冠心病与精神心理疾病的相关性与研究现状

黄万众; 苏强

doi:10.16766/j.cnki.issn.1674-4152.003602

冠心病与精神心理疾病的相关性与研究现状

doi: 10.16766/j.cnki.issn.1674-4152.003602

黄万众,
苏强^,

广西壮族自治区江滨医院心血管内科，广西南宁 530021

基金项目:

国家自然科学基金项目 82260072

广西自然科学基金杰出青年科学基金项目 2020GXNSFFA297002

详细信息

通讯作者:
苏强，E-mail：drsuqiang@163.com

中图分类号: R541.4 R749.92
计量
- 文章访问数: 28
- HTML全文浏览量: 8
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-27
- 网络出版日期: 2024-09-05

The correlation and research status of coronary heart disease and psychiatric disorders: a literature review

HUANG Wanzhong,
SU Qiang^,

Department of Cardiovascular Medicine, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China

摘要

摘要: 《中国心血管健康与疾病报告2022概要》报道，我国冠心病据推测患病人数1 139万人，而且还呈现上升趋势。心理因素如焦虑、抑郁等与心脏健康密切相关，急性冠状动脉综合征(ACS)合并焦虑或抑郁的患者1年内非致死性心肌梗死和再住院风险分别增加约2倍和5倍，冠心病患者合并焦虑抑郁的概率最高≥80%，心理疾病对冠心病等心血管疾病的发展和预后产生重要影响，两者共病是影响我国居民健康的重大公共卫生问题。本文回顾了心理心脏病学的历史及中国心理心脏病学的发展，从双心医学的提出到相关专家共识的发布，强调了心理因素在中国心血管疾病防治中的地位和作用。结合最新研究对心理心脏病学的研究现状进行了梳理，涉及风险因素评估、遗传及生物学指标、疾病识别与筛查、药物治疗以及跨学科合作等方面的内容，对证据相对充分的干预方式进行介绍，同时涉及西医、中医及中西医结合。针对现有研究的矛盾及局限性进行分析，并对心理心脏病学的未来研究方向提出设想。倡导建立全生命周期管理理念，调查心理心脏健康的早期决定因素，以及不同生命阶段干预的影响，着眼于发展个性化的心理心脏病学方法，将基因、环境和心理社会因素融合起来，为个体患者定制预防和治疗策略，探寻心血管疾病预防和治疗更有效的策略。
- 冠心病 /
- 精神心理疾病 /
- 心理心脏病学
Abstract: Summary of the 2022 Report on Cardiovascular Health and Diseases in China: It is estimated that there are 11.39 million cases of coronary heart disease (CHD) in China, and the number is on the rise. Psychological factors such as anxiety and depression are closely related to heart health. Patients with acute coronary syndrome (ACS) combined with anxiety or depression have a risk of non-fatal myocardial infarction and rehospitalization within one year which is approximately doubled and quintupled, respectively. The probability of CHD patients having comorbid anxiety and depression is highest at over 80%. Psychological disorders have a significant impact on the development and prognosis of cardiovascular diseases such as CHD, and comorbidity between the two is a major public health issue affecting the health of Chinese residents. This article reviews the history of psychocardiology and the development of psychocardiology in China, from the proposal of bidirectional medicine to the publication of relevant expert consensus, emphasizing the status and role of psychological factors in the prevention and treatment of cardiovascular diseases in China. It provides an overview of the current research status of psychocardiology, covering aspects such as risk factor assessment, genetic and biological indicators, disease identification and screening, drug therapy, and interdisciplinary collaboration. It introduces evidence-based intervention methods and discusses both Western medicine, traditional Chinese medicine, and integrated approaches. Analyzing the contradictions and limitations of existing research, it proposes directions for future research in psychocardiology. It advocates for the establishment of a lifecycle management concept, investigation of early determinants of psychocardiac health, examination of the impact of interventions at different stages of life, and the development of personalized psychocardiology methods that integrate genetics, environment, and psychosocial factors. This aims to tailor prevention and treatment strategies to individual patients and explore more effective strategies for the prevention and treatment of cardiovascular diseases.
- Coronary heart disease /
- Mental disorders /
- Psychocardiology

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参考文献(42)

[1]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2022概要[J]. 中国循环杂志, 2023, 38(6): 583-612. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202407010.htm The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on Cardiovascular Health and Diseases in China 2022: an Updated Summary[J]. Chinese Circulation Journal, 2023, 38(6): 583-612. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202407010.htm
[2]	杜晓宁, 杨芳, 姚金兰. 积极心理学在心血管健康领域的研究进展[J]. 中西医结合护理(中英文), 2019, 5(10): 210-215. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXHL201910061.htm DU X N, YANG F, YAO J L. Research progress of positive psychology for cardiovascular health[J]. Journal of Clinical Nursing in Practice, 2019, 5(10): 210-215. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXHL201910061.htm
[3]	刘业发, 丁荣晶, 孟晓萍, 等. 冠心病患者自我报告的生活质量现状及其影响因素分析[J]. 中华内科杂志, 2023, 62(4): 384-392. LIU Y F, DING R J, MENG X P, et al. Self-reported quality of life in patients with coronary heart disease and analysis of the associated factors[J]. Chinese Journal of Internal Medicine, 2023, 62(4): 384-392.
[4]	XIA K, WANG L F, YANG X C, et al. Comparing the effects of depression, anxiety, and comorbidity on quality-of-life, adverse outcomes, and medical expenditure in Chinese patients with acute coronary syndrome[J]. Chin Med J (Engl), 2019, 132(9): 1045-1052.
[5]	蒋跃绒. 从"心主神明"理论探讨心理应激性心肌缺血的治疗[J]. 中西医结合心脑血管病杂志, 2021, 19(23): 4187-4190. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202123043.htm JIANG Y R. Discussing the treatment of psychological stress myocardial ischemia from the theory of "heart governing the mind"[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2021, 19(23): 4187-4190. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202123043.htm
[6]	Alexander Mugar Klein. The Oxford Handbook of William James[M]. Oxford: Oxford University Press, 2024.
[7]	DE VOS J H, SCHRUERS K R J, DEBARD G, et al. The role of the peripheral and central adrenergic system in the construction of the subjective emotional experience of panic[J]. Psychopharmacology (Berl), 2024, 241(3): 627-635.
[8]	RAGGI A, SERRETTI A, FERRI R. A comprehensive overview of post-stroke depression treatment options[J]. Int Clin Psychopharmacol, 2024, 39(3): 127-138.
[9]	ALVARENGA M E. The Handbook of Psychocardiology[M]. Springer, 2016: 7-9.
[10]	CLYBURN C, SEPE J J, HABECKER B A. What gets on the nerves of cardiac patients? Pathophysiological changes in cardiac innervation[J]. J Physiol, 2022, 600(3): 451-461.
[11]	YLDRM D, KOCATEPE V. Evaluating death anxiety and death depression levels among patients with acute myocardial infarction[J]. Omega (Westport), 2023, 86(4): 1402-1414.
[12]	史鑫鑫, 符德, 玉谢君, 等. 基于"血瘀"证素探析冠心病合并焦虑和/或抑郁状态患者冠状动脉病变的相关因素[J]. 天津中医药, 2022, 39(10): 1229-1234. https://www.cnki.com.cn/Article/CJFDTOTAL-TJZY202210002.htm SHI X X, FU D, YU X J, et al. Exploration on the correlation of coronary artery disease in patients with coronary heart disease complicated with anxiety and/or depression based on "blood stasis" syndrome element[J]. Tianjin Journal of Traditional Chinese Medicine, 2022, 39(10): 1229-1234. https://www.cnki.com.cn/Article/CJFDTOTAL-TJZY202210002.htm
[13]	张瑾怡, 张世忠. 心血管疾病与心理疾病流行病学及相关机制研究新进展[J]. 中国全科医学, 2024, 27(8): 893-899. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202408001.htm ZHANG J Y, ZHANG S Z. Advances in Epidemiology and Related Mechanisms of Cardiovascular Diseases and Mental Illness[J]. Chinese General Practice, 2024, 27(8): 893-899. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202408001.htm
[14]	胡大一. 我是如何悟出并提出"双心医学"的[J]. 中华心血管病杂志, 2021, 49(06): 543-544. HU D Y. How I discovered and proposed "Dual Heart Medicine"[J]. Chinese Journal of Cardiology, 2021, 49(6): 543-544.
[15]	胡大一. 从"双心医学"到"五大处方"[J]. 中华心血管病杂志, 2021, 49(11): 1061-1062. HU D Y. From"Psycho-Cardiology"to"Five Prescriptions for Cardiovascular Health"[J]. Chinese Journal of Cardiology, 2021, 49(11): 1061-1062.
[16]	中国康复医学会心血管病预防与康复专业委员会, 中国老年学学会心血管病专业委员会, 中华医学会心身医学分会. 在心血管科就诊患者心理处方中国专家共识(2020版)[J]. 中华内科杂志, 2020, 59(10): 764-771. Chinese Association of Rehabilitation Medicine Cardiovascular Disease Prevention and Rehabilitation Professional Committee, Chinese Geriatrics Society Cardiovascular Disease Professional Committee, Chinese Medical Association Psychosomatic Medicine Branch. China expert consensus on psychological prescription for patients with cardiovascular disease(2020)[J]. Chinese Journal of Internal Medicine, 2020, 59(10): 764-771.
[17]	中国医师协会心血管内科医师分会双心学组, 北京医学会心脏心理分会. 稳定性冠心病合并心理问题基层诊疗共识(2023年)[J]. 中华全科医师杂志, 2023, 22(12): 1224-1234. Psycho-cardiology Group, Branch of Cardiovascular Physicians of Chinese Medical Doctor Association, Psycho-cardiology Group of Beijing Medical Association. Expert consensus on diagnosis and treatment of stable coronary artery disease combined with mental disorders in primary care (2023 edition)[J]. Chinese Journal of General Practitioners, 2023, 22(12): 1224-1234.
[18]	中华医学会心身医学分会, 中国康复医学会心血管病预防与康复专委会. 双心门诊建设规范中国专家共识[J]. 中国全科医学, 2024, 27(3): 253-261. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202403001.htm Psychosomatic Medicine Society of the Chinese Medical Association, Cardiovascular Disease Prevention and Rehabilitation Committee of Chinese Association of Rehabilitation Medicine. Chinese Expert Consensus on the Construction Standardization of Psycho-cardiology Outpatient[J]. Chinese General Practice, 2024, 27(3): 253-261. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202403001.htm
[19]	VACCARINO V, ALMUWAQQAT Z, KIM J H, et al. Association of mental stress-induced myocardial ischemia with cardiovascular events in patients with coronary heart disease[J]. JAMA, 2021, 326(18): 1818-1828.
[20]	NIEDHAMMER I, BERTRAIS S, WITT K. Psychosocial work exposures and health outcomes: a meta-review of 72 literature reviews with meta-analysis[J]. Scand J Work Environ Health, 2021, 47(7): 489-508.
[21]	朱芸, 马金玉, 赵佩. 冠心病住院患者共病焦虑抑郁的危险因素分析[J]. 中国实用医刊, 2023, 50(16): 52-54. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202006032.htm ZHU Y, MA J Y, ZHAO P. Risk factors of comorbid anxiety and depression in inpatients with coronary heart disease[J]. Chinese Journal of Practical Medicine, 2023, 50(16): 52-54. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202006032.htm
[22]	何玮琳, 祝颖, 熊维, 等. 冠心病PCI术后患者焦虑抑郁的影响因素分析[J]. 中华现代护理杂志, 2022, 28(35): 4958-4962. https://www.cnki.com.cn/Article/CJFDTOTAL-DDZT202207011.htm HE W L, ZHU Y, XIONG W, et al. Influencing factors of anxiety and depression in patients with coronary heart disease after PCI[J]. Chinese Journal of Modern Nursing, 2022, 28(35): 4958-4962. https://www.cnki.com.cn/Article/CJFDTOTAL-DDZT202207011.htm
[23]	BRANDT J, WARNKE K, JÖRGENS S, et al. Association of FKBP5 genotype with depressive symptoms in patients with coronary heart disease: a prospective study[J]. J Neural Transm, 2020, 127(12): 1651-1662.
[24]	WARNKE K, BRANDT J, JÖRGENS S, et al. Association of 5-HTTLPR/rs25531 with depressive symptoms in patients with coronary heart disease: a prospective study[J]. J Affect Disord, 2020, 277: 531-539.
[25]	RØDEVAND L, BAHRAMI S, FREI O, et al. Polygenic overlap and shared genetic loci between loneliness, severe mental disorders, and cardiovascular disease risk factors suggest shared molecular mechanisms[J]. Transl Psychiatry, 2021, 11(1): 3. DOI: 10.1038/s41398-020-01142-4.
[26]	KHANDAKER G M, ZUBER V, REES J M B, et al. Shared mechanisms between coronary heart disease and depression: findings from a large UK general population-based cohort[J]. Mol Psychiatry, 2020, 25(7): 1477-1486.
[27]	ASANOVA R, SHARAPOVA D, TURAYEV B, et al. Features of the treatment of patients with mental disorders and cardiovascular pathology[J]. Sci Innov, 2023, 2(D12): 545-550.
[28]	ZHOU L N, MA X C, WANG W. Inflammation and coronary heart disease risk in patients with depression in China mainland: a cross-sectional study[J]. Neuropsychiatr Dis Treat, 2020: 81-86. DOI: 10.2147/NDT.S216389.
[29]	IVANKOVIC S, CORIC V, PAIC F, et al. The association of preoperative depression, and C-reactive protein levels with a postoperative length of stay in patients undergoing coronary artery bypass grafting[J]. Appl Sci, 2022, 12(20): 10201. DOI: 10.3390/app122010201.
[30]	范玉欢, 吴志红, 王建军. 冠心病患者焦虑检出情况及其对心电图的影响[J]. 国际精神病学杂志, 2023, 50(1): 96-98. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202301020.htm FAN Y H, WU Z H, WANG J J. Anxiety detection in patients with coronary heart disease and its influence on electrocardiogram[J]. Journal Of International Psychiatry, 2023, 50(1): 96-98. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202301020.htm
[31]	BATES K, SWEETING J, YEATES L, et al. Psychological adaptation to molecular autopsy findings following sudden cardiac death in the young[J]. Genet Med, 2019, 21(6): 1452-1456.
[32]	SOLMI M, FIEDOROWICZ J, PODDIGHE L, et al. Disparities in screening and treatment of cardiovascular diseases in patients with mental disorders across the world: systematic review and meta-analysis of 47 observational studies[J]. Am J Psychiatry, 2021, 178(9): 793-803.
[33]	RAFANELLI C, GOSTOLI S, BUZZICHELLI S, et al. Sequential combination of cognitive-behavioral treatment and well-being therapy in depressed patients with acute coronary syndromes: a randomized controlled trial (TREATED-ACS Study)[J]. Psychother Psychosom, 2020, 89(6): 345-356.
[34]	张宇格, 韩红亚, 马涵英, 等. 冠心病合并焦虑的影响因素及干预疗法的研究进展[J]. 中国医药, 2023, 18(6): 922-926. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202306028.htm ZHANG Y G, HAN H Y, MA H Y, et al. Researchprogresson influencing factor and interventional therapy of coronary aatherosclerotic heart disease with anxiety[J]. China Medicine, 2023, 18(6): 922-926. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202306028.htm
[35]	LEVINE G N, COHEN B E, COMMODORE-MENSAH Y, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association[J]. Circulation, 2021, 143(10): e763-e783.
[36]	李韬, 李莹鸿, 张六燕, 等. 中药治疗冠状动脉粥样硬化性心脏病伴焦虑抑郁患者疗效及安全性的系统评价[J]. 中医临床研究, 2023, 15(26): 39-46. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202326007.htm LI T, LI Y H, ZHANG L Y, et al. Systematic evaluation of the efficacy and safety of TCM medicine in the treatment of coronary heart disease with anxiety and depression[J]. Clinical Journal Of Chinese Medicine, 2023, 15(26): 39-46. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202326007.htm
[37]	曾丽萍, 曾建斌, 万蝉俊, 等. 5种中成药联合西医常规疗法治疗冠心病合并焦虑抑郁的网状meta分析[J]. 国际中医中药杂志, 2023, 45(4): 472-480. ZENG L P, ZENG J B, WAN C J, et al. A network meta-analysis of 5 Chinese patent medicines combined with conventional westernmedicine in the treatment of coronary heart disease complicated with anxiety anddepression[J]. International Journal of Traditional Chinese Medicine, 2023, 45(4): 472-480.
[38]	刘金旭, 雷善言, 程俊宁, 等. 成人冠心病患者焦虑抑郁管理的最佳证据总结[J]. 中华健康管理学杂志, 2022, 16(8): 565-571. LIU J X, LEI S Y, CHENG J N, et al. Best evidence summary of anxiety and depression management in adults with coronary heart disease[J]. Chinese Journal of Health Management, 2022, 16(8): 565-571.
[39]	周苗, 郭晓岚. 以认知行为疗法为主的双心护理在急性心肌梗死术后焦虑患者中的应用效果研究[J]. 实用心脑肺血管病杂志, 2022, 30(1): 108-112. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL202201020.htm ZHOU M, GUO X L. Application Effect of Double Heart Nursing Based on Cognitive Behavioral Therapy in Postoperative Anxiety Patients with Acute Myocardial Infarction[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2022, 30(1): 108-112. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL202201020.htm
[40]	张展, 李杏, 莫琳勤, 等. 结局引导的双心服务在冠心病不稳定型心绞痛患者PCI围手术期中的应用[J]. 国际医药卫生导报, 2024, 30(4): 641-646. ZHANG Z, LI X, MO L Q, et al. Application of outcome guided bicardiac service in patients with unstable angina pectoris of coronary heart disease during the perioperative period of PCI[J]. International Medicine and Health Guidance News, 2024, 30(4): 641-646.
[41]	李晓燕, 郁志明. 结合病例谈双心疾病的诊疗[J]. 中华医学信息导报, 2023, 38(10): 18. LI X Y, YU Z M. Diagnosis and treatment of double heart disease based on case analysis[J]. China Medical News, 2023, 38(10): 18.
[42]	袁雯, 周霄云, 张雅丽. 中医护理技术对冠心病患者心理状况、生活质量及睡眠质量的影响[J]. 中华全科医学, 2020, 18(1): 150-153. doi: 10.16766/j.cnki.issn.1674-4152.001191 YUAN W, ZHOU X Y, ZHANG Y L. Effect of TCM nursing technology on psychological status, quality of life and sleep quality of patients with coronary heart disease[J]. Chinese Journal of General Practice, 2020, 18(1): 150-153. doi: 10.16766/j.cnki.issn.1674-4152.001191