高血红蛋白水平与冠心病患者的不良预后相关分析

High hemoglobin level was associated with worse prognosis in patients with angiographic coronary artery disease

目的:研究冠心病患者中高血红蛋白(HGB)水平对预测不良心血管事件的作用。方法:在经冠状动脉造影明确诊断为冠心病的住院患者677例中,其中584例患者纳入本项研究,记录纳入样本的临床资料,检测患者HGB水平,白细胞及肌酐水平等,包括hs-CRP水平、心血管病危险因素,测量左心室射血分数。并对这些患者进行随访,记录终点事件发生情况。终点事件定义为:不良心血管事件(MACCE),包括全因死亡、靶血管病变重建、随访期间发生的心肌梗死、脑卒中或者一过性脑缺血、需要住院治疗的不稳定心绞痛和心功能衰竭。结果:平均随访时间为(14.3±8.4)个月,所有的样本根据HGB水平均分为4组,HGB水平随着年龄升高而逐渐下降;男性及吸烟患者HGB水平分别高于女性和非吸烟患者。随访期间共124例患者发生MACCE。单因素及多因素COX回归分析,显示:高HGB水平是冠心病患者将来MACCE的独立预测因素(RR=1.02,95%CI 1.002,1.029,P=0.023)及(RR=1.03,95%CI 1.009,1.041,P=0.003)。结论:高HGB水平与年龄、性别及吸烟相关并且与冠心病患者的不良预后连续相关。

Objective：To investigate the association between high hemoglobin（HGB） level and cardiovascular prognosis.Methods： A total of 584 among 677 hospitalized patients with angiographic CAD were enrolled.Baseline HGB,white blood cells,hs-CRP and so on were routinely measured.All patients＇ clinical data,left ventricle ejection fraction were measured,classic cardiovascular risk factors were recorded after admission and all patients were tracked for（14.3±8.4） months.The primary end point was combination occurrence of major adverse cardiovascular and cerebral events（MACCE）,including death,targeted vascular revascularization,non-fatal myocardial infarction and rehospitalization due to unstable angina,rehospitalization due to heart failure,transient ischemic attack and stroke.Results： All patients were divided into quartiles according to HGB level.A total of 124 MACCE occurred during following up.There was a negative association between HGB level and age.HGB level was higher in male and current smoker than female and non-smoker,repectively.In univariate and multivariate Cox regression analysis high HGB level is an independent predictors of MACCE in patients with CAD（RR=1.02,95%CI 1.002,1.029,P=0.023） and（RR=1.03,95%CI 1.009,1.041,P=0.003） respectively.Conclusion： High HGB level is associated with age,gender,smoking and independently predict the prognosis of coronary artery disease.