冠心病高危因素对PCI术的影响及预后效果研究

Effect of high risk factors on percutaneous coronary intervention in patients with coronary heart disease and its prognostic effect

目的探讨冠心病患者经皮冠状动脉介入术(PCI)的高危因素及其对患者预后的影响,为临床治疗提供参考依据。方法回顾性分析2014年9月至2016年11月期间于北京武警总医院心血管内科诊治的384例冠心病患者的临床资料,对患者的疾病临床资料和相关血液生化指标进行高危因素和多因素Logistic回归分析,PCI术后随访3个月,统计患者的心脏不良事件(MACE)和死亡情况。结果 (1)术后随访3个月,384例PCI术后患者中有65例发生MACE,发生率为16.93%,其中主要MACE为心衰、心绞痛、心梗复发、再次PCI及心源性死亡;(2)MACE组和非MACE组患者的高密度脂蛋白(HDL-C)[(1.27±0.84)mmol/L vs(1.67±0.96)mmol/L]、低密度脂蛋白(LDL-C)[(2.72±0.33)mmol/L vs(2.11±0.24)mmol/L]、总胆固醇(TC)[(4.42±1.81)mmol/L vs(4.03±1.79)mmol/L]、甘油三酯(TG)[(1.79±0.63)mmol/L vs(1.52±0.46)mmol/L],超敏C反应蛋白(hs-CRP)[(4.82±0.78)mg/L vs(4.61±0.35)mg/L],糖化血红蛋白(Hb Alc)[(6.94±1.02)mmol/L vs(6.32±1.14)mmol/L],肌钙蛋白I(c TNI)[(0.06±0.01)mmol/L vs(0.18±0.05)mmol/L]比较差异均有统计学意义(P<0.05);(3)多因素Logistic回归分析结果显示,高龄、吸烟史、合并高血压、糖尿病和高脂血症、PCI支架安装个数及HDL-C、LDL-C、TC、TG、hs-CRP、Hb Alc、c TNI是PCI术预后的影响因素(P<0.05)。结论冠心病患者存在的高危因素较多,能够直接影响PCI术后患者的治疗效果,临床工作中应在PCI术前进行相关高危因素筛查,选择积极的控制措施,减少心脏不良事件的发生。

Objective To investigate the effect of high risk factors on percutaneous coronary intervention（PCI） in patients with coronary heart disease（CHD） and its influence on the prognosis, and to provide the reference for clinical treatment. Methods The clinical data of 384 patients with CHD who underwent cardiovascular surgery in Department of Cardiovascular Medicine of General Hospital of Armed Police Forces from September 2014 to November2016 were retrospectively analyzed. The patients＇ disease clinical data and related blood biochemical indicators were taken for high risk factors and multivariate logistic regression analysis. After a follow-up of 3 months after PCI, the patients＇ major adverse cardiac events（MACE） and death occurrence were recorded. Results（1） During the 3 months follow-up period, there were 65 patients with MACE in the 384 patients after PCI, with the incidence of 16.93%. The main MACE were heart failure, angina pectoris, myocardial infarction recurrence, secondary PCI and cardiac death.（2） There were significant differences in high density lipoprotein（HDL-C）（1.27±0.84） mmol/L vs（1.67±0.96） mmol/L, low-density lipoprotein（LDL-C）（2.72 ± 0.33） mmlo/L vs（2.11 ± 0.24） mmol/L, total cholesterol（TC）（4.42 ± 1.81） mmol/L vs（4.03 ±1.79） mmol/L, triglyceride（TG）（1.79 ± 0.63） mmol/L vs（1.52 ± 0.46） mmol/L, hypersensitivity C reactive protein（hs-CRP）（4.82 ± 0.78） mg/L vs（4.61 ± 0.35） mg/L, glycosylated hemoglobin（Hb Alc）（6.94 ± 1.02） mmol/L vs（6.32 ±1.14） mmol/L, cardiac troponin I（c Tn I）（0.06±0.01） mmol/L vs（0.18±0.05） mmol/L between the MACE group and the no-MACE group（all P〈0.05）.（3） Multivariable logistic regression analysis results showed that age, smoking history, hypertension, diabetes and hyperlipidemia and PCI bracket installation number and HDL-C, LDL-C, TC, TG, hs-CRP,Hb Alc and c Tn I were the influence factors of PCI prognosis（P〈0.05）. Conclusion There are many risk factors in patients with coronary heart disease, which can directly affect the treatment effect of patients after PCI. Clinical follow-up of high risk factors should be carried out before PCI, and active control measures should be selected to reduce the incidence of MACE.