急性冠状动脉综合征患者的临床特征及预后因素分析

Clinical characteristics in patients with acute coronary syndrome and analysis of prognostic factors

目的研究行经皮冠状动脉介入治疗(PCI)的不同类型急性冠状动脉综合征(ACS)患者的临床特征及影响介入治疗的预后因素。方法选取2014年1月至2015年3月于该院住院诊断为ACS并行PCI的患者377例,其中ST段提高型ACS患者(ST-ACS组)172例,非ST段提高型急性冠状动脉综合征(NST-ACS组)205例,收集患者的基线资料及检查指标,计算患者入院时全球急性冠状动脉事件注册(GRACE)评分,并建立数据库、规律随访,对预后进行分析。结果吸烟史、急诊PCI、冠状动脉造影TIMI分级(0~1级)、高迁移率族蛋白B1(HMGB1)、GRACE评分、入院时心率、白细胞计数、中性粒细胞比率、淋巴细胞比率、单核细胞比率、中性粒细胞绝对值、高密度脂蛋白、载脂蛋白b、病变血管支数、左室射血分数在ST-ACS与NST-ACS组间比较差异有统计学意义(P<0.05),相关性分析显示HMGB1与GRACE评分显著相关(r=0.836,P<0.01)。为期2年的随访结果显示既往心肌梗死及PCI病史、Killip分级(Ⅱ~Ⅳ)、冠状动脉造影TIMI分级(0~1级)、HMGB1、GRACE评分、血小板平均体积、年龄、病变血管支数在发生与未发生规定终点事件患者间比较差异有统计学意义(P<0.05),Logistic回归分析显示HMGB1、GRACE评分、年龄、PCI病史、Killip分级(Ⅱ~Ⅳ)为心血管事件的独立危险因素(P<0.05)。COX生存分析显示HMGB1、PCI病史、Killip分级(Ⅱ~Ⅳ)为心血管事件的独立危险因素(P<0.05)。受试者工作特征曲线显示HMGB1准确性较好,曲线下面积为0.844(95%CI 0.803~0.885,P<0.05),预测终点事件的临界值为480.44ng/mL。结论 HMGB1在ST-ACS与NST-ACS组间有差异,且与GRACE有很好的相关性。

Objective To study the clinical characteristics in the patients with different types of acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI)and the factors affecting the PCI treatment.Methods A total of 377 inpatients with ACS undergoing PCI in this hospital from January 2014 to March 2015 were selected,including 172 cases of ST-elevation acute coronary syndrome(ST-ACS)group and 205 cases of non-ST-elevation ACS(NST-ACS group).The baseline data and detection indexes were collected,the GRACE score on admission was calculated,the database was established,regular follow-up was performed,and the prognosis was analyzed.Results The smoking history,emergency PCI,coronary angiography TIMI grade≤1,HMGB1,GRACE score,heart rate on admission,white blood cell(WBC)count,neutrophil ratio,lymphocyte ratio,monocytes ratio,absolute neutrophil count,high density lipoprotein,apolipoprotein b,number of lesion vessels and left ventricular ejection fraction had statistical differences between the ST-ACS group and NST-ACS group(P<0.05);the correlation analysis showed that HMGB1 and GRACE score were significantly correlated(r=0.836,P<0.01).The 2-year follow-up results showed that the previous myocardial infarction and PCI history,Killip grade(Ⅱ-Ⅳ),coronary angiography TIMI grade≤1,HMGB1,GRACE score,mean platelet volume,age and number of lesion vessels had differences between the end point event occurrence group and end point event non-occurrence group(P<0.05).The Logistic regression analysis showed that HMGB1,GRACE score,age,previous PCI histoty,Killip grade(Ⅱ-Ⅳ)were the independent risk factors for cardiovascular events(P<0.05).The Cox survival analysis showed that HMGB1,previous PCI history,Killip grade(Ⅱ-Ⅳ)were the independent risk factors for cardiovascular events(P<0.05).The ROC survival curve showed that the accuracy of HMGB1 was good,the areas under the curve was 0.844(95%CI:0.803-0.885,P<0.05),the critical value predicting the end point events was 480.44 ng/mL.Conclusion HMGB1 has difference between the ST-ACS group and NST-ACS group,and has a good correlation with GRACE score.