科研之友
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摘要
Background: Acute coronary syndrome (ACS) is mainly caused by the formation and rupture of vulnerable plaques. Some studies have demonstrated that stressful life events can increase the risk of ACS. However, it is still unclear whether stressful life events can cause ACS through influencing plaque vulnerability. At the same time, studies have confirmed that stressful life events can induce depression in individuals, which is closely related to plaque vulnerability. However, whether depression plays a mediating role between stressful life events and plaque vulnerability is also unknown. Objective: To explore the relationship between stressful life events and coronary atherosclerotic plaque vulnerability within one year before the onset of ACS, and analyze the mediating effect of depression. Methods: A total of 311 patients with ACS diagnosed by coronary angiography for the first time were selected as the research objects from the Department of Cardiology in a tertiary Class A hospital in Harbin from September 2018 to April 2019. The Life Events Scale(LES) and Self-Rating Depression Scale(SDS) were used to investigate the occurrence of stressful life events and depression in the year before the onset of ACS. Meanwhile, optical coherence tomography (OCT) was used to measure the vulnerability of coronary atherosclerotic plaques in patients, including thin-cap fibroatheroma(TCFA, measured by fibrous cap thickness and lipid arc), plaque rupture, lipid-rich plaque, thrombosis, macrophage and cholesterol crystallization. Results: Stressful life events occurred in 165(53. 1%) patients with ACS within one year before the onset of the disease, and 67(21.5%) patients had depression. Multivariate Logistic regression analysis showed that stressful life events were the independent influencing factors of TCFA〔OR=1.029, 95%CI(1.016, 1.043), P<0.001〕, plaque rupture〔OR=1.022, 95%CI(1.010, 1.034), P<0.001〕, lipid-rich plaque〔OR=1.018, 95%CI(1.005, 1.031), P=0.005〕, thrombosis〔OR=1.032, 95%CI(1.014, 1.050), P=0.001〕, and cholesterol crystallization〔OR=1.013, 95%CI(1.002, 1.024), P=0.025〕. Spearman correlation analysis showed that stressful life events were positively correlated with depression(rs=0.461, P<0.01), lipid arc(rs=0.385, P<0.01), and negatively correlated with fibrous cap thickness(rs=-0.465, P<0.01). Depression was positively correlated with lipid arc (rs=0.406, P<0.01) and negatively correlated with fibrous cap thickness(rs=-0.494, P<0.01). Pathway analysis and Bootstrap test showed that depression had the mediating effect in the relationship between stressful life events and fibrous cap thickness 〔β=-0.117, 95%CI(-0.157, -0.089), P<0.01〕 and lipid arc〔β=0.114, 95%CI(0.070, 0.173), P<0.01〕. Conclusion: The stressful life events within one year before the onset of ACS are closely related to the coronary atherosclerotic plaque vulnerability, and depression plays a mediating role between them. Hence, the early screening of stressful life events and depression among individuals would contribute to the identification of high-risk groups with vulnerable plaques. The timely psychological intervention is beneficial to slowing down the occurrence of vulnerable plaques and carrying out the prevention and treatment of ACS in advance.
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