Lee Jea-Geun, Choi Joon Hyouk, Kim Song-Yi, Kim Ki-Seok, Joo Seung-Jae
Division of Cardiology, Department of Internal Medicine, School of Medicine, Jeju National University, Jeju, Korea.
Korean Circ J. 2016 Mar;46(2):169-78. doi: 10.4070/kcj.2016.46.2.169. Epub 2016 Mar 21.
A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain.
Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram.
Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R(2)=0.092, p=0.004; β= -0.525, R(2)=0.290, p=0.010).
No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.
心脏病专家对胸痛患者的精神症状进行评估的情况较为罕见。本研究旨在确定有无冠状动脉疾病（CAD）患者的精神特征，并探讨其与胸痛强度的关系。
在连续转诊至心脏病门诊的139例患者中，排除31例有非典型胸痛（烧心、反酸、呼吸困难和心悸）的患者，108例纳入本研究。纳入的患者在首次门诊就诊时接受了胸痛完整数字评分量表和轻度精神障碍症状清单评估。非CAD组由运动试验、冠状动脉计算机断层扫描血管造影或冠状动脉造影正常的患者组成，CAD组包括冠状动脉造影异常的患者。
19例患者（17.6%）被诊断为CAD。两组间精神特征未观察到差异。在非CAD组中，“感到紧张”“自责”和“入睡困难”更为常见（p = 0.007；p = 0.046；p = 0.044）。在逐步选择的多元线性回归分析中，非CAD组无胸痛的躯体化症状和CAD组的疑病症与胸痛强度呈线性相关（β = 0.108，R² = 0.092，p = 0.004；β = -0.525，R² = 0.290，p = 0.010）。
两组间精神特征未观察到差异。胸痛强度与非CAD组无胸痛的躯体化症状呈线性相关，与CAD组的疑病症呈负线性相关。
