低踝臂血压指数与冠状动脉性心脏病高危人群1年内因缺血性事件再住院的关系

The relationship between low ankle-brachial index and re-hospitalization within one year due to ischemic events in the high-risk population of coronary heart disease

目的分析踝臂血压指数(ABI)<0.9(低ABI)的冠状动脉性心脏病(冠心病)高危人群的临床特征及其1年内因缺血性事件再住院情况。方法用全自动动脉硬化检测仪(VP-2000)对心脏科拟作冠状动脉造影的患者1002例行ABI检查并随访1年,采用Kaplan-Meier生存分析评估再住院率,采用Log-Rank法对其进行检验。结果与ABI≥0.9者相比,ABI<0.9者年龄较高,女性多于男性,左心室射血分数(LVEF)低[(54.1±8.7)%比(60.3±6.0)%,P<0.05],冠心病、高血压、糖尿病、脑梗死、慢性肾功能不全、高尿酸血症患病率高,多支冠状动脉血管病变发生率高(50.6%比39.5%,P<0.05),高敏C反应蛋白(hsCRP)、肾素、血管紧张素Ⅱ、纤维蛋白原水平高(P<0.05)。Cox回归分析显示,年龄、ABI<0.9、高血压和LVEF是患者再住院的主要影响因素(RR分别为1.06,1.60,1.77,0.97,均P<0.01)。Logistic回归分析表明,高龄、低LVEF、合并高血压、糖尿病及低ABI是冠心病患者再住院的预测因素(OR分别为1.93,1.44,2.31,1.68,0.93;均P<0.01)。结论 ABI<0.9是1年内因缺血性心脑血管事件再住院的独立危险因素。

Objective To analyse the clinical characteristics and re-hospitalization within one year due to ischemic e- vents in the high-risk population of coronary heart disease with low ankle-brachial index （ABI） which was lower than 0.9. Methods One thousand and two patients in the cardiology department who prepared to undergo coronary an- giography received the examination of ABI by the fully automated arterial elasticity function apparatus, and were fol- lowed up for one year. The re-hospitalization rate was evaluated and tested by Kaplan Meier analysis and Log-Rank test. Results Compared with those in the ABI≥0.9 group, the age, female proportion, incidence rates of coro- nary heart disease （CHD）, hypertension, diabetes mellitus, cerebral infarction, chronic kidney failure, hyperuricaci demia and multiple coronary artery branches lesions （50.6% vs 39.5%, P〈0.05）, the concentrations of hsCRP, rennin, angiotensin 11 and fibrinogen （P〈0.05） in the ABI〈0.9 group were higher, while the left ventricular ejec- tion fraction （LVEF） was lower 1-{54. 14-8.7）% vs （60. 3±6.0） %, P〈0.05]. Cox regression analysis showed that age, ABI〈0.9, hypertension and LVEF were main influencing factors for re-hospitalization due to ischemic e vents （RR = 1.06, 1.60, 1.77, 0.97 respectively; all P〈0.01 ）. Logistic regression analysis showed that ad- vanced age, low LVEF and with hypertension, diabetes mellitus and low ABI were predictive factors for re-hospitali- zation in CHD patients （OR=I. 93, 1.44, 2.31, 1.68, 0.93, respectively; all P〈0.01）. Conclusion ABI〈0.9 is an independent risk factor for re-hospitalization due to ischemic cardiovascular and cerehrovascular events.