CAJ | 학술논문

目的：探讨急性冠脉综合征（ACS）患者不同冠脉病变程度与临床预后的相关性，并分析其影响因素。方法纳入2007年4月～2008年4月解放军总医院确诊的729例ACS患者，按照冠脉造影（CAG）结果分为轻度病变组（冠脉狭窄＜50%且不伴血管闭塞，n=51）和显著病变组（冠脉狭窄≥50%伴或不伴血管闭塞，n=678），随访终点为主要不良心血管事件（MACE，包括心源性死亡、心绞痛、心肌梗死和心源性休克），最长随访时限为5年。结果所有患者中位随访时间为4.3年，随访成功率为95.34%（695/729），其中轻度病变组49例，显著病变组646例。显著病变组MACE发生率高于轻度病变组（32.67%vs.18.37%，P=0.038），显著病变组在随访期间共有18例（2.79%）患者死亡，轻度病变组无死亡发生，两组生存率有统计学差异（P=0.0016）。Cox多元回归分析显示，糖尿病和年龄均是不良心血管事件的危险预测因子（糖尿病：OR=1.5，95%CI：1.13～2.08，P=0.006；年龄：OR=1.0，95%CI：1.00～1.03，P=0.037）。结论 ACS患者冠脉狭窄越严重则MACE发生率越高，糖尿病是MACE发生的因素。
목적：탐토급성관맥종합정（ACS）환자불동관맥병변정도여림상예후적상관성，병분석기영향인소。방법납입2007년4월～2008년4월해방군총의원학진적729례ACS환자，안조관맥조영（CAG）결과분위경도병변조（관맥협착＜50%차불반혈관폐새，n=51）화현저병변조（관맥협착≥50%반혹불반혈관폐새，n=678），수방종점위주요불양심혈관사건（MACE，포괄심원성사망、심교통、심기경사화심원성휴극），최장수방시한위5년。결과소유환자중위수방시간위4.3년，수방성공솔위95.34%（695/729），기중경도병변조49례，현저병변조646례。현저병변조MACE발생솔고우경도병변조（32.67%vs.18.37%，P=0.038），현저병변조재수방기간공유18례（2.79%）환자사망，경도병변조무사망발생，량조생존솔유통계학차이（P=0.0016）。Cox다원회귀분석현시，당뇨병화년령균시불양심혈관사건적위험예측인자（당뇨병：OR=1.5，95%CI：1.13～2.08，P=0.006；년령：OR=1.0，95%CI：1.00～1.03，P=0.037）。결론 ACS환자관맥협착월엄중칙MACE발생솔월고，당뇨병시MACE발생적인소。
Objective To discuss the correlation between the degree of coronary lesion and clinical prognosis in the patients with acute coronary syndrome (ACS), and analyze the influence factors.Methods The patients (n=729) were chosen from the Chinese PLA General Hospital from Apr. 2007 to Apr. 2008, and then they were divided, according to the outcomes of coronary angiography (CAG), into mild lesion group (coronary stenosis<50%without coronary occlusion,n=51) and severe lesion group (coronary stenosis≥50% with or without coronary occlusion,n=678). The endpoint of follow-up was major adverse cardiovascular events (MACE, including cardiaogenic death, angina pectoris, myocardial infarction and cardiogenic shock). The longest follow-up period was 5 years.Results The median follow-up time was 4.3 years in all patients. The success rate of follow-up was 95.34% (695/729), and there were 49 cases in mild lesion group and 646 in severe lesion group. The incidence of MACE was higher in severe lesion group than that in mild lesion group (32.67%vs. 18.37%,P=0.038). During the follow-up period, there were 18 cases (2.79%) died in severe lesion group and no case died in mild lesion group, and there was statistical difference in survival rate between two groups (P=0.0016). The analysis of Cox multiple regression showed that diabetes and age were risk predictive factors for MACE (diabetes:OR=1.5, 95%CI: 1.13-2.08, P=0.006; age:OR=1.0, 95%CI: 1.00-1.03,P=0.037).Conclusion The incidence of MACE will be higher when coronary stenosis is severer, and diabetes is a predictor of MACE.