中国循证心血管医学杂志
中國循證心血管醫學雜誌
중국순증심혈관의학잡지
CHINESE JOURNAL OF EVIDENCE-BASES CARDIOVASCULAR MEDICINE
2015年
2期
202-206,210
,共6页
赵晓茜%骆雷鸣%叶平%杜瑞雪%肖铁卉
趙曉茜%駱雷鳴%葉平%杜瑞雪%肖鐵卉
조효천%락뢰명%협평%두서설%초철훼
下呼吸道感染%炎症%心血管事件%全因死亡
下呼吸道感染%炎癥%心血管事件%全因死亡
하호흡도감염%염증%심혈관사건%전인사망
Lower respiratory tract infection%Inflammation%Cardiovascular events%All-cause mortality
目的:探讨老年稳定性冠状动脉粥样硬化性心脏病(冠心病)患者,合并急性下呼吸道感染近期(90 d)心血管事件(CVEs)及全因死亡的发生情况及相关危险因素。方法采用前瞻性队列观察研究方法,连续入选2011年1月至2013年12月在解放军总医院因急性下呼吸道感染(ALRTI)住院的稳定性冠心病(sCAD)老年患者,作为感染组,同期住院的稳定性sCAD患者作为非感染组。随访两组近期阶段的7 d(D7)、30 d(D30)、90 d(D90)发生CVEs及全因死亡情况。结果共有426例老年sCAD患者纳入最终分析。其中,感染组257例,非感染组169例,平均年龄88±5岁。随访阶段的D7、D30、D90期间,整个队列的CVEs发生率分别为7.5%、15.0%和24.6%,全因死亡的发生率分别为0.7%,2.6%和8.7%。感染组与非感染组发病后三个不同阶段的CVEs和全因死亡的发生率比较,CVEs发生率在D7(10.9%vs.2.4%,P=0.001)、D30(20.6%vs.6.5%,P<0.001)和D90(31.9%vs.13.6%,P<0.001)均明显高于非感染组;全因死亡发生率在D7(1.2%vs.0%,P=0.28)、D30(3.9%vs.0.6%%,P=0.021)和D90(13.2%vs.1.8%,P<0.001)阶段也显著高于非感染组。感染组的CVEs多集中在感染后的30 d之内,其中冠脉事件则集中在2周内,非感染组的事件无时间规律。多因素回归分析显示:急性下呼吸道感染(OR=2.162,95%CI:1.023~4.569,P=0.043)、慢性肾脏病(OR=2.086,95%CI:1.085~4.013, P=0.028)、入院时呼吸≥24次/min(OR=1.093,95%CI:1.006~1.187,P=0.036)和入院时心率≥125次/分(OR=1.018,95%CI:1.000~1.037,P=0.045)与90 dCVEs及全因死亡的复合终点风险增加独立相关。发生CVEs的患者,近期死亡率明显高于未发生CVEs者(P=0.004)。结论老年sCAD患者,发生急性下呼吸道感染后,显著增加近期多种心血管事件和全因死亡风险。有效预防和积极治疗下呼吸道感染,有望可能减少老年冠心病患者的心血管事件和死亡。
目的:探討老年穩定性冠狀動脈粥樣硬化性心髒病(冠心病)患者,閤併急性下呼吸道感染近期(90 d)心血管事件(CVEs)及全因死亡的髮生情況及相關危險因素。方法採用前瞻性隊列觀察研究方法,連續入選2011年1月至2013年12月在解放軍總醫院因急性下呼吸道感染(ALRTI)住院的穩定性冠心病(sCAD)老年患者,作為感染組,同期住院的穩定性sCAD患者作為非感染組。隨訪兩組近期階段的7 d(D7)、30 d(D30)、90 d(D90)髮生CVEs及全因死亡情況。結果共有426例老年sCAD患者納入最終分析。其中,感染組257例,非感染組169例,平均年齡88±5歲。隨訪階段的D7、D30、D90期間,整箇隊列的CVEs髮生率分彆為7.5%、15.0%和24.6%,全因死亡的髮生率分彆為0.7%,2.6%和8.7%。感染組與非感染組髮病後三箇不同階段的CVEs和全因死亡的髮生率比較,CVEs髮生率在D7(10.9%vs.2.4%,P=0.001)、D30(20.6%vs.6.5%,P<0.001)和D90(31.9%vs.13.6%,P<0.001)均明顯高于非感染組;全因死亡髮生率在D7(1.2%vs.0%,P=0.28)、D30(3.9%vs.0.6%%,P=0.021)和D90(13.2%vs.1.8%,P<0.001)階段也顯著高于非感染組。感染組的CVEs多集中在感染後的30 d之內,其中冠脈事件則集中在2週內,非感染組的事件無時間規律。多因素迴歸分析顯示:急性下呼吸道感染(OR=2.162,95%CI:1.023~4.569,P=0.043)、慢性腎髒病(OR=2.086,95%CI:1.085~4.013, P=0.028)、入院時呼吸≥24次/min(OR=1.093,95%CI:1.006~1.187,P=0.036)和入院時心率≥125次/分(OR=1.018,95%CI:1.000~1.037,P=0.045)與90 dCVEs及全因死亡的複閤終點風險增加獨立相關。髮生CVEs的患者,近期死亡率明顯高于未髮生CVEs者(P=0.004)。結論老年sCAD患者,髮生急性下呼吸道感染後,顯著增加近期多種心血管事件和全因死亡風險。有效預防和積極治療下呼吸道感染,有望可能減少老年冠心病患者的心血管事件和死亡。
목적:탐토노년은정성관상동맥죽양경화성심장병(관심병)환자,합병급성하호흡도감염근기(90 d)심혈관사건(CVEs)급전인사망적발생정황급상관위험인소。방법채용전첨성대렬관찰연구방법,련속입선2011년1월지2013년12월재해방군총의원인급성하호흡도감염(ALRTI)주원적은정성관심병(sCAD)노년환자,작위감염조,동기주원적은정성sCAD환자작위비감염조。수방량조근기계단적7 d(D7)、30 d(D30)、90 d(D90)발생CVEs급전인사망정황。결과공유426례노년sCAD환자납입최종분석。기중,감염조257례,비감염조169례,평균년령88±5세。수방계단적D7、D30、D90기간,정개대렬적CVEs발생솔분별위7.5%、15.0%화24.6%,전인사망적발생솔분별위0.7%,2.6%화8.7%。감염조여비감염조발병후삼개불동계단적CVEs화전인사망적발생솔비교,CVEs발생솔재D7(10.9%vs.2.4%,P=0.001)、D30(20.6%vs.6.5%,P<0.001)화D90(31.9%vs.13.6%,P<0.001)균명현고우비감염조;전인사망발생솔재D7(1.2%vs.0%,P=0.28)、D30(3.9%vs.0.6%%,P=0.021)화D90(13.2%vs.1.8%,P<0.001)계단야현저고우비감염조。감염조적CVEs다집중재감염후적30 d지내,기중관맥사건칙집중재2주내,비감염조적사건무시간규률。다인소회귀분석현시:급성하호흡도감염(OR=2.162,95%CI:1.023~4.569,P=0.043)、만성신장병(OR=2.086,95%CI:1.085~4.013, P=0.028)、입원시호흡≥24차/min(OR=1.093,95%CI:1.006~1.187,P=0.036)화입원시심솔≥125차/분(OR=1.018,95%CI:1.000~1.037,P=0.045)여90 dCVEs급전인사망적복합종점풍험증가독립상관。발생CVEs적환자,근기사망솔명현고우미발생CVEs자(P=0.004)。결론노년sCAD환자,발생급성하호흡도감염후,현저증가근기다충심혈관사건화전인사망풍험。유효예방화적겁치료하호흡도감염,유망가능감소노년관심병환자적심혈관사건화사망。
Objective To discuss the incidence and risk factors of short-term (within 90 d) cardiovascular events (CVEs) and all-cause mortality in elderly patients with stable coronary artery disease (sCAD) complicating acute lower respiratory tract infection (ALRTI).Methods The elderly patients with sCAD hospitalized due to acute lower respiratory tract infection (infection group) and sCAD patients without acute lower respiratory tract infection (non-infection group) were chosen from Jan. 2011 to Dec. 2013. The incidences of CVEs and all-cause mortality were followed up for 7 d (D7), 30 d (D30) and 90 d (D90).Results There were totally 426 elderly sCAD patients included the analysis, among them 257 in infection group and 169 in non-infection group (average age=885). During follow-up period, the incidence of CVEs was 7.5% at D7, 15.0% at D30 and 24.6 % at D90, and incidence of all-cause mortality was 0.7% at D7, 2.6% at D30 and 8.7% D90 in whole cohort. The incidence of CVEs (10.9%vs. 2.4%,P=0.001) at D7, (20.6%vs. 6.5%,P<0.001) at D30 and (31.9%vs. 13.6%,P<0.001) at D90 was higher in infection group than those in non-infection group, and all-cause mortality (1.2%vs. 0%,P=0.28) at D7, (3.9%vs. 0.6%,P=0.021) at D30 and (13.2%vs. 1.8%,P<0.001) at D90 was also higher in infection group than those in non-infection group. In infection group, CVEs occurred centrally within 30 d and sCAD occurred centrally within 2 w, and there were no time laws in non-infection group. The multi-factor regression analysis showed that acute lower respiratory tract infection (OR=2.162, 95%CI: 1.023~4.569,P=0.043), chronic kidney disease (OR=2.086, 95%CI:1.085~4.013,P=0.028), admission respiratory rate≥24 time/min (OR=1.093, 95%CI: 1.006~1.187,P=0.036) and admission heart rate≥125 time/min (OR=1.018, 95%CI: 1.000~1.037,P=0.045) were independently correlated to risk increase of composite end-point of CVEs and all-cause mortality at D90. The short-term mortality was significantly higher in patients with sCAD than that in those without sCAD (P=0.004).Conclusion In elderly sCAD patients, the risk of short-term multiple cardiovascular events and all-cause mortality will increase when they suffer from acute lower respiratory tract infection. The effective prevention and active treatment of lower respiratory tract infection may reduce cardiovascular events and death in elderly CHD patients.