【摘要】 目的 探讨不明原因胸痛患者抑郁情绪的发生及其可能的机制。方法 收集2009年10月至2013年12月在汕头大学医学院第一附属医院就诊的118例患者的临床资料。根据病史将患者分为不明原因胸痛组（38例）、急性心肌梗死组（有典型胸痛的急性心肌梗死患者,48例）和抑郁症对照组（有抑郁而无胸痛的患者,32例）,另外选取同年龄段健康体检者38名为健康对照组。对各组受试者采用汉密尔顿抑郁量表（HAMD）进行抑郁评分,采用高效液相色谱法检测血小板5-羟色胺水平,流式细胞术测定外周血CD₄⁺、CD₈⁺细胞百分比,酶联免疫吸附测定法检测炎性因子C反应蛋白（CRP）、白细胞介素6（IL-6）水平。结果 不明原因胸痛组CRP、CD₄⁺/CD₈⁺明显低于急性心肌梗死组[3.3（2.2,4.3）mg/L比11.4（5.8,29.6）mg/L,（1.6±0.8）比（2.5±1.5）],差异有统计学意义（P<0.05）;IL-6水平[6.7（4.4,7.9）ng/L]明显高于健康对照组[2.3（1.3,4.3）ng/L],但明显低于急性心肌梗死组[14.8（10.0,22.4）ng/L]和抑郁症对照组[12.3（5.5,34.0）ng/L],差异均有统计学意义（均P<0.05）;5-羟色胺水平[674（228,1214）nmol/L]明显低于急性心肌梗死组[1336（738,1 793）nmol/L]及健康对照组[850（582,1815）nmol/L],但高于抑郁症对照组[256（130,689）nmol/L],差异均有统计学意义（均P<0.05）。不明原因胸痛组抑郁评分明显高于急性心肌梗死组与健康对照组[（16.5±4.8）分比（10.3±3.1）、（8.2±2.7）分],差异有统计学意义（P<0.05）,其中14例患者HAMD评分>20分,占36.8%。5-羟色胺是不明原因胸痛患者抑郁发生的独立危险因素（比值比=0.997,95%置信区间0.995⁰.999,P<0.05）。结论 不明原因胸痛患者中有36.8%伴随有抑郁。5-羟色胺是不明原因胸痛患者的独立危险因素。更多还原

【Abstract】 Objective To explore the incidence and the mechanism of depression in patients with unidentified chest pain.Methods Totally 118 patients from October 2009 to December 2013 were enrolled and divided into unidentified chest pain group（38 cases）,acute myocardial infarction group（48 cases） and depression group（32 cases）,in addition,38 healthy volunteers were enrolled as control group.The Hamilton’s depression scale（HAMD） was used to assess the depressed state,the high performance liquid chromatography was used to detect the serotonin（5-HT） in platelet,the flow cytometry was used to measure the percentage of the CD₄⁺/CD₈⁺ immunocyte in the peripheral blood,the enzyme-linked immunosorbent assay was used to detect the levels of C-reaction protein（CRP） and interleukin（IL）-6.Results The CRP level and percentage of CD₄⁺/CD₈⁺ immunocyte in unexplained chest pain group were significantly lower than those in acute myocardial infarction group[3.3（2.2,4.3） mg/Lvs 11.4（5.8,29.6） mg/L,（1.6±0.8） vs（2.5 ± 1.5）]（<0.05）.The IL-6 level in unidentified chest pain group[6.7（4.4,7.9） ng/L]was significantly higher than that in control group[2.3（1.3,4.3）ng/L],but was significantly lower than that in depression group[12.3（5.5,34.0）ng/L]and myocardial infarction group[14.8（10.0,22.4） ng/L]（all P<0.05）.The 5-HT level in unidentified chest pain group[674（228,1214） nmol/L]was significantly lower than that in control group[850（582,1 815） nmol/L]and acute myocardial infarction group[1 336（738,1 793） nmol/L]（P < 0.05）,but was higher than that in depression group[256（130,689） nmol/L]（all P<0.05）.In unidentified chest pain group,there were 14 with HAMD score > 20,and the score was significantly higher than that in control group and acute myocardial infarction group[（16.5±4.8） scores vs（10.3 ±3.1）,（8.2±2.7） scores]（all P<0.05）.5-HT was an independent risk factor of depression in patients with unidentified chest pain（OR = 0.997,95%CI:0.995-0.999）.Conclusions The incidence of depression in unidentified chest pain patients is high.5-HT is an independent risk factor of depression in patients with unidentified chest pain.更多还原