急性冠状动脉综合征患者头发皮质醇水平与倦怠的相关性及其对生活质量的影响研究

背景　头发皮质醇水平是一个反映慢性压力的指标，课题组前期研究结果提示倦怠可能是急性冠状动脉综合征（ACS）的独立危险因素，但目前国内尚缺乏关于头发皮质醇水平与倦怠和ACS的研究。目的　探讨ACS患者头发皮质醇水平与倦怠的相关性，以及头发皮质醇水平对患者出院1个月后生活质量的影响。方法　以2015年3月-2018年2月因首次发生ACS收住昆明医科大学第一附属医院心内科的89例患者为试验组，以同期在本院进行年度体检的42例健康者为对照组。取两组受试者少量头发进行皮质醇水平检测，采用哥本哈根倦怠量表（CBI）的一般倦怠子量表评估ACS患者的倦怠水平，采用生活质量8条简明量表（SF-8）和西雅图心绞痛量表（SAQ）评估ACS患者出院１个月后的生活质量。对头发皮质醇数据进行自然对数转换，两组头发皮质醇水平比较采用成组t检验，并采用多重线性回归排除混杂因素对结果的影响；ACS患者头发皮质醇水平和倦怠的相关性采用偏相关分析；构建多重线性回归模型分析ACS患者头发皮质醇水平与出院1个月后生活质量的关系。结果　75例ACS患者和38例健康者提供了头发样本进行皮质醇水平检测。ACS患者的头发皮质醇水平高于健康者〔（2.00±1.82）ln ng/g比（1.59±1.48）ln ng/g，t=2.42，P=0.017〕，构建多重线性回归模型排除性别、年龄、体质指数、工作状况、受教育程度、吸烟、饮酒的影响后，组别是头发皮质醇水平的影响因素〔b（95%CI）=2.038（0.198，3.878），P=0.037〕。偏相关分析结果显示，排除性别、年龄、体质指数、工作状况、受教育程度、婚姻状况、吸烟、饮酒、Killip心功能分级、既往史、心血管病家族史的影响后，ACS患者的头发皮质醇水平与倦怠评分呈正相关（偏相关系数为0.303，P=0.011）。ACS患者头发皮质醇水平是出院1个月后SF-8生理健康评分、SAQ心绞痛稳定状态和心绞痛发作频率评分的影响因素〔b（95%CI）分别为-1.459（-1.984，-0.934）、-8.821（-15.629，-2.013）、-6.342（-12.653，-0.031），P均<0.05〕。结论　ACS患者的头发皮质醇水平高于健康者；在ACS患者中，倦怠与头发皮质醇水平呈正相关关系；基线头发皮质醇水平高的ACS患者出院1个月后的生活质量较差。

Associations of Hair Cortisol with Burnout and Quality of Life in Patients with a First Episode of Acute Coronary Syndrome

Background Hair cortisol is a biomarker that reflects chronic stress.Previous studies of our research team show that burnout may be an independent risk factor for acute coronary syndrome(ACS).But the associations of hair cortisol with burnout and ACS are rarely reported in China.Objective To investigate the associations of hair cortisol with burnout and quality of life at one month after discharge in patients with a first episode of ACS.Methods Participants were recruited from the First Affiliated Hospital of Kunming Medical University from March 2015 to February 2018,including 89 inpatients with a first onset of ACS from Cardiovascular Department(experimental group),and 42 healthy cases undergoing annual physical examination(control group).Hair cortisol assay was conducted in both groups by detecting a small sample of hair.Personal burnout subscale of the Copenhagen Burnout Inventory(CBI)was used to measure the burnout level.8-item Short-Form Health Survey(SF-8)and Seattle Angina Questionnaire(SAQ)were adopted to assess the quality of life at one month after discharge.T-test was applied to compare natural log transformed hair cortisol data between the groups,and multiple linear regression was used to analyze the results after excluding the confounding factors.Partial correlation analysis was conducted to investigate the correlation between hair cortisol and burnout in ACS patients.Multiple linear regression model was developed and used to analyze the correlation between hair cortisol and quality of life at one month after discharge in ACS patients.Results Finally,75 ACS patients and 38 healthy controls underwent the hair cortisol assay.ACS patients had higher mean hair cortisol concentration than the controls〔2.00±1.82(ln ng/g)vs 1.59±1.48(ln ng/g),t=2.42,P=0.017〕.After excluding confounding factors of sex,age,BMI,employment status,education level,smoking and drinking,multiple linear regression analysis found ACS was associated with hair cortisol〔b(95%CI)=2.038(0.198,3.878),P=0.037〕.Hair cortisol was correlated positively with burnout level in ACS patients after excluding confounding factors of sex,age,BMI,employment status,education level,marital status,smoking,drinking,Killip class,past and family medical history of cardiovascular disease(partial correlation coefficient=0.303,P=0.011).Hair cortisol concentration was significantly associated with physical function score of SF-8〔b(95%CI)=-1.459(-1.984,-0.934),P<0.05〕,anginal stability score of SAQ〔b(95%CI)=-8.821(-15.629,-2.013),P<0.05〕,and anginal frequency score of SAQ〔b(95%CI)=-6.342(-12.653,-0.031),P<0.05〕in ACS patients at one month after discharge.Conclusion ACS patients showed higher hair cortisol concentration than healthy people.Burnout level increased with hair cortisol concentration in ACS patients.Higher hair cortisol concentration at baseline was associated with lower quality of life in ACS patients at one month of discharge.