CAJ | 학술논문

目的研究血清总胆红素(serum total bilirubin,STB)水平与急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术预后的关系.方法入选2009年6月至2010年12月在郑州大学第一附属医院心内科成功行PCI术患者1273例,记录患者入院后24 h内空腹STB水平及其他临床资料.于2012年8月至11月进行电话或门诊随访,记录终点事件的发生情况.一级终点事件为全因死亡,二级终点事件包括心肌梗死,再次PCI或冠状动脉搭桥术,因心绞痛、心衰、脑卒中再入院.依据STB水平分为四组:低于正常水平组(G1:STB＜ 3.4 μmol/L)、正常水平低值组(G2:3.4 μmol/L≤STB≤10.3 μmoL/L)、正常水平高值组(G3:10.3 μmol/L＜STB≤17.1μmol/L)、高于正常水平组(G4:STB＞17.1μmol/L).应用单因素分析和多因素Logistic回归分析探索PCI术预后的相关因素,Kaplan-Meier生存曲线比较不同STB水平患者生存率的差异.P＜0.05为差异具有统计学意义.结果 (1)成功随访1152例(随访率90.5％),随访时间为(30.4±5.0)个月.187例发生终点事件(16.2％),死亡45例(3.9％)；(2) G1、G2、G3、G4组总终点事件的发生率逐渐降低(28.8％,17.1％,11.2％,8.5％,x2=22.159,P＜0.01),但4组一级终点事件发生率的差异无统计学意义(6.6％,4.3％,3.0％,2.8％,x2=2.366,P=0.500).(3)多因素Logistic逐步回归分析显示,G3和G4组患者终点事件的发生率较G1组分别减少56.4％(OR=0.436,95％CI:0.237～0.804,P=0.008)和63.6％(OR=0.364,95％CI:0.190～0.695,P=0.002).(4) Kaplan-Meier生存曲线分析显示:4组患者无终点事件的累积生存率差异具有统计学意义(P＜0.01).结论 STB与ACS患者PCI术后终点事件的发生呈负相关,但与PCI术后的病死率无明显关系.
목적 연구혈청총담홍소(serum total bilirubin,STB)수평여급성관맥종합정(acute coronary syndrome,ACS)환자경피관상동맥개입(percutaneous coronary intervention,PCI)술예후적관계.방법 입선2009년6월지2010년12월재정주대학제일부속의원심내과성공행PCI술환자1273례,기록환자입원후24 h내공복STB수평급기타림상자료.우2012년8월지11월진행전화혹문진수방,기록종점사건적발생정황.일급종점사건위전인사망,이급종점사건포괄심기경사,재차PCI혹관상동맥탑교술,인심교통、심쇠、뇌졸중재입원.의거STB수평분위사조:저우정상수평조(G1:STB＜ 3.4 μmol/L)、정상수평저치조(G2:3.4 μmol/L≤STB≤10.3 μmoL/L)、정상수평고치조(G3:10.3 μmol/L＜STB≤17.1μmol/L)、고우정상수평조(G4:STB＞17.1μmol/L).응용단인소분석화다인소Logistic회귀분석탐색PCI술예후적상관인소,Kaplan-Meier생존곡선비교불동STB수평환자생존솔적차이.P＜0.05위차이구유통계학의의.결과 (1)성공수방1152례(수방솔90.5％),수방시간위(30.4±5.0)개월.187례발생종점사건(16.2％),사망45례(3.9％)；(2) G1、G2、G3、G4조총종점사건적발생솔축점강저(28.8％,17.1％,11.2％,8.5％,x2=22.159,P＜0.01),단4조일급종점사건발생솔적차이무통계학의의(6.6％,4.3％,3.0％,2.8％,x2=2.366,P=0.500).(3)다인소Logistic축보회귀분석현시,G3화G4조환자종점사건적발생솔교G1조분별감소56.4％(OR=0.436,95％CI:0.237～0.804,P=0.008)화63.6％(OR=0.364,95％CI:0.190～0.695,P=0.002).(4) Kaplan-Meier생존곡선분석현시:4조환자무종점사건적루적생존솔차이구유통계학의의(P＜0.01).결론 STB여ACS환자PCI술후종점사건적발생정부상관,단여PCI술후적병사솔무명현관계.
Objective To investigate the predictive value of serum total bilirubin (STB) level in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 1273 consecutive patients treated with PCI in cardiology department,First Affiliated Hospital of Zhengzhou University from June 2009 to December 2010 were enrolled in this study.Patient' s fasting STB concentrations within 24 h after admission and other relevant clinical data were recorded.The patients were followed-up by telephone or in the Out-patient Department from August to November 2012.All end events were recorded.The primary end events were death resulted from various causes.The secondary end events were acute myocardial infarction,repeated PCI or coronary artary bapass grafting,readmission for angina pectoris,heart failure or stroke.The patients were divided into four groups according to the levels of STB:the subnormal low STB group (G1:STB ＜3.4 μmol/L),the low limit of normal STB group (G2:3.4 μmol/L≤STB≤10.3 μ mol/L),the upper limit of normal STB group (G3:10.3 μmol/L ＜ STB ≤ 17.1 μ mol/L) and the high level above normal STB group (G4:STB ＞ 17.1 μmol/L).Application of univariate and multivariate logistic regression analyses to explore factors associated with the prognosis.The survival rate was estimated using Kaplan-Meier survival curve.P ＜ 0.05 was considered as statistically significant difference.Results (1) 1152 patients (90.5 ％) were successfully followed-up.Mean follow-up time were (30.4-±5.0) months,and 187 patients experienced end events (16.2％),and 45 patients died (3.9％).(2) The incidence of total end events in the four groups decreased with increase in STB (28.8％,17.1％,11.2％,8.5％,x2 =22.159,P＜0.01).There were no differences in incidence of primary end events between 4 groups (6.6％,4.3％,3.0％,2.8％,x2 =2.366,P=0.500).(3) Multivariate logistic regression analysis showed that the incidences of total end events in G3 and G4 group were decreased to 56.4％ (OR=0.436,95％CI:0.237-0.804,P=0.008) and to 63.6％ (OR=0.364,95％ CI:0.190-0.695,P =0.002) respectively.(4) Kaplan-Meier survival curve analysis showed that there were significent differences in cumulative survival rates without end events between 4 groups (P ＜ 0.01).Conclusions STB concentration is associated negatively with the end events in patients with ACS after PCI.But it is not associated with mortality.