摘要
目的探讨主动脉内球囊反搏(IABP)对急性心肌梗死(AMI)并发心原性休克患者短期生存率的影响是否具有性别差异。方法纳入2012年6月至2018年5月间阜外医院收治的AMI合并心原性休克患者共209例,回顾性收集其临床资料进行分析,依据性别及是否接受IABP治疗对患者进行分组。观察终点为28 d(自心原性休克诊断明确起)的生存情况。采用Kaplan-Meier生存分析法比较不同性别/接受IABP治疗与否患者的28 d生存率。调整年龄、收缩压、ST段抬高型心肌梗死、双联抗血小板、昏迷、APACHEⅡ评分及SAPSⅡ评分等因素,采用Cox回归分析在不同人群中IABP治疗是否影响患者的28 d全因死亡风险,应用Z检验评估性别因素对IABP治疗效果的修饰作用。结果共纳入209例患者,其中男性148例[80例(54.05%)接受IABP支持],女性61例[22例(36.06%)接受IABP支持]。接受IABP治疗者102例。男性患者的28 d生存率高于女性[39.2%(58/148)比26.2%(16/61),Log-rank P=0.034]。接受IABP治疗患者的28 d生存率高于未接受IABP者[46.1%(47/102)比25.2%(27/107),Log-rank P=0.0017]。在女性患者中,接受IABP与未接受IABP患者的28 d生存率差异无统计学意义(P=0.889);而在男性患者中,接受IABP者的28 d生存率高于未接受IABP者[51.2%(41/80)比25.0%(17/68),P=0.001]。接受IABP治疗的男性患者的28 d生存率高于未接受IABP治疗的男性患者及接受或未接受IABP的女性患者(P均>0.05)。调整混杂因素后,Cox回归分析结果显示,不同性别患者中,IABP对28 d全因死亡风险的影响并不一致,在男性患者中IABP治疗可降低28 d全因死亡风险(HR=0.44,95%CI 0.25~0.77,P=0.004),而在女性患者中IABP治疗对28 d全因死亡风险无影响(P=0.401),性别与IABP疗效存在交互作用(Z值=-2.32,P=0.020)。结论IABP支持对患者28 d死亡风险的影响存在性别差异,仅在男性患者中表现出保护作用。
Objective To investigate the effect of gender on the efficacy of intra-aortic balloon pump(IABP)applied in patients with cardiogenic shock complicated by acute myocardial infarction(AMI).Methods A total of 209 patients diagnosed as cardiogenic shock complicated by AMI admitted in Fuwai Hospital from June 2012 to May 2018 were enrolled in our study.We collected the data from medical records and investigated their clinical manifestation and laboratory examination and IABP support,as well as 28-day(from diagnosis of cardiogenic shock)mortality retrospectively.Kaplan-Meier survival analysis was used to compare the 28-day survival rates of patients of different genders/with or without IABP treatment.Adjustment for age,systolic blood pressure,ST segment elevation myocardial infarction,dual antiplatelet,coma,APACHEⅡscore and SAPSⅡscore,Cox regression analysis was used to detect the affect of IABP treatment on the risk of all-cause mortality in different crowd,and using Z test to evaluate the modification effect of gender on IABP treatment efficacy.Results A total of 209 patients were included in this study,with 148 males(80(54.05%)cases received IABP support)and 61 females(22(36.06%)cases received IABP support).A total of 102 patients received IABP treatment.The 28-day survival rate of male patients was higher than that of females(39.2%(58/148)vs.26.2%(16/61),Log-rank P=0.034).The 28-day survival rate of patients receiving IABP was significantly higher than that of non-IABP groups(46.1%(47/102)vs.25.2%(27/107),Log-rank P=0.0017).Among female patients,there was no statistically significant difference in 28-day survival rate between those who received IABP and those who did not receive IABP(P=0.889).While in male patients,the 28-day survival rate of those who received IABP was higher than that of those who did not receive IABP(51.2%(41/80)vs.25.0%(17/68),P=0.001).The survival rate of male patients treated with IABP was higher than that of male patients who did not receive IABP,female patients who did not receive IABP and female patients who received IABP(all P<0.05).After multiple regression analysis and adjustment of confounding factors,it was found that IABP implantation can significantly reduce the 28-day mortality risk in male patients(HR=0.44,95%CI 0.25-0.77 P=0.004).While it had no inpact on the death risk in female patients(P=0.401).The impact of IABP implantation in patients of different genders was significantly different(Z=-2.32,P=0.020).Conclusion In AMI patients complicating cardiogenic shock,there is a gender difference in the impact of IABP implantation on the 28-day mortality risk,and protective effects are seen only in men.
作者
郭超
滕浩波
张峻
李佳
许浩博
王心宇
袁建松
杨伟宪
胡奉环
吴元
乔树宾
Guo Chao;Teng Haobo;Zhang Jun;Li Jia;Xu Haobo;Wang Xinyu;Yuan Jiansong;Yang Weixian;Hu Fenghuan;Wu Yuan;Qiao Shubin(Center of Coronary Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2020年第8期675-681,共7页
Chinese Journal of Cardiology
关键词
休克
心原性
心肌梗死
主动脉球囊反搏
性别
Shock,cardiogenic
Myocardial infarction
Intra-aortic balloon pump
Gender