Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
Min-Hwei Junior College of Health Care Management, Tainan City, Taiwan.
Medicine (Baltimore). 2022 Aug 5;101(31):e29620. doi: 10.1097/MD.0000000000029620.
Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain. Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease. A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005). In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.
胸痛的原因可能从良性到危及生命的病症不等，而且在许多情况下并非一定与心脏有关。非心源性胸痛的一个可能原因可能是由慢性肝脏疾病引起的焦虑或抑郁。本研究的目的是调查焦虑和抑郁与非心源性胸痛患者慢性肝病之间的关系。从台湾南部一家地区医院招募了因胸闷或胸痛而接受跑步机运动测试的患者。使用患者的病历来确定慢性肝病的存在和类型。进行了多项逻辑回归分析，以评估焦虑和抑郁与慢性肝病之间的关联。共分析了 2537 例肝功能检查结果和腹部超声数据，其中 1965 例患者的跑步机运动试验呈阴性。这些 1965 例患者的平均年龄为 51.9 岁，54.2%为男性。酒精性肝病、乙型肝炎、丙型肝炎和脂肪肝的患病率分别为 10.6%、10.9%、3.7%和 27.0%。多因素逻辑回归分析结果显示，酒精性肝病患者焦虑（调整后的优势比[aOR] = 1.83，P <.001）和抑郁（aOR = 1.85，P <.001）的风险显著更高。脂肪肝患者的焦虑显著更高（aOR = 1.30，P =.031），慢性丙型肝炎患者的抑郁风险显著更高（aOR = 2.18，P =.005）。总之，在非心源性胸痛患者中，酒精性肝病与焦虑和抑郁显著相关，而脂肪肝和慢性丙型肝炎分别与焦虑和抑郁相关。临床医生在实践中应警惕这些相关性。
