and mental health of the elderly during COVID-19: a theoretical review[J]. Int J Environ Res Public Health, 2020, 17(21): 8098. DOI: 10.3390/ijerph17218098.
[12]	HAN Q, ZHENG B, DAINES L, et al. Long-term sequelae of COVID-19: a systematic review and meta-analysis of one-year follow-up studies on post-COVID symptoms[J]. Pathogens, 2022, 11(2): 269. DOI: 10.3390/pathogens11020269.
[13]	苗连海, 陈继群, 朱德发, 等. 老年综合评估模式对老年冠心病患者的临床疗效[J]. 中国慢性病预防与控制, 2022, 30(3): 218-220. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202203013.htm MIAO L H, CHEN J Q, ZHU D F, et al. Clinical efficacy of geriatric comprehensive assessment model in elderly patients with coronary heart disease[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2022, 30(3): 218-220. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202203013.htm
[14]	PARLAPANI E, HOLEVA V, NIKOPOULOU V A, et al. A review on the COVID-19-related psychological impact on older adults: vulnerable or not?[J]. Aging Clin Exp Res, 2021, 33(6): 1729-1743. doi: 10.1007/s40520-021-01873-4
[15]	SAYINKASAR K, KARAMAN E. Life in lockdown: Social isolation, loneliness and quality of life in the elderly during the COVID-19 pandemic: a scoping review[J]. Geriatr Nurs, 2021, 42(5): 1222-1229. doi: 10.1016/j.gerinurse.2021.03.010
[16]	LEE Y, LUI L M W, CHEN L D, et al. Government response moderates the mental health impact of COVID-19: a systematic review and meta-analysis of depression outcomes across countries[J]. J Affect Disord, 2021, 290: 364-377. doi: 10.1016/j.jad.2021.04.050
[17]	ARMITAGE R, NELLUMS L B. COVID-19 and the consequences of isolating the elderly[J]. Lancet Public Health, 2020, 5(5): e256. DOI: 10.1016/S2468-2667(20)30061-X.
[18]	SEPÚLVEDA-LOYOLA W, RODRÍGUEZ-SÁNCHEZ I, PÉREZ-RODRÍGUEZ P, et al. Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations[J]. J Nutr Health Aging, 2020, 24(9): 938-947. doi: 10.1007/s12603-020-1500-7
[19]	IZQUIERDO M, MERCHANT R A, MORLEY J E, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines[J]. J Nutr Health Aging, 2021, 25(7): 824-853.
[20]	姚元龙, 史威力, 冯娴, 等. 老年共病的研究管理策略[J]. 中华全科医学, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574 YAO Y L, SHI W L, FENG X, et al. Research management strategies for multimorbidity in elderly patients[J]. Chinese Journal of General Practice, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574