Yin Han, Cheng Xingyu, Liang Yanting, Liu Anbang, Wang Haochen, Liu Fengyao, Guo Lan, Ma Huan, Geng Qingshan
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
School of Medicine, South China University of Technology, Guangzhou, China.
Front Cardiovasc Med. 2021 Nov 29;8:769857. doi: 10.3389/fcvm.2021.769857. eCollection 2021.
To determine the association of perceived stress with coagulation function and their predictive values for clinical outcomes. This prospective cohort study derived from a cross-sectional study for investigating the psychological status of inpatients with suspicious coronary heart disease (CHD). In this study, the 10-item Perceived Stress Scale (PSS-10) as an optional questionnaire was used to assess the severity of perceived stress. Coagulation function tests, such as activated partial thromboplastin time (APTT), prothrombin time (PT), and fibrinogen were measured within 1 h after admission. Furthermore, 241 patients with CHD out of 705 consecutive inpatients were included in the analyses and followed with a median of 26 months for the clinical outcomes. The patients in high perceived stress status (PSS-10 score > 16) were with shorter APTT (36.71 vs. 38.45 s, = 0.009). Shortened APTT ( ≤ 35.0 s) correlated with higher PSS-10 score (14.67 vs. 11.22, = 0.003). The association of APTT with depression or anxiety was not found. Multiple linear models adjusting for PT estimated that every single point increase in PSS-10 was relevant to approximately 0.13 s decrease in APTT ( = 0.001) regardless of the type of CHD. APTT (every 5 s increase: hazard ratio () 0.68 [0.47-0.99], = 0.041) and perceived stress (every 5 points increase: 1.31 [1.09-1.58], = 0.005) could predict the cardiovascular outcomes. However, both predictive values would decrease when they were simultaneously adjusted. After adjusting for the physical clinical features, the associated of perceived stress on cardiac ( 1.25 [1.04-1.51], = 0.020) and composite clinical outcomes ( 1.24 [1.05-1.47], = 0.011) persisted. For the patients with CHD, perceived stress strongly correlates with APTT. The activation of the intrinsic coagulation pathway is one of the mechanisms that high perceived stress causes cardiovascular events. This hints at an important role of the interaction of mental stress and coagulation function on cardiovascular prognosis. More attention needs to be paid to the patients with CHD with high perceived stress.
确定感知压力与凝血功能之间的关联及其对临床结局的预测价值。这项前瞻性队列研究源自一项横断面研究，该横断面研究旨在调查疑似冠心病（CHD）住院患者的心理状况。在本研究中，使用10项感知压力量表（PSS-10）作为可选问卷来评估感知压力的严重程度。入院后1小时内进行凝血功能测试，如活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）和纤维蛋白原。此外，在705例连续住院患者中，241例冠心病患者被纳入分析，并对临床结局进行了中位数为26个月的随访。感知压力高状态（PSS-10评分>16）的患者APTT较短（36.71对38.45秒，P = 0.009）。APTT缩短（≤35.0秒）与较高的PSS-10评分相关（14.67对11.22，P = 0.003）。未发现APTT与抑郁或焦虑之间存在关联。调整PT后的多元线性模型估计，无论冠心病类型如何，PSS-10每增加1个单位与APTT约0.13秒的降低相关（P = 0.001）。APTT（每增加5秒：风险比（HR）0.68[0.47 - 0.99]，P = 0.041）和感知压力（每增加5分：HR 1.31[1.09 - 1.58]，P = 0.005）可预测心血管结局。然而，当同时调整两者时，两者的预测价值都会降低。在调整了身体临床特征后，感知压力与心脏（HR 1.25[1.04 - 1.51]，P = 0.020）和综合临床结局（HR 1.24[1.05 - 1.47]，P = 0.011）之间的关联仍然存在。对于冠心病患者，感知压力与APTT密切相关。内源性凝血途径的激活是高感知压力导致心血管事件的机制之一。这暗示了心理压力与凝血功能相互作用在心血管预后中的重要作用。需要更多关注感知压力高的冠心病患者。
