2019 年第 9 期 第 14 卷

心理应激与传统压力应激诱发稳定型冠状动脉粥样硬化性心脏病心肌缺血的发生率及性别差异的Meta分析

Incidence of myocardial ischemia induced by mental stress and conventional stress in patients with stable coronary atherosclerotic heart disease and the difference between gender: a meta-analysis

作者：郗萌周蓉任延平

英文作者：

单位：710062西安交通大学第一附属医院老年内一科

英文单位：

关键词：稳定型冠状动脉粥样硬化性心脏病；心理应激性心肌缺血；传统压力相关性心肌缺血

英文关键词：

• 摘要：

• 【摘要】目的    探讨心理应激与传统压力应激诱发稳定型冠状动脉粥样硬化性心脏病（冠心病）患者心肌缺血的发生率及性别差异。方法    在万方医学网、中国知网、维普、Ovid、Pubmed数据库中检索与心理应激性心肌缺血（MSIMI）和传统压力相关性心肌缺血（CSIMI）有关的自身前后对照研究文献。按照纳入与排除标准提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。结果    最终纳入8篇文献，包括4 371例患者，其中给予心理应激4 371例，给予传统压力应激4 364例。Meta分析结果显示，心理应激诱发稳定型冠心病患者急性心肌缺血的发生率低于传统压力应激［15.2%(664/4 371)比32.4%(1 414/4 364)］，差异有统计学意义（比值比=0.37，95%置信区间：0.34～0.41，P＜0.05）。不同性别稳定型冠心病患者MSIMI和CSIMI发生率比较差异均无统计学意义（风险差=1.10，95%置信区间：0.79～1.53，P=0.57；风险差=0.00，95%置信区间：-0.10～0.11，P=0.98）。结论    在稳定型冠心病患者中MSIMI的发生率较CSIMI低，但不同性别患者的MSIMI和CSIMI的发生率未见明显差异。

• 【Abstract】Objective    To assess the incidence of myocardial ischemia induced by mental stress and conventional stress in patients with stable coronary atherosclerotic heart disease（CHD） and to analyze the difference between gender. Methods    Self-controlled literatures related to mental stress-induced myocardial ischemia(MSIMI) and conventional stress-related myocardial ischemia(CSIMI) were identified using Wanfang Medical Network, China National Knowledge Infrastructure, VIP Database, Ovid and Pubmed. Valid data were retrieved in compliance with the inclusion and exclusion criteria. Risk of bias of the studies was evaluated. Meta-analysis was performed using RevMan 5.3 software. Results    Eight literatures were included, including 4 371 patients, of whom 4 371 were treated with mental stress and 4 364 were treated with conventional stress. Meta-analysis showed that the incidence of MSIMI was lower than that of CSIMI［15.2%(664/4 371) vs 32.4%(1 414/4 364)］, with significant difference(odds ratio=0.37, 95% confidence interval: 0.34-0.41, P＜0.05). No significant difference was observed in the incidences of MSIMI and CSMI between males and females(risk difference=1.10, 95% confidence interval: 0.79-1.53, P=0.57; risk difference=0.00, 95% confidence interval: -0.10-0.11, P=0.98). Conclusions    The incidence of MSIMI in patients with CHD is lower than that of CSIMI. There is no significant difference in the incidence of MSIMI and CSMI between genders.