抑郁症误诊为冠心病患者临床特点分析

目的分析抑郁症误诊为冠心病患者的临床特点,提高心内科医生对抑郁症的识别水平及重视程度。方法入选北京军区总医院心内科"双心门诊"2006年11月~2013年4月期间误诊"冠心病"的抑郁症患者143例。对纳入患者进行精神心理问诊、抑郁量表评分,进行抗抑郁治疗并随诊。对患者临床特点的进行总结与分析。结果 143例误诊"冠心病"抑郁症患者,临床主要表现为"胸闷"或"胸背痛"症状,但胸痛发作部位、疼痛持续及缓解时间不固定。均存在全身性多种症状或不适,95.1%(136例)的患者伴有睡眠障碍。82.5%(118例)的患者发作时心电图无异常。抗冠心病药物不能明显改善胸闷胸痛症状。根据贝克抑郁问卷评分,轻度抑郁39.9%(57例),中度56.7%(81例),重度3.5%(5例)。给予抗抑郁治疗8周后躯体症状可明显缓解,抑郁评分显著下降(19.6±9.87 vs.10.87±8.34,P=0.001)。结论抑郁症可表现出与冠心病相似的症状,易被误诊为冠心病,心内科医生熟练掌握冠心病及抑郁症的基础知识对于该部分患者的诊断和治疗有重要的临床意义。

Clinical characteristics of patients with depression misdiagnosed as coronary heart disease

Objective To analyze the clinical characteristics of patients with depression misdiagnosed as coronary heart disease （CHD）, and improve the recognition ability and emphasis in physicians of cardiologic department. Methods The patients （n=143） with depression misdiagnosed as CHD were chosen from the outpatient service of psycho-cardiology of the Department of Cardiology of General Hospital of PLA Beijing Military Area Command from Nov. 2006 to Apr. 2013. All patients were given mental inquiry, depression scale scoring, anti-depression treatment and follow-up. The clinical characteristics of the patients were summed up and analyzed. Results In 143 patients, main clinical symptoms were chest congestion or chest and back pain, but the positions, duration time and relief time of these symptoms were not fixed. All patients had general multiple symptoms or discomfort, and there were 136 （95.1%） with somnipathy, and 118 （82.5%） with normal ECG when disease onset. The symptoms of chest congestion or chest and back pain were not relieved by anti-CHD drugs. According to the Beck depression scoring questionnaire, there were 57 cases （39.9%） with mild depression, 81 （56.7%） with moderate depression, and 5 （3.5%） with severe depression. After anti-depression treatment for 8 w, the body symptoms were significantly relived and depression scores decreased significantly （19.6±9.87 vs. 10.87±8.34, P=0.001）. Conclusion Depression can manifest the similar symptoms as CHD, so it is often misdiagnosed as CHD. It is necessary for cardiologic physicians to master some psychological knowledge.