Kendel Friederike, Gelbrich Götz, Wirtz Markus, Lehmkuhl Elke, Knoll Nina, Hetzer Roland, Regitz-Zagrosek Vera
Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, Germany.
Arch Intern Med. 2010 Oct 25;170(19):1717-21. doi: 10.1001/archinternmed.2010.368.
Depression is a prevalent condition in patients undergoing coronary artery bypass graft surgery (CABG) and is often associated with a less favorable health status. The aim of this study was to investigate the relationship between depression and physical functioning in patients undergoing CABG.
The analyses were based on a sample of 883 consecutive subjects (aged 35-93 years; 19.8% women) undergoing CABG. Depression was assessed using the Patient Health Questionnaire (PHQ); the subscale "physical functioning" was taken from the 36-Item Short-Form Health Survey. Questionnaires were administered 1 to 3 days before surgery (T1) and 2 months (T2) and 1 year (T3) after surgery.
A cross-lagged path analytic model showed that an increase in depressive symptoms predicted a decrease in physical functioning (β(T)₁₋(T)₂ = -0.15 [P < .001]; β(T)₂₋(T)₃= -0.17 [P < .001]), but not the other way around. Multigroup comparisons revealed one moderator effect: in patients with systolic heart failure (left ventricular ejection fraction [LVEF], ≤45%), the effect of depression on physical functioning from T2 to T3 was significantly stronger than in patients with preserved LVEF (β(T)₂₋(T)₃= -0.30 [P < .001] vs β(T)₂₋(T)₃= -0.14 [P < .001]; χ²(diff) = 3.885 [P = .049]).
More attention should be paid to diagnosis and treatment of depression in patients undergoing CABG. After surgery, patients with systolic heart failure and depressive symptoms in particular seem at risk of a deterioration of their physical functioning.
抑郁症在接受冠状动脉旁路移植术（CABG）的患者中很常见，并且通常与较差的健康状况相关。本研究的目的是调查接受CABG的患者中抑郁症与身体功能之间的关系。
分析基于883名连续接受CABG的受试者（年龄35 - 93岁；19.8%为女性）的样本。使用患者健康问卷（PHQ）评估抑郁症；“身体功能”子量表取自36项简短健康调查。在手术前1至3天（T1）、手术后2个月（T2）和1年（T3）进行问卷调查。
交叉滞后路径分析模型显示，抑郁症状的增加预示着身体功能的下降（β(T)₁₋(T)₂ = -0.15 [P <.001]；β(T)₂₋(T)₃ = -0.17 [P <.001]），但反之则不然。多组比较揭示了一个调节效应：在收缩性心力衰竭患者（左心室射血分数[LVEF]≤45%）中，从T2到T3抑郁症对身体功能的影响明显强于LVEF保留的患者（β(T)₂₋(T)₃ = -0.30 [P <.001] 对比 β(T)₂₋(T)₃ = -0.14 [P <.001]；χ²（差异） = 3.885 [P =.049]）。
对于接受CABG的患者，应更加关注抑郁症的诊断和治疗。手术后，尤其是有收缩性心力衰竭和抑郁症状的患者，其身体功能似乎有恶化的风险。
