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混合焦虑抑郁障碍(MADD)对高血压患者血压及内皮功能,血小板因子4的影响

发布时间:2018-05-18 04:23

  本文选题:高血压 + 焦虑 ; 参考:《南昌大学》2017年硕士论文


【摘要】:背景及目的:心血管疾病具有较高的心理障碍发生率,同时伴有焦虑障碍的心血管人群更容易发生心脑血管事件。明显的焦虑情绪或者抑郁情绪是高血压独立的危险因素,不仅降低药物治疗效果,影响高血压患者的预后,还因为焦虑抑郁情绪与高血压相互作用而明显降低患者生活质量。本研究拟初步探讨高血压合并焦虑、抑郁及混合焦虑抑郁状态(MADD)患者的流行病学资料;同时比较正常血压、正常血压合并MADD、高血压、高血压合并焦虑、高血压合并抑郁及高血压合并MADD人群相关指标差异,并探讨高血压合并MADD的有效治疗方案,以为高血压合并焦虑、抑郁或MADD患者的诊断、治疗提供有参考。研究方法:横断面调查研究以门诊确诊为高血压患者2000例为调查对象,收集调查患者的年龄、性别、血压、血管内皮功能、血小板因子4及焦虑自评量表(SAS)、抑郁自评量表(SDS)评分等资料。前瞻性对照研究以正常血压、正常血压合并MADD、高血压、高血压合并焦虑、高血压合并抑郁及高血压合并MADD共6类人群作为研究对象。6组研究对象纳入研究后分别给予个体化的最佳治疗方案,其中高血压的治疗用药均首选长效二氢吡啶类钙拮抗剂(氨氯地平),若血压不能达标则加用血管紧张素转化酶抑制剂(依那普利),若仍不能达标则退出研究;高血压合并焦虑、抑郁及MADD组患者均给予氟哌噻吨美利曲辛(商品名:黛力新;生产厂家:丹麦灵北制药;批准文号:H20080175)治疗,6组患者的研究周期均为2个月。2个月后重新收集患者的相关指标,并比较治疗后与治疗前相关指标的改善程度及比较各组间的治疗效果差异。研究结果:横断面研究共纳入高血压患者2000例,其中单纯高血压、高血压合并焦虑、高血压合并抑郁及高血压合并MADD分别为1275例(63.75%)、269例(13.45%)、283例(14.15%)及173例(8.65%);高血压合并焦虑组的SAS评分(59.7±18.5)显著高于另外3组(38.9±11.4,P=0.000;37.8±12.43,P=0.000;38.4±10.6,P=0.000),高血压合并抑郁组的SDS评分(64.7±18.1)显著高于其他3组(44.1±13.2,P=0.000;44.7±11.9,P=0.000;45.6±12.7,P=0.000),差异具有显著性。高血压合并MADD组的RHI(1.49±0.36)明显低于另外3组(1.93±0.54,P=0.000;1.65±0.51,P=0.000;1.62±0.47,P=0.000),血小板因子(49.41±2.73)显著高于其他3组(6.73±2.15,P=0.000;7.19±1.98,P=0.000;7.45±2.10,P=0.000),差异均具有显著性。前瞻性研究共纳入正常血压组、高血压组、正常血压合并MADD组、高血压合并焦虑组、高血压合并抑郁组及高血压合并MADD组6组各40例。组间比较:高血压合并MADD组RHI(1.47±0.38)显著低于高血压组(1.91±0.52),而血小板因子4(9.14±2.37)、dSBP(38.9±35.9)、dDBP(117.9±24.2)、nSBP(117.8±24.6)、nDBP(94.1±22.2)、24hSBP标准差(16.9±5.4)、24hSBP变异系数(31.95)、24hDBP标准差(10.9±3.4)及24hDBP变异系数(31.19)显著高于高血压组。治疗后高血压合并MADD组RHI(1.66±0.48)明显低于高血压组(1.94±0.56,P=0.017);高血压合并MADD组RHI(1.66±0.48)明显低于高血压合并焦虑组(1.83±0.56,P=0.04)及高血压合并抑郁组(1.82±0.71,P=0.017),差异均具有显著性。组内比较:治疗后高血压合并焦虑组SAS评分38.2±11.2显著低于治疗前59.8±18.6,高血压合并抑郁组的SDS评分(43.1±12.8)明显低于治疗前(64.8±18.8,P=0.000);治疗后高血压合并MADD组、高血压组、高血压合并焦虑组及高血压合并抑郁组的RHI明显升高,而血小板因子4、dSBP、dDBP、nSBP、nDBP、24hSBP标准差、24hSBP变异系数、24hDBP标准差及24hDBP变异系数明显降低;差异均具有显著性(P0.05)。结论:1.高血压合并MADD患者的血管内皮功能低于单纯高血压、高血压合并焦虑及高血压合并抑郁患者,而血压变异性更高;2.降压药物联合黛力新治疗高血压合并焦虑、高血压合并抑郁及高血压合并MADD患者均可延缓甚至逆转血管内皮功能降低,同时降低血压变异性
[Abstract]:Background and purpose: cardiovascular disease has a high incidence of mental disorders. Cardiovascular events in people with anxiety disorders are more likely to occur in cardiovascular and cerebrovascular events. Obvious anxiety or depression is a risk factor for hypertension, which not only reduces the effect of drug treatment, but also affects the prognosis of hypertensive patients, but also because of anxiety and depression. The study of hypertension combined with anxiety, depression and mixed anxiety and depression (MADD) was a preliminary study of the epidemiological data of hypertension, normal blood pressure, normal blood pressure combined with MADD, hypertension, high blood pressure combined with anxiety, hypertension combined with depression and hypertension. MADD population related indicators difference, and explore the effective treatment of hypertension combined with MADD, think of hypertension combined with anxiety, depression or MADD diagnosis, treatment provides a reference. Research methods: a cross-sectional study of 2000 cases of hypertension patients diagnosed as outpatient diagnosis of the image, collect investigation of the age, sex, blood pressure, intravascular Skin function, platelet factor 4 and anxiety self rating scale (SAS), self rating Depression Scale (SDS) score and other data. Prospective control study on normal blood pressure, normal blood pressure combined with MADD, hypertension, hypertension and anxiety, hypertension combined with depression and hypertension combined with MADD in a total of 6 groups were taken as subjects in group.6 after the study was included in the study, respectively. The best individualized treatment scheme was given, in which the treatment of hypertension was the first choice of the long effect two hydropyridine calcium antagonist (amlodipine). If the blood pressure could not reach the standard, the angiotensin converting enzyme inhibitor (Bea Knapp Leigh) was added to the study. The patients in the group of high blood pressure combined with anxiety, depression and MADD were given fluperthiazine. (commodity name: Deanxit: Deanxit; manufacturer: Danish Ling north pharmaceutical; Approval Number: H20080175) treatment. The study cycle of 6 groups of patients was 2 months after.2 months to re collect the related indexes, and compared the improvement of the related indexes after treatment and before treatment and compared the difference of treatment effect between each group. The results of the study: cross section The study included 2000 patients with hypertension, of which simple hypertension, hypertension combined anxiety, hypertension combined with depression and hypertension combined with MADD were 1275 (63.75%), 269 (13.45%), 283 (14.15%) and 173 (8.65%), and high blood pressure combined anxiety group (59.7 + 18.5) (59.7 + 18.5) was significantly higher than that of another 3 group (P=0.000; P =0.000; 38.4 + 10.6, P=0.000), the SDS score of the hypertension combined with depression group (64.7 + 18.1) was significantly higher than the other 3 groups (44.1 + 13.2, P=0.000; 44.7 + 11.9, P=0.000; 45.6 + 12.7, P=0.000), with significant difference. The RHI (1.49 + 0.36) of the hypertension combined with MADD group was significantly lower than that of the other groups (P=0.000, P=0.000; P=0.000; P=0.000, P=0.000), Platelet factor (49.41 + 2.73) was significantly higher than that of other 3 groups (6.73 + 2.15, P=0.000; 7.19 + 1.98, P=0.000, 7.45 + 2.10, P=0.000), and the differences were all significant. The prospective study included normal blood pressure group, hypertension group, normal blood pressure combined with MADD, hypertension combined anxiety group, hypertension combined with depression group and 6 groups of hypertension with MADD group 40 cases each. Group MADD: hypertension combined with RHI (1.47 + 0.38) was significantly lower than that of hypertension group (1.91 + 0.52), platelet factor 4 (9.14 + 2.37), dSBP (38.9 + 35.9), dDBP (117.9 + 24.2), nSBP (117.8 + 24.6), 24hSBP standard deviation, 24hSBP variation coefficient, 24hDBP standard deviation and 24hDBP variation coefficient. MADD group RHI (1.66 + 0.48) after treatment was significantly lower than that of hypertension group (1.94 + 0.56, P=0.017); hypertension combined with MADD group RHI (1.66 + 0.48) was significantly lower than hypertension combined anxiety group (1.83 + 0.56, P=0.04) and hypertension combined with depression group (1.82 + 0.71, P=0.017), and the difference was significant. The SAS score of hypertension combined anxiety group was 38.2 + 11.2 significantly lower than 59.8 + 18.6 before treatment. The SDS score of hypertension combined with depression group (43.1 + 12.8) was significantly lower than that before treatment (64.8 + 18.8, P=0.000). After treatment, the RHI of hypertension group, hypertension group, hypertension combined anxiety group and hypertension combined with depression group increased significantly, and platelets were significantly increased, and platelets were platelets. Factor 4, dSBP, dDBP, nSBP, nDBP, 24hSBP standard deviation, 24hSBP variation coefficient, 24hDBP standard deviation and 24hDBP variation coefficient significantly decreased, the difference was significant (P0.05). Conclusion: 1. the vascular endothelial function of patients with hypertension combined with MADD is lower than that of simple hypertension, hypertension combined with anxiety and hypertension with depression, and the blood pressure variability is higher; 2 Hypotensive drugs combined with Deanxit in the treatment of hypertension combined with anxiety, hypertension combined with depression and hypertension combined with MADD patients could delay or even reverse the decrease of vascular endothelial function and reduce blood pressure variability.
【学位授予单位】:南昌大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R544.1;R749

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