中华临床医师杂志(电子版)
中華臨床醫師雜誌(電子版)
중화림상의사잡지(전자판)
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
24期
11131-11135
,共5页
李韶南%李广镰%黄慧芳%陈平安%刘震%雷晓明
李韶南%李廣鐮%黃慧芳%陳平安%劉震%雷曉明
리소남%리엄렴%황혜방%진평안%류진%뢰효명
钙质沉着症%血管成形术,经腔,经皮冠状动脉%预后%血压变异性
鈣質沉著癥%血管成形術,經腔,經皮冠狀動脈%預後%血壓變異性
개질침착증%혈관성형술,경강,경피관상동맥%예후%혈압변이성
Calcinosis%Angioplasty,transluminal,percutaneous coronary%Prognosis%Blood pressure variability
目的:探讨不稳定型心绞痛(UAP)患者冠状动脉钙化积分(CCS)与血压变异性(BPV)及冠状动脉病变严重程度的关系,并评价CCS与BPV对经皮冠状动脉腔内介入治疗(PCI)的UAP患者预后的预测价值。方法回顾性分析2009年6月至2011年6月在我院心内科住院首次接受冠状动脉造影(CAG)及PCI治疗的466例UAP患者,入选患者均在PCI术前接受320排螺旋CT心脏冠状动脉成像检查及24 h动态血压监测(ABPM),分别测量CCS及血压变异系数(CV),入选病例按CCS分为CCS≤100,CCS 101~400和CCS>400三组,比较三组患者血压变异性及冠状动脉病变严重程度的差异,PCI术后对三组患者进行12个月的随访,记录术后死亡、非致命性心肌梗死、靶病变血运重建及再发心绞痛入院等主要心脏不良事件(MACE)发生情况。结果 CCS>400组患者24 h收缩压变异系数(SBP-CV),24 h舒张压变异系数(DBP-CV)高于其他两组(13.2±2.2 vs.12.4±2.2 vs.11.8±1.7;10.8±1.5 vs.10.3±1.5 vs.9.7±1.0,P<0.05);冠状动脉病变更为严重,表现为冠状动脉多支病变比例、B2/C 型病变比例及冠状动脉病变Gensini积分均显著升高(47.6%vs.29.1%vs.18.3%;45.0%vs.27.3%vs.15.7%;56.8±16.9 vs.52.8±13.6 vs.36.7±17.1;P<0.05);并且CCS与SBP-CV呈正相关(r=0.322,P<0.05)。随访12个月,Kaplan-Meier生存分析发现三组患者累积无MACE事件生存率差异有统计学意义(88.8%vs.84.2%vs.77.2%,Log rank 8.044,P=0.005),在校正了年龄后,多因素Cox回归分析显示CCS>400及SBP-CV是UAP患者PCI术后MACE发生的独立预测因子。CCS>400组患者较CCS≤100组患者术后发生MACE的风险增加4.741倍(RR=4.741,P<0.01)。结论 CCS较高的UAP患者具有较高的血压变异性,并且冠状动脉病变更为严重,CCS及24 h SBP-CV对接受PCI治疗的UAP患者的临床预后具有预测价值。
目的:探討不穩定型心絞痛(UAP)患者冠狀動脈鈣化積分(CCS)與血壓變異性(BPV)及冠狀動脈病變嚴重程度的關繫,併評價CCS與BPV對經皮冠狀動脈腔內介入治療(PCI)的UAP患者預後的預測價值。方法迴顧性分析2009年6月至2011年6月在我院心內科住院首次接受冠狀動脈造影(CAG)及PCI治療的466例UAP患者,入選患者均在PCI術前接受320排螺鏇CT心髒冠狀動脈成像檢查及24 h動態血壓鑑測(ABPM),分彆測量CCS及血壓變異繫數(CV),入選病例按CCS分為CCS≤100,CCS 101~400和CCS>400三組,比較三組患者血壓變異性及冠狀動脈病變嚴重程度的差異,PCI術後對三組患者進行12箇月的隨訪,記錄術後死亡、非緻命性心肌梗死、靶病變血運重建及再髮心絞痛入院等主要心髒不良事件(MACE)髮生情況。結果 CCS>400組患者24 h收縮壓變異繫數(SBP-CV),24 h舒張壓變異繫數(DBP-CV)高于其他兩組(13.2±2.2 vs.12.4±2.2 vs.11.8±1.7;10.8±1.5 vs.10.3±1.5 vs.9.7±1.0,P<0.05);冠狀動脈病變更為嚴重,錶現為冠狀動脈多支病變比例、B2/C 型病變比例及冠狀動脈病變Gensini積分均顯著升高(47.6%vs.29.1%vs.18.3%;45.0%vs.27.3%vs.15.7%;56.8±16.9 vs.52.8±13.6 vs.36.7±17.1;P<0.05);併且CCS與SBP-CV呈正相關(r=0.322,P<0.05)。隨訪12箇月,Kaplan-Meier生存分析髮現三組患者纍積無MACE事件生存率差異有統計學意義(88.8%vs.84.2%vs.77.2%,Log rank 8.044,P=0.005),在校正瞭年齡後,多因素Cox迴歸分析顯示CCS>400及SBP-CV是UAP患者PCI術後MACE髮生的獨立預測因子。CCS>400組患者較CCS≤100組患者術後髮生MACE的風險增加4.741倍(RR=4.741,P<0.01)。結論 CCS較高的UAP患者具有較高的血壓變異性,併且冠狀動脈病變更為嚴重,CCS及24 h SBP-CV對接受PCI治療的UAP患者的臨床預後具有預測價值。
목적:탐토불은정형심교통(UAP)환자관상동맥개화적분(CCS)여혈압변이성(BPV)급관상동맥병변엄중정도적관계,병평개CCS여BPV대경피관상동맥강내개입치료(PCI)적UAP환자예후적예측개치。방법회고성분석2009년6월지2011년6월재아원심내과주원수차접수관상동맥조영(CAG)급PCI치료적466례UAP환자,입선환자균재PCI술전접수320배라선CT심장관상동맥성상검사급24 h동태혈압감측(ABPM),분별측량CCS급혈압변이계수(CV),입선병례안CCS분위CCS≤100,CCS 101~400화CCS>400삼조,비교삼조환자혈압변이성급관상동맥병변엄중정도적차이,PCI술후대삼조환자진행12개월적수방,기록술후사망、비치명성심기경사、파병변혈운중건급재발심교통입원등주요심장불량사건(MACE)발생정황。결과 CCS>400조환자24 h수축압변이계수(SBP-CV),24 h서장압변이계수(DBP-CV)고우기타량조(13.2±2.2 vs.12.4±2.2 vs.11.8±1.7;10.8±1.5 vs.10.3±1.5 vs.9.7±1.0,P<0.05);관상동맥병변경위엄중,표현위관상동맥다지병변비례、B2/C 형병변비례급관상동맥병변Gensini적분균현저승고(47.6%vs.29.1%vs.18.3%;45.0%vs.27.3%vs.15.7%;56.8±16.9 vs.52.8±13.6 vs.36.7±17.1;P<0.05);병차CCS여SBP-CV정정상관(r=0.322,P<0.05)。수방12개월,Kaplan-Meier생존분석발현삼조환자루적무MACE사건생존솔차이유통계학의의(88.8%vs.84.2%vs.77.2%,Log rank 8.044,P=0.005),재교정료년령후,다인소Cox회귀분석현시CCS>400급SBP-CV시UAP환자PCI술후MACE발생적독립예측인자。CCS>400조환자교CCS≤100조환자술후발생MACE적풍험증가4.741배(RR=4.741,P<0.01)。결론 CCS교고적UAP환자구유교고적혈압변이성,병차관상동맥병변경위엄중,CCS급24 h SBP-CV대접수PCI치료적UAP환자적림상예후구유예측개치。
Objective To investigate the relationship between coronary artery calcium score (CCS), blood pressure variability(BPV) and unstable angina pectoris(UAP) patients and their predictive value for patient's prognosis. Methods 466 patients with UAP who underwent PCI for the first time from June 2009 to June 2011 were analyzed retrospectively. Patients received 320-slice multi-detector row computed tomography scanning examinations and ambulatory blood pressure monitoring (ABPM) before PCI, CCS and coefficient variation (CV) of blood pressure were measured. After PCI, patients were followed up for 12 months and major cardiac adverse events (MACE) were recorded. Results UA Patients were divided into three group according to their CCS levels:CCS≤100 group, CCS 101-400 group and CCS>400 group. patients in CCS>400 group had higher BPV and more serious coronary artery diseases than the other two groups. CCS was positive correlated with CV of systolic blood pressure (SBP-CV)(r=0.322, P<0.05). After 12 months of follow-up, Kaplan-Meier survival analysis showed patients of three groups had significantly different cumulative non-events survival rates(88.8%vs. 84.2%vs. 77.2%, Log rank 8.044, P=0.005). Multivariate Cox regression analysis showed the risk of MACE in CCS>400 group increased 4.741 folds compared with CCS≤100 group(RR=4.471, P<0.01). Both CCS and SBP-CV were two strong independent predictors for prognosis of UAP patients undergoing PCI. Conclusion UAP patients with high CCS were associated with high BPV and serious coronary artery diseases, CCS and SBP-CV were valuable in predicating the prognosis of UA patients undergoing PCI.