| ObjectiveTo explore the effect of hypersensitive C-reactive protein（Hs-CRP）levels of patients with coronary stent implantation（CSI）preoperatively on anxiety and depression in patients 6 months after surgery,the results of the study It can provide a scientific basis for the prevention of anxiety and depression in patients undergoing postoperative CSI.MethodA cohort approach was used in this study.Patients who were diagnosed with CHD and required CSI in the Department of Cardiology of the first hospital in Zibo City were selected as study subjects,and preoperative Hs-CRP levels were used as exposure factors（subjects with Hs-CRP in the range of 0-5mg/L as a control group and subjects with Hs-CRP>5mg/L as an exposure group）,using the hospital anxiety and Depression Scale（Hospital Anxiety and depressionScale,HADS）measures preoperative anxiety and depression status of study subjects.Study subjects with mild and above anxiety and depression status preoperatively were not included in this study.Meanwhile,other clinical data of the patients were collected.Follow up was performed 6 months postoperatively and study subject hads and Seattle Angina scale（SAQ）scores were measured again.The Hs-CRP of study subjects before operation as an independent variable together with other clinical data indicators were subjected to univariate and multivariate logistic regression analysis to evaluate the effect of preoperative Hs-CRP level on the development of anxiety and depression in study subjects,and to screen the influencing factors on the development of anxiety and depression in study subjects 6 months after operation.Researchers stayed in the internal medicine in Zibo No.1 Hospital from January 1st,2018 to February 26th,2019 and selected the patients conducted artery stent implantation as target.Before the operation,the Hs-CRP was measured and other clinic information about the patients were collected.Hospital Anxiety and Depression Scale（HAD）and he Seattle Angina Questionnaire（SAQ）were followed up.Those whose scores in HADS ≤7 were the non-anxiety and depression group while those whose scores in HADS>7 were the anxiety and depression group.With the Hs-CRP and other clinic information as independent variable,and HADS after the operation as dependent variable.Multiple Logistic regression analysis were performed to analyze the the connection between the level of Hs-CRP before the operation and patients’ anxiety and depression after the operation.Enter data from all questionnaires into SPSS25.0 statistical software and conduct data analysis through double review.The measurement is represented by "mean ±standard deviation" and the count is represented in percentage.χ2 test is used for counting data,rank and test for grade data;t is used for measurement data;multi-factor regression analysis adopts Logistic regression analysis,with P<0.05 has statistical significance.Result1.The baseline of this cohort study included 248 subjects,238 of whom were followed up,10 of whom were not followed up,4%of whom were not followed up,2 of whom were exposed,3.1%of whom were not followed up,and 8 of whom were in the control group,the dropout rate was 4.6%.Chi-square test was performed in the two groups,χ2=0.281,P=0.596,P>0.05.There was no significant difference.A total of 238 subjects were included in the analysis.The results of the characteristic distribution of people in the exposed and control groups showed that the two groups compared gender,occupation,education,medical insurance type with no statistical significance（P>0.05）,the age,disease and bilirubin,the difference had statistical significance（P<0.05）.2.The preoperative Hs-CRP level of the subjects and its influencing factors The results of the study 238 subjects preoperative Hs-CRP ranged from 0.13-109.16 mg/L,showing a skewed distribution,with a median M of 2.23 mg/L;the exposure group was 65 The median preoperative Hs-CRP level M was 12.12 mg/L;in the control group 173 people,the preoperative median Hs-CRP level M was 1.21 mg/L.The analysis of factors affecting the level of Hs-CRP before surgery showed that age（P=0.023）,disease type（P=0.002）and direct bilirubin（P=0.028）may be confounding factors affecting anxiety and depression emotional state.3.Results the incidence of anxiety and depression was 72.31%in the exposure group and 26.01%in the control group.There was significant difference between the two groups（χ2=50.629,P<0.001）.The incidence of anxiety and depression 6 months after operation in the exposure group was significantly higher than that in the control group,46.3%higher than that in the control group.The incidence of postoperative anxiety and depression in men and women in the exposure group were 74.47%and 25.53%respectively.There was significant difference between sexes（P<0.05）.The results showed that the incidence of anxiety and depression in high exposure group and low exposure group was significantly higher than that in control group,and the incidence of anxiety and depression in high exposure group was significantly higher than that in low exposure group（P<0.05）.In addition,the incidence rate of anxiety and depression in patients with Acute coronary syndromes（ACS）6 months after CSI was significantly higher than that in patients with chronic coronary artery disease（Chronic coronary Artery Disease,CAD）.Compared with the group,the incidence rate of anxiety and depression in the high exposure group of 6 months after operation was significantly higher than that in the low exposure group and the control group.The difference was statistically significant（P<0.05）.4.Results the preoperative Hs-CRP level and its influencing factors of 238 subjects ranged from 0.13 to 109.16mg/l,showing a skewed distribution,with a median m of 2.23 mg/L;The results of correlation analysis between preoperative Hs-CRP level and postoperative anxiety and depression showed that there was a correlation between preoperative Hs-CRP level and postoperative anxiety and depression.In addition,age,disease type and direct bilirubin were also associated with postoperative anxiety and depression.The results of multivariate analysis showed that Hs-CRP（P=0.001,or=1.125,95%CI（1.003-1.413））,age（P=0.004,or=1.216,95%CI（1.001-1.546））and disease type(P=0.043,or=1.618,95%CI（1.223-1.892）were independent risk factors for the occurrence of anxiety and depression after CSI.In order to exclude the influence of potential confounding factors on the results,after adjusting for disease and direct bilirubin,the association between Hs-CRP and the risk of anxiety and depression still existed（P=0.003）;After adjusting for age,disease type and direct bilirubin,the association between Hs-CRP and the risk of anxiety and depression still exists（P=0.007）.Hs-CRP is an independent influencing factor of anxiety and depression 6 months after CSI.Conclusion1.High preoperative Hs-CRP level is an independent risk factor for postoperative anxiety and depression,which can increase the risk of anxiety and depression 6 months after CSI.2.The risk of postoperative anxiety and depression in men with high preoperative Hs-CRP level is higher than that in women.3.Age and ACS were associated with the preoperative Hs-CRP level and the risk of anxiety and depression 6 months after CSI,which were the confounding factors in this study;After adjusting for confounding factors,Hs-CRP was an independent risk factor for anxiety and depression after CSI.SuggestionFor the subjects with high preoperative Hs-CRP level,it is recommended to timely analyze the causes of the increase of Hs-CRP and carry out clinical treatment and nursing intervention in advance,so as to reduce the occurrence of anxiety and depression 6 months after CSI.Patients with postoperative anxiety and depression should be actively treated to reduce the impact of anxiety and depression on the body’s inflammatory response. |
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