双心医学模式在冠心病、高血压伴心理障碍患者中的应用

目的: 探讨双心医学模式在冠心病、高血压合并心理障碍患者中的应用.方法: 收集120例冠心病、高血压合并抑郁、焦虑患者,随机分为观察组和对照组,对照组给予常规药物治疗,观察组在此基础上应用双心医学模式进行心理干预,治疗前和治疗后4周观察2组患者的临床症状、心电图、血压、Zung抑郁/焦虑自评量表(SDS/SAS)评分、B型脑钠肽(BNP)、左心室射血分数(LVEF)、血皮质醇、白介素-10(IL-10)、肿瘤坏死因子α(TNFα)和TNFα/IL-10比值.结果: 治疗后2组患者的临床症状、心电图、血压、SDS评分、SAS评分、BNP、JNFα LVEF均有改善(P<0.05~P<0.01).治疗后2组患者的IL-10水平均有升高,观察组升高更明显(P<0.05);血皮质醇在治疗后均有降低,观察组降低更显著(P<0.05).结论: 双心医学模式治疗可提高冠心病、高血压伴心理障碍患者的整体临床疗效,其内在机制可能与血皮质醇作用以及体内促炎、抗炎机制平衡失调有关.

The application of psycho-cardiology medical mode in patients with coronary artery disease and hypertension complicated with psychological disorder

Objective： To investigate the application of psycho-cardiology medical mode in patients with coronary artery disease（ CAD）and hypertension complicated with psychological disorder. Methods： One hundred and twenty patients with CAD and hypertension complicated with depression and anxiety were randomly divided into the observation group and control group. The observation group and control group were treated with the intervention of psycho-cardiology medical mode based on routine medication and routine medication,respectively. The clinical symptoms,electrocardiogram,blood pressure,scores of Zung self-rating depression /anxiety scale（ SDS /SAS）,B-type natriuretic peptide（ BNP）,left ventricular ejection fraction（ LVEF） and levels of plasma cortisol,IL-10 and TNFα,and ratio of TNFα to IL-10 in two groups were observed before therapy and after 4 weeks of therapy. Results： The clinical symptoms,electrocardiogram,blood pressure,scores of SDS and SAS,BNP JNFα and LVEF in two groups were improved after therapy（ P〈0. 05 to P〈0. 01）. The levels of IL-10 in two groups increased after therapy,the increasing degree of which in observation group were more than which in control group（ P〈0. 05）. The levels of cortisol in two groups decreased after therapy,the decreasing degrees of whose in observation group were more than whose in control group（ P〈0. 05）. Conclusions： The treatment of patients with CAD and hypertension complicated with psychological disorder with psycho-cardiology medical mode can improve the clinical effects,the related mechanisms of which are associated with the role of plasma cortisol and imbalance between inflammation and anti-inflammation.