入院血红蛋白水平对经皮冠状动脉介入治疗术后患者长期预后影响

Effect of admission hemoglobin level on long-term prognosis of patients after percutaneous coronary intervention

目的研究入院血红蛋白水平与接受经皮冠状动脉介入治疗(PCI)的冠心病患者长期预后的关系。方法采用回顾性队列研究,收集2008年1月-2016年12月就诊于新疆医科大学第一附属医院的冠心病PCI术后患者的临床资料,入院血红蛋白水平、基础生化数据、心血管疾病相关危险因素等资料。设定随访终点:死亡、出血事件、主要心脑血管不良事件(MACCE)。进行平均(35.9±22.6)个月的跟踪随访。最终纳入6 046例患者,根据入院血红蛋白水平四分位数分为4组:Q1组(血红蛋白≤129 g/L,n=1 398)、Q2组(血红蛋白130～140 g/L,n=1 526)、Q3组(血红蛋白141～150 g/L,n=1 533)及Q4组(血红蛋白>150 g/L,n=1 589)。结果男性占比、年龄、吸烟、饮酒、糖尿病、高血压、体质指数、心率、舒张压、血肌酐、血尿酸、尿素氮、血糖组间对比差异有统计学意义(P<0.05)。随访期间共计发生全因死亡(ACM)309例,其中Q1组96例(6.9%),Q2组84例(5.5%),Q3组68例(4.4%),Q4组61例(3.8%);共计发生心原性死亡(CM)251例,其中Q1组78例(5.6%),Q2组65例(4.3%),Q3组55例(3.6%),Q4组53例(3.3%);主要心脑血管不良事件(MACCE)共计发生862例,其中Q1组219例(15.7%),Q2组243例(15.9%),Q3组197例(12.9%),Q4组203例(12.8%)。随血红蛋白水平降低,全因死亡、心原性死亡、MACCE发生率增加,出血事件的发生率4组间对比无统计学差异。多因素COX回归分析显示相较于血红蛋白>150 g/L,血红蛋白≤120 g/L时,其死亡率增加2.054倍[HR=2.054(1.063～3.967),P=0.032];血红蛋白(130～140 g/L)时,其死亡率增加2.092倍[HR=2.092(1.139～3.842),P=0.017];血红蛋白(141～150 g/L)时其死亡率增加1.876倍[HR=1.876(1.009～3.491),P=0.047],血红蛋白水平可作为冠心病PCI术后长期死亡的独立危险因素。结论低血红蛋白水平与PCI术后不良预后相关,是全因死亡的独立预测因素。

ObjectivetoTo investigate the relationship between admission hemoglobin levels and long-term prognosis of coronary artery disease(CHD)patients undergoing percutaneous coronary intervention(PCI).MethodsRetrospective cohort study was conducted to collect clinical data of patients with coronary heart disease after PCI,who admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2016.The clinical data include data of hemoglobin level,basic biochemical data and cardiovascular disease-related risk factors.Follow-up endpoints were:death,bleeding events,major cardio-cerebral vascular adverse events(MACCE).The duration time of follow-up was(35.9±22.6)months.Finally,a total of 6 046 patients was enrolled and divided into 4 groups,according to the quartile of hemoglobin levels:Q1 group(≤129 g/L,n=1 398),Q2 group(130-140 g/L,n=1 526),Q3 group(141-150 g/L,n=1 533)and Q4 group(>150 g/L,n=1 589).ResultsThere were statistically significant difference in males′proportion,age,smoking,alcohol consumption,diabetes,hypertension,body mass index,heart rate,diastolic blood pressure,serum creatinine,blood uric acid,urea nitrogen,blood glucose between these groups(P<0.05).During the follow-up period,there were 309 all-cause deaths(ACM),including 96(6.9%)in Q1 group,84(5.5%)in Q2 group,68(4.4%)in Q3 group,and 61(3.8%)in Q4 group.A total of 251 cases of cardiogenic death(CM)occurred,including 78 cases(5.6%)in Q1 group,65 cases(4.3%)in Q2 group,55 cases(3.6%)in Q3 group,and 53 cases(3.3%)in Q4 group.There were 862 major cardiac and cerebrovascular adverse events(MACCE),including 219(15.7%)in Q1,243(15.9%)in Q2,197(12.9%)in Q3,and 203(12.8%)in Q4.With the decrease of hemoglobin level,all-cause death,cardiogenic death,MACCE incidence increased,the incidence of bleeding events were not statistically different between the four groups.Multivariate COX regression analysis showed that,compared to Q4 group,the mortality in Q1 group was increased by 2.054 times[HR=2.054(1.063-3.967),P=0.032],the mortality in Q2 group was increased by 2.092 times[HR=2.092(1.139-3.842),P=0.017],the mortality in Q3 group was increased by 1.876 times[HR=1.876(1.009-3.491),P=0.047].The hemoglobin level could be an independent risk factor for long-term mortality after PCI.ConclusionLow hemoglobin levels are associated with poor prognosis after PCI and was independent predictor of all-cause mortality.