恶性肿瘤合并冠心病患者临床特点及死亡危险因素分析

Clinical characteristics and risk factors of death in malignancy patients with coronary artery disease

目的探讨恶性肿瘤合并冠心病患者的临床特点及其死亡的危险因素。方法回顾性分析2013年1月至2017年8月在中国医学科学院北京协和医学院阜外医院住院治疗的恶性肿瘤合并冠心病患者的临床资料,根据临床结局将纳入患者分为死亡组和生存组,采用单因素和多因素Logistic回归分析探讨影响恶性肿瘤合并冠心病患者死亡的危险因素。结果 140例恶性肿瘤合并冠心病患者纳入研究并完成随访,其中死亡患者33例(23.6%)。死亡组有高血压和陈旧性心肌梗死的患者占比均显著低于生存组(均P<0.05),慢性肾脏病及处于肿瘤进展和围治疗期的患者占比均显著高于生存组(均P<0.05);死亡组患者血清脑钠肽水平显著高于生存组(P<0.05),血红蛋白水平显著低于生存组(P<0.05)。多因素Logistic回归分析结果表明,患者处于肿瘤进展或围治疗期、出院时脑钠肽水平升高、血红蛋白水平降低均是恶性肿瘤合并冠心病患者死亡的独立危险因素(均P<0.05)。结论恶性肿瘤合并冠心病患者预后不良,患者处于肿瘤进展或围治疗期、脑钠肽水平升高、贫血均是其死亡的独立危险因素,应给予针对性的医疗干预以改善患者预后。

Objective To analyze the characteristics and risk factors of death in malignancy patients with coronary artery disease(CAD).Method Retrospectively searched the malignancy patients with CAD in the hospitalized database of Fuwai Hospital,Peking Union Medical College&Chinese Academy Medical Sciences from January 2013 to August 2017,which were divided into death group and survival group based on the outcome of follow-up.Univariate and multivariate Logistic regression analysis were used to investigate the risk factors of death in malignancy patients with CAD.Result 140 patients with malignancy patients with CAD were included in the study and completed follow-up,among which 33 patients died.The proportion of hypertension and old myocardial infarction in death group were significantly lower than those in survival group(all P<0.05),the proportion of chronic kidney disease and tumor progression and peri-therapy in death group were significantly higher than those in survival group(all P<0.05),the level of serum brain natriuretic peptide(BNP)in death group was significantly higher than that in survival group(P<0.05),hemoglobin levels in death group were significantly lower than that in survival group(P<0.05).Multivariate Logistic regression analysis showed that patients with advanced tumors or peri-therapy,increased BNP level and decreased hemoglobin level were independent risk factors for death in patients with malignancy patients with CAD.Conclusion The prognosis of patients with malignancy patients with CAD is poor,the patients in the tumor progression or peri-therapy period,elevated BNP level and anemia are the independent risk factors for the death of patients with malignancy patients with CAD.Therefore,the targeted medical intervention should be given to improve the prognosis of patients.