中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
10期
1147-1152
,共6页
孙同文%徐青艳%姚海木%关方霞%张晓娟%郝雪琴%张竞超%吴琼%彭飞%杨飞%马尚超%路喃喃%张金盈%阚全程
孫同文%徐青豔%姚海木%關方霞%張曉娟%郝雪琴%張競超%吳瓊%彭飛%楊飛%馬尚超%路喃喃%張金盈%闞全程
손동문%서청염%요해목%관방하%장효연%학설금%장경초%오경%팽비%양비%마상초%로남남%장금영%감전정
急性冠脉综合征%血管成形术%经皮冠状动脉介入%代谢综合征%胰岛素抵抗%心脏不良事件%预后
急性冠脈綜閤徵%血管成形術%經皮冠狀動脈介入%代謝綜閤徵%胰島素牴抗%心髒不良事件%預後
급성관맥종합정%혈관성형술%경피관상동맥개입%대사종합정%이도소저항%심장불량사건%예후
Acute coronary syndrome%Angioplasty%Percutaneous coronary intervention%Metabolic syndrome,Insulin resistance%Adverse cardiovascular events%Prognosis
目的 探讨代谢综合征( metabolic syndromes,MS)对于急性冠脉综合征(acute coronary syndromes,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后预后的影响.方法 连续选取2009年9月至2010年6月于郑州大学第一附属医院心内科住院的ACS患者660例为研究对象.入选标准:冠脉造影显示至少一支血管狭窄程度为75％以上,成功接受PCI手术治疗且资料完整者.排除标准:肝肾功能损伤或患有肿瘤、心脏瓣膜病.记录患者入院时的临床资料及生化检查结果,于2011年3月至6月进行门诊和电话随访,记录心脏不良事件的发生情况.根据是否合并MS将患者分为MS和非MS组,并进行临床特征的比较.组间率的比较应用x2检验,多因素Logistic回归模型探索与预后相关的因素,Kaplan-Meier生存曲线比较两组无心脏不良事件的生存率.以P ＜0.05为差异具有统计学意义.结果 ①成功随访605例(随访率91.7％),随访时间为(14.3±1.7)个月.95例患者发生心脏不良事件(发生率15.7％).②符合MS诊断患者有393例,占64.96％.MS组患者除具有体质量指数高、收缩压高、舒张压高、血糖高、血脂紊乱(P＜0.05)外,男性患者所占比例稍低(P =0.016),目前仍吸烟者较少(P=0.008),血小板计数升高(P =0.037).MS和非MS组心脏不良事件的发生率分别为17.81％和11.79％,差异无统计学意义(P＞0.05).③多因素Logistic分析显示:与心脏不良事件发生相关的危险因素为年龄(OR=2.628,95％可信区间,CI):1.395～4.954,P=0.003),纽约心脏病学会(New York Heart Association,NYHA)心功能分级≥3级(0R=2.310,95％ CI 1.095 ～4.870,P=0.028)和左心室射血分数(left ventricular ejection fraction,LVEF)(OR=4.328,95％ CI:1.955～ 9.580,P＜0.001),而MS与预后无相关性(OR=1.170,95％ CI0.583 ～2.345,P=0.659).④Kaplan-Meier生存曲线分析显示两组无心脏事件的累积生存率差异无统计学意义(P＞0.05).结论 MS是冠心病的高危因素,但对于ACS患者PCI术后心脏不良事件的发生无明显影响.
目的 探討代謝綜閤徵( metabolic syndromes,MS)對于急性冠脈綜閤徵(acute coronary syndromes,ACS)患者經皮冠狀動脈介入(percutaneous coronary intervention,PCI)術後預後的影響.方法 連續選取2009年9月至2010年6月于鄭州大學第一附屬醫院心內科住院的ACS患者660例為研究對象.入選標準:冠脈造影顯示至少一支血管狹窄程度為75％以上,成功接受PCI手術治療且資料完整者.排除標準:肝腎功能損傷或患有腫瘤、心髒瓣膜病.記錄患者入院時的臨床資料及生化檢查結果,于2011年3月至6月進行門診和電話隨訪,記錄心髒不良事件的髮生情況.根據是否閤併MS將患者分為MS和非MS組,併進行臨床特徵的比較.組間率的比較應用x2檢驗,多因素Logistic迴歸模型探索與預後相關的因素,Kaplan-Meier生存麯線比較兩組無心髒不良事件的生存率.以P ＜0.05為差異具有統計學意義.結果 ①成功隨訪605例(隨訪率91.7％),隨訪時間為(14.3±1.7)箇月.95例患者髮生心髒不良事件(髮生率15.7％).②符閤MS診斷患者有393例,佔64.96％.MS組患者除具有體質量指數高、收縮壓高、舒張壓高、血糖高、血脂紊亂(P＜0.05)外,男性患者所佔比例稍低(P =0.016),目前仍吸煙者較少(P=0.008),血小闆計數升高(P =0.037).MS和非MS組心髒不良事件的髮生率分彆為17.81％和11.79％,差異無統計學意義(P＞0.05).③多因素Logistic分析顯示:與心髒不良事件髮生相關的危險因素為年齡(OR=2.628,95％可信區間,CI):1.395～4.954,P=0.003),紐約心髒病學會(New York Heart Association,NYHA)心功能分級≥3級(0R=2.310,95％ CI 1.095 ～4.870,P=0.028)和左心室射血分數(left ventricular ejection fraction,LVEF)(OR=4.328,95％ CI:1.955～ 9.580,P＜0.001),而MS與預後無相關性(OR=1.170,95％ CI0.583 ～2.345,P=0.659).④Kaplan-Meier生存麯線分析顯示兩組無心髒事件的纍積生存率差異無統計學意義(P＞0.05).結論 MS是冠心病的高危因素,但對于ACS患者PCI術後心髒不良事件的髮生無明顯影響.
목적 탐토대사종합정( metabolic syndromes,MS)대우급성관맥종합정(acute coronary syndromes,ACS)환자경피관상동맥개입(percutaneous coronary intervention,PCI)술후예후적영향.방법 련속선취2009년9월지2010년6월우정주대학제일부속의원심내과주원적ACS환자660례위연구대상.입선표준:관맥조영현시지소일지혈관협착정도위75％이상,성공접수PCI수술치료차자료완정자.배제표준:간신공능손상혹환유종류、심장판막병.기록환자입원시적림상자료급생화검사결과,우2011년3월지6월진행문진화전화수방,기록심장불량사건적발생정황.근거시부합병MS장환자분위MS화비MS조,병진행림상특정적비교.조간솔적비교응용x2검험,다인소Logistic회귀모형탐색여예후상관적인소,Kaplan-Meier생존곡선비교량조무심장불량사건적생존솔.이P ＜0.05위차이구유통계학의의.결과 ①성공수방605례(수방솔91.7％),수방시간위(14.3±1.7)개월.95례환자발생심장불량사건(발생솔15.7％).②부합MS진단환자유393례,점64.96％.MS조환자제구유체질량지수고、수축압고、서장압고、혈당고、혈지문란(P＜0.05)외,남성환자소점비례초저(P =0.016),목전잉흡연자교소(P=0.008),혈소판계수승고(P =0.037).MS화비MS조심장불량사건적발생솔분별위17.81％화11.79％,차이무통계학의의(P＞0.05).③다인소Logistic분석현시:여심장불량사건발생상관적위험인소위년령(OR=2.628,95％가신구간,CI):1.395～4.954,P=0.003),뉴약심장병학회(New York Heart Association,NYHA)심공능분급≥3급(0R=2.310,95％ CI 1.095 ～4.870,P=0.028)화좌심실사혈분수(left ventricular ejection fraction,LVEF)(OR=4.328,95％ CI:1.955～ 9.580,P＜0.001),이MS여예후무상관성(OR=1.170,95％ CI0.583 ～2.345,P=0.659).④Kaplan-Meier생존곡선분석현시량조무심장사건적루적생존솔차이무통계학의의(P＞0.05).결론 MS시관심병적고위인소,단대우ACS환자PCI술후심장불량사건적발생무명현영향.
Objective To investigate the predictive value of metabolic syndrome in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 660 patients with ACS admited to cardiovascular department,first affiliated hospital of zhengzhou university were enrolled in this study from January 2009 to June 2010.The enrollment criteria were:the stenosis degree were above 75％ in at least one coronary artery by coronary angiography and successful PCI procedure.Exculsion criteria were:liver and renal insufficiency,malignancies and valvular heart diseases.The relevant clinical data and labtory examination were recorded after admission. The patients were followed up by outpatients interview or telephone from March to June 2011 and adverse cardiovascular events were recorded.The patients were divided into MS and non-MS groups,and basic clinical data were compared between two groups.The proportion difference between two groups were tested by chi square. Multivariate logistic regression was established to analyze the factors related to progonosis.The survival ratio was estimated using the Kaplan-Meier method.Statistical significance was established at a P value of less than 0.05.Results ①A total of 606 (91.7％) patients successfully accepted follow-up.Mean follow-up time were ( 14.3 ±1.7 ) months.95 patients experienced adverse cardiovascular events ( 15.7％ ).②There were 393 patients (64.96％ ) satisfied the definition of metabolic syndrome.The patients in MS group were with higher BMI,SBP,DBP,blood glucose and disordered lipid (all P ＜ 0.05 ),with less fale patients (P =0.016),less current somking (P =0.008 ) and with higher platelet (P =0.037 ). The incidence of adverse cardiovascular events in two groups were 17.81％ and 11.79％ ( P ＞ 0.05 ). ③ Multivarite logistic regression revealed that the predictors of adverse cardiovascular events were age [ OR =2.628,95％ confidence interval (CI) 1.395 ～ 4.954,P =0.003 ],New York Heart Association (NYHA) ≥ 3 grade ( OR =2.310,95％ CI 1.095 ～4.870,P =0.028) and left ventricular ejection fraction (LVEF) ( OR =4.328,95％ CI 1.955 ～9.580,P ＜ 0.001 ).However,MS was not related with prognosis ( OR =1.170,95％ CI 0.583 ～ 2.345,P =0.659 ).④The cumulative survival rates of no adverse cardiovascular events in the two groups were no significant difference ( P ＞ 0.05 ).Conclusions MS is a risk factor with coronary heart disease.Howerer,it has no relationship with adverse cardiovascular events in patients with ACS after PCI.
