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Article(id=1211269042543923899, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269034906088369, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.03.11, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1595174400000, receivedDateStr=2020-07-20, revisedDate=1604332800000, revisedDateStr=2020-11-03, acceptedDate=null, acceptedDateStr=null, onlineDate=1766718644033, onlineDateStr=2025-12-26, pubDate=1616860800000, pubDateStr=2021-03-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766718644033, onlineIssueDateStr=2025-12-26, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766718644033, creator=13701087609, updateTime=1766718644033, updator=13701087609, issue=Issue{id=1211269034906088369, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='3', pageStart='213', pageEnd='318', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766718642212, creator=13701087609, updateTime=1766718779849, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269612247838856, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269034906088369, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269612247838857, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269034906088369, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=280, endPage=285, ext={EN=ArticleExt(id=1211269042883662553, articleId=1211269042543923899, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Progress of clinical research on complicated anxiety and depression after percutaneous coronary intervention, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Percutaneous coronary intervention (PCI) is one of the effective treatments for coronary heart disease (CHD), but it may cause stress events since its invasive might lead to various somatization symptoms, and then bring about anxiety, depression and other psychological disorders, thus affecting its curative effect and prognosis. In recent years, due to the extensive development of PCI treatment, such patients are not rare in clinic. It has been proved that anxiety and/or depression and CHD are reciprocal and influenced by multiple factors, but the pathophysiological mechanism is still not clear. With the continuous development of "double-heart medicine" model, clinical workers have paid more attention to the identification and diagnosis of cardiovascular disease complicated with psychological problems. The research progress of clinical diagnosis and treatment of patients with complicated anxiety and/or depression after PCI has been reviewed in present paper, thus provides a reference for the implementation of clinical work.

, correspAuthors=Gui-Zhou Tao, authorNote=null, correspAuthorsNote=
*E-mail:
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经皮冠状动脉介入治疗(PCI)是冠心病的有效治疗手段之一，但因其为有创性操作，可使患者产生压力性事件，出现各种躯体化症状，进而出现焦虑、抑郁等心理障碍，从而影响其疗效及预后。近年来由于PCI的广泛开展，此类患者在临床并不少见，并已证实焦虑抑郁与冠心病的发生互为因果且受多种因素影响，但目前其病理生理机制尚不明确。随着“双心医学”的不断发展，临床工作者对心血管疾病合并心理问题的识别及诊治更加重视。该文对PCI术后合并焦虑和(或)抑郁患者的临床研究进展进行综述，以期为临床工作的实施提供参考依据。

, correspAuthors=陶贵周, authorNote=null, correspAuthorsNote=
陶贵周，E-mail：
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朱晓婧，硕士研究生，主要从事冠心病的基础与临床研究。E-mail：

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朱晓婧，硕士研究生，主要从事冠心病的基础与临床研究。E-mail：

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朱晓婧，硕士研究生，主要从事冠心病的基础与临床研究。E-mail：

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经皮冠状动脉介入治疗术后合并焦虑抑郁的临床研究进展
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朱晓婧 , 陶贵周 *
解放军医学杂志 | 综述 2021,46(3): 280-285
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解放军医学杂志 | 综述 2021, 46(3): 280-285
经皮冠状动脉介入治疗术后合并焦虑抑郁的临床研究进展
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朱晓婧 , 陶贵周*
作者信息
  • 锦州医科大学附属第一医院心内科，辽宁 锦州 121000

    • 朱晓婧，硕士研究生，主要从事冠心病的基础与临床研究。E-mail：

通讯作者:

陶贵周，E-mail：
Progress of clinical research on complicated anxiety and depression after percutaneous coronary intervention
Xiao-Jing Zhu , Gui-Zhou Tao*
Affiliations
  • Department of Cardiology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China
出版时间: 2021-03-28 doi: 10.11855/j.issn.0577-7402.2021.03.11
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摘要
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经皮冠状动脉介入治疗(PCI)是冠心病的有效治疗手段之一，但因其为有创性操作，可使患者产生压力性事件，出现各种躯体化症状，进而出现焦虑、抑郁等心理障碍，从而影响其疗效及预后。近年来由于PCI的广泛开展，此类患者在临床并不少见，并已证实焦虑抑郁与冠心病的发生互为因果且受多种因素影响，但目前其病理生理机制尚不明确。随着“双心医学”的不断发展，临床工作者对心血管疾病合并心理问题的识别及诊治更加重视。该文对PCI术后合并焦虑和(或)抑郁患者的临床研究进展进行综述，以期为临床工作的实施提供参考依据。

经皮冠状动脉介入治疗  /  冠心病  /  焦虑  /  抑郁

Percutaneous coronary intervention (PCI) is one of the effective treatments for coronary heart disease (CHD), but it may cause stress events since its invasive might lead to various somatization symptoms, and then bring about anxiety, depression and other psychological disorders, thus affecting its curative effect and prognosis. In recent years, due to the extensive development of PCI treatment, such patients are not rare in clinic. It has been proved that anxiety and/or depression and CHD are reciprocal and influenced by multiple factors, but the pathophysiological mechanism is still not clear. With the continuous development of "double-heart medicine" model, clinical workers have paid more attention to the identification and diagnosis of cardiovascular disease complicated with psychological problems. The research progress of clinical diagnosis and treatment of patients with complicated anxiety and/or depression after PCI has been reviewed in present paper, thus provides a reference for the implementation of clinical work.

percutaneous coronary intervention  /  coronary heart disease  /  anxiety  /  depression
朱晓婧, 陶贵周. 经皮冠状动脉介入治疗术后合并焦虑抑郁的临床研究进展. 解放军医学杂志, 2021 , 46 (3) : 280 -285 . DOI: 10.11855/j.issn.0577-7402.2021.03.11
Xiao-Jing Zhu, Gui-Zhou Tao. Progress of clinical research on complicated anxiety and depression after percutaneous coronary intervention[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (3) : 280 -285 . DOI: 10.11855/j.issn.0577-7402.2021.03.11
正文
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近年来，随着生物-心理-社会医学模式的完善及“双心医学”在心血管疾病(cardiovascular disease，CVD)诊疗中的发展，冠心病合并焦虑抑郁障碍的基础与临床研究逐渐深入。1985年，Jefferson[1]第一次提出“双心医学”的概念，认为若患者仅有CVD症状而无客观依据，则考虑为焦虑综合征。1995年，胡大一教授在我国首次提出了心脏与心理双心同治的“双心医学”理论，开启了双心医学发展的新篇章[2]。如今，双心医学已在临床上广泛开展，受到越来越多临床专家及学者的关注与重视，并使众多患者受益。
冠状动脉粥样硬化性心脏病(简称冠心病)，归属于缺血性心脏病，是动脉粥样硬化导致器官病变的最常见类型[3]。目前，冠心病在世界范围内的发病率及死亡率居高不下。经皮冠状动脉介入治疗(PCI)作为治疗冠心病的重要手段[4]，可明显缓解患者的临床症状，降低病死率，并明显改善其生活质量；PCI治疗冠心病尤其是急性冠脉综合征(ACS)的效果显著[5]。但与PCI相关的风险及潜在的并发症(如支架内再狭窄、支架内血栓形成等)[6]可能会增加患者的精神压力，从而增加术后焦虑及抑郁的发生率。因此，早期识别、预防及治疗ACS或经PCI治疗后合并焦虑抑郁障碍的患者，对其预后及远期生活质量尤为重要。本文就PCI术后合并焦虑抑郁障碍的临床研究进展进行综述。
1 流行病学
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有研究指出，情绪障碍是CVD的危险因素之一，而抑郁是影响冠心病预后的独立危险因素[7-8]，抑郁症与PCI术后病死率增高及不良临床结局相关。鉴于抑郁症对PCI术后恢复的负面影响，在PCI术后患者中识别出抑郁症至关重要[9]。与CVD发展相关的另一个心理因素是焦虑，且可单独发生或与抑郁症同时发生。Watkins等[10]发现，焦虑与抑郁症同时发生对冠心病的预后有严重的不利影响。有研究发现，接受PCI治疗的患者可发生情感障碍，包括焦虑及抑郁[11]。PCI术后第1周，焦虑症的患病率为25%~37%[12]，抑郁症的患病率高达67%，其中老年冠心病患者的抑郁症患病率为60.7%[13]。因此，对行PCI治疗的患者应予以足够重视，在PCI术前、术中及术后给予适当的宣传教育、焦虑抑郁筛查及相应的治疗指导，鼓励患者正确认识该疾病并积极配合治疗。
2 影响因素
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随着PCI的有效性、可行性及安全性在临床应用中得到肯定，接受PCI的患者人数逐年增加。但由于PCI是一种侵入性治疗，对患者是一个严重的压力事件。有研究指出，部分患者PCI术后可能出现心理问题[14-15]，主要由以下原因所致：对疾病本身及手术干预的认识不足，在手术操作过程中的心理压力，以及缺少足够的医学教育所产生的种种担心等。此类问题在老年患者中尤为常见，可能严重影响患者的日常生活及工作。常见的心理问题包括以下3种情况：(1)由于对疾病认识不足或经历首次医疗接触(first medical contact，FMC)时间较长等，患者可能对冠脉血管造影和(或)PCI之前的情况感到焦虑；(2)在血管造影和(或)PCI期间，长时间的仰卧姿势可引起患者的不适，拔除鞘管后也可出现穿刺部位疼痛及自觉不安[16]；(3)PCI术后患者通常被转入冠心病监护病房(CCU)，需要完全卧床休息，尤其是自股动脉入路操作的患者，术后须将下肢制动，增加了患者的心理负担；在CCU特殊环境中，虽然减少了术后并发症的发生机会，但也会让患者感到陌生与压力，从而可能导致患者在PCI术后出现焦虑和(或)抑郁。此外，患者对术后第1天潜在的心脏功能损害的过度关注也是术后出现焦虑及抑郁症状的危险因素[14]。冠心病后焦虑症(post-CHD anxiety)是指在冠心病发作后发生的焦虑症，其可能的潜在危险因素包括年龄大、女性、受教育程度低、有吸烟饮酒等不良生活行为、冠状动脉粥样硬化狭窄严重、冠心病病程长及有冠心病合并症等[17]，这些危险因素也增加了PCI术后发生焦虑抑郁的风险[18]。
3 病理生理学机制
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PCI术后发生焦虑抑郁的确切机制目前尚未明确。动物研究表明，PCI术后发生焦虑抑郁的机制主要与大脑边缘系统-纹状体-丘脑神经递质环路被阻断有关[19]。但部分研究发现，慢性焦虑症常伴随一系列病理生理过程，包括生理行为机制、心理因素及遗传因素[20]，如交感神经系统活性增强[21]及炎症反应等[22]。焦虑或抑郁症状可加重冠心病患者的炎症反应，且手术本身也可增强交感神经活性及炎症反应[14]。
焦虑抑郁与ACS的病理生理过程相似，并可通过生理及行为改变增加ACS患者再发心血管事件的风险[20]。焦虑抑郁可导致患者的血小板活性增加、内皮功能障碍、炎症反应增强、心率变异性降低及神经内分泌失调，以上改变均可增加其发生心血管事件的风险。
焦虑抑郁可直接或间接地导致冠状动脉疾病的风险增加。在抑郁症患者中，焦虑抑郁可预测心脏事件并促进动脉粥样硬化的生物标志物表达水平升高[18]。抑郁症通过持续不健康的生活方式间接增加了焦虑抑郁障碍的发生及发展风险[20]。焦虑抑郁症可能降低ACS患者二级预防的依从性，如戒烟限酒、低盐低脂饮食、适当运动、寻求医疗帮助及参与心脏康复等。在此类因素影响下，PCI术后发生焦虑或抑郁症可能导致ACS患者发生不良心血管事件。因此，尽早识别、积极干预焦虑抑郁可改善ACS患者的预后。
4 筛查
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PCI术后焦虑抑郁障碍的发病率及患病率均较高。有研究提示，有必要对PCI术后患者常规进行焦虑抑郁情况筛查[23]。美国心脏病学会建议使用《患者健康问卷9项》(PHQ-9)对冠心病患者进行抑郁症状筛查，以识别存在抑郁风险的患者，并提供了进一步的评估及治疗方案[24]。美国家庭医师学会建议，应在患者发生心肌梗死后的急性期(包括住院期间)定期检查其是否患有抑郁症[25]，且有研究证实将PHQ-9用于住院冠心病患者的抑郁症筛查具有一定实用性[26]。此外，还有研究发现，《广泛焦虑问卷7项》(GAD-7)可用于冠心病患者的焦虑症筛选[27]。PHQ-9及GAD-7能可靠地筛查冠心病住院患者的焦虑状况，并可用于临床工作中，其阳性筛查结果可作为临床干预焦虑抑郁障碍的依据。
5 诊断
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5.1 诊断流程
鉴于临床工作的实际需要，可先进行初筛：首先，对患者进行询问；其次，对患者的回答进行评估；最后，针对患者的病情进行个体化系统性治疗。初筛可采用“三问法”：是否有睡眠不好或已经明显影响日间精神状态或需要用药治疗；是否有心烦不安或对以前感兴趣的事物失去兴趣；是否有明显的身体不适但多次检查均不能发现明确的原因。若有两个问题回答“是”，则有80%的可能诊断为精神障碍。或选用“二问法”初筛，即采用《患者健康问卷2项》(PHQ2)[28]及《广泛焦虑问卷2项》(GAD-2)[29]进行筛查。当评分>3分时，建议进一步采用PHQ-9、GAD-7评估抑郁、焦虑或压力水平。PHQ-9与GAD-7的评分标准一致：<5分为正常，只需在针对CVD进行标准治疗的同时随访患者心理状况；5~14分[5~9分为轻度抑郁和(或)焦虑，10~14分为中度抑郁和(或)焦虑]时，则须接受中西医结合双心医学治疗，随访评估疗效；≥15分[15~19分为中重度抑郁和(或)焦虑，≥20分为重度抑郁和(或)焦虑]时，患者需要转诊至精神专科进行系统治疗。当躯体化症状较严重时，可采用《躯体化症状自评量表》(SSS)或《患者健康问卷15项》(PHQ-15)进行躯体化症状评估。SSS评分：<30分为正常；30~39分为轻度躯体化症状；40~59分为中度躯体化症状；≥60分为重度躯体化症状。PHQ-15评分：0~4分为无躯体化症状，5~9分为轻度躯体化症状，10~14分为中度躯体化症状，15~30分为重度躯体化症状[30]。
5.2 诊断标准
应用PHQ-9、GAD-7量表评估患者心理状况，5~10分可诊断为PCI术后合并焦虑抑郁，须接受中西医结合双心医学治疗[31]。
6 治疗
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主要采用“防治结合，防大于治”的治疗理念，还应注重个体化及灵活用药，重视心理治疗及社会支持等综合干预措施，但最有效的治疗手段是药物治疗。
6.1 一般治疗
6.1.1 双心医学治疗
专家建议对PCI术前术后出现抑郁和(或)焦虑的患者采用双心医学治疗[32]，即通过开设双心门诊、开展双心查房等手段，关心患者心理问题，了解患者心理情况及疾病进展，做到心脏及心理双心同治，从而提高患者的生活质量。
6.1.2 加强心理疏导
心理疏导对于改善焦虑抑郁障碍患者的焦虑、抑郁症状及预后非常重要，可在心理动机、认知行为及人文主义等方面减轻患者的情绪低落或长期压力，但同时应加强术前术后对患者的教育。认知行为疗法、支持性心理治疗、放松训练及音乐疗法等对轻、中度焦虑均有很好的治疗效果[33]。
因此，在患者PCI术前术后均应给予预防性心理干预，为患者详细讲解手术的具体流程及相关注意事项，实时观察患者的心理状态，对其不良情绪加以有效疏导，加强医学教育，增强患者心理承受能力，以最终改善患者的预后。
6.2 运动疗法
低运动量训练可缓解患者PCI术后合并的焦虑抑郁症状[34]。适度的有氧运动(如中国传统运动八段锦、易筋经及24式太极拳等)不仅能明显缓解冠心病患者PCI术后的焦虑抑郁症状，减轻在疾病恢复过程中的不适，还能降低其心绞痛的发作频率及程度，增加长期患病患者的社会交往机会，有利于其恢复心理健康并积极融入社会。
6.3 药物治疗
药物治疗在PCI术后合并焦虑抑郁治疗中的地位不容忽视。PCI术后治疗不仅包括支架植入术后常规保护支架用药，还应针对患者病情给予抗焦虑抑郁药物。用药原则：诊断明确，全面考虑，个体化合理用药；剂量逐步递增，采用最小有效剂量使不良反应降至最低，提高服药依从性；小剂量疗效不佳时，根据不良反应及耐受情况调整至足量、足疗程；如无效，可考虑换药；尽可能单一用药，足量、足疗程治疗，一般不主张2种以上药物联用。在用药前应向患者及家属阐明药物性质、作用、可能发生的不良反应及对策，争取患者及家属的配合，以提高治疗的依从性[35]。
6.3.1 抗焦虑药
目前，临床上常用的抗焦虑药物包括苯二氮䓬类药物(BZD)、选择性5-羟色胺1A受体激动剂、β肾上腺素能受体阻滞剂，另有部分兼具抗焦虑作用的抗抑郁药，临床也作为抗焦虑药物使用。其中β肾上腺素能受体阻滞剂对躯体性焦虑尤其是焦虑症的心血管症状，或有药物滥用倾向者较为适宜；口服β受体阻滞剂可用于急性冠脉综合征后的二级预防，能降低病死率，对远期心功能恢复具有积极影响。
6.3.2 抗抑郁药
选择性5-羟色胺再摄取抑制剂(SSRI)作为新型抗抑郁药目前已广泛应用于临床，包括舍曲林、氟西汀及艾司西酞普兰等。SSRI不仅克服了三环类抗抑郁药的缺点，而且药物半衰期短(除氟西汀外)、疗效定位准确、不良反应小、耐受性好、用药方便，从而提高了患者的依从性，尤其适用于合并内科疾病的抑郁症患者。周学平等[36]采用舍曲林治疗冠心病行PCI术后患者的焦虑抑郁状态，发现其疗效显著。
6.3.3 其他药物
(1)配方/合剂药物：代表药物为氟哌噻吨美利曲辛。除SSRI类药物外，氟哌噻吨美利曲辛也被广泛使用，对PCI术后合并焦虑抑郁患者具有较好疗效[37]。(2)中药制剂：有一定镇静安神，抗焦虑、抑郁作用，安全性好，可用于轻中度焦虑抑郁患者，重度患者应联合使用抗抑郁药。其中，心内科门诊患者合并心理疾病最常见的几种证型及代表药物包括：①肝火扰心证，代表药有逍遥散、加味逍遥散、龙胆泻肝丸、当归龙荟丸；②痰热扰心证，代表药为牛黄清心丸；③心血瘀阻证，最常见的代表药为冠心丹参滴丸；④心脾两虚证，代表药有人参归脾丸、九味镇心颗粒、天王补心丹等[30]。其中九味镇心颗粒作为一种新型抗焦虑抑郁药物，具有养心补脾、益气安神的功效，适用于善思多虑不解、失眠或多梦、心悸、食欲不振、神疲乏力、头晕、易汗出、善太息、面色萎黄的患者[33]。组方中含有君药人参、酸枣仁，有气血双补、心脾两调功效；臣药五味子、远志、茯苓、延胡索，有镇静安神、补脾益肾功效；佐药天冬、熟地黄，有养心血、滋心阴功效；使药肉桂，有沟通阴阳、气血上下疏通功效。其组方中人参皂苷、五味子木脂素可抑制脑组织中5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)等单胺类神经递质的释放[38-39]；酸枣仁、熟地黄及远志中的成分延胡索中提取的生物碱可增强γ-氨基丁酸受体的抑制作用，导致氯离子通道开放的频率增快，从而加强中枢抑制效应，共同发挥抗焦虑作用。九味镇心颗粒可缓解患者的焦虑症状，促进神经功能恢复，其作用机制可能为调节机体神经递质以抑制自主神经功能紊乱，从而减轻焦虑情绪[40]。
近年来，中药治疗冠心病合并焦虑抑郁障碍已成为CVD领域的研究热点[17,41]。目前，九味镇心颗粒联合PCI术后常规治疗对于心脾两虚证患者的效果显著。郭佳飞[42]比较了草酸艾司西酞普兰片(来士普)与九味镇心颗粒治疗PCI术后焦虑抑郁的临床效果，结果发现，经4周治疗后，九味镇心颗粒组的预后及安全性均较好。Ma等[43]在一项双盲、随机、安慰剂对照试验中发现，心可舒片可减轻冠心病患者的焦虑或抑郁症状。上述研究结果表明，中药治疗可有效解决冠心病患者PCI术后的情绪异常，并改善其生活质量。
7 双心医学实施的可行性
收起
关于心内科医师治疗心血管疾病合并轻中度精神障碍患者的可行性，《在心血管科就诊患者的心理处方中国专家共识(2020版)》指出，通过培养心内科医师掌握精神心理卫生知识，对有轻中度心理障碍的患者给予对症抗抑郁治疗，症状缓解有效率高达79.4%[27]，提示心内科处理轻中度心理障碍是一种可行的干预模式。心血管疾病患者尤其是门诊患者如合并精神障碍，大多就诊于心内科门诊，因此，心内科医师在门诊发现患者存在精神心理改变时，应对其进行筛查、评估后予以诊治，轻中度心理障碍患者可给予对症处置，中重度患者及时与精神科、心理科联合双心医学治疗，以避免漏诊及延误病情。
8 总结与展望
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尽管PCI治疗具有创伤小的优点，但仍为有创治疗手段。因此，针对PCI术后合并焦虑抑郁障碍的患者，应及时采取措施进行干预。在临床工作中积极开展双心医学治疗，可改善患者的焦虑抑郁情绪，提高患者的生活质量。对于PCI术后合并焦虑抑郁的治疗仍在不断探究，未来将会有更多中药用于PCI术后合并焦虑抑郁的治疗。
基金
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  • 国家重点研发计划(2016YFC1301300)
文献
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2021年第46卷第3期
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doi: 10.11855/j.issn.0577-7402.2021.03.11
  • 接收时间：2020-07-20
  • 首发时间：2025-12-26
  • 出版时间：2021-03-28
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  • 收稿日期：2020-07-20
  • 修回日期：2020-11-03
基金
National Key Research and Department Project of China(2016YFC1301300)
国家重点研发计划(2016YFC1301300)
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    锦州医科大学附属第一医院心内科，辽宁 锦州 121000

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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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