SYNTAX积分与冠心病患者并发脑梗死的关系研究

Study on the Relationship between SYNTAX Score and Cerebral Infarction in Patients with Coronary Heart Disease

背景冠心病患者常易并发脑梗死,多数学者认为二者具有相关性,但仍有不少研究持不同意见,分析原因可能与冠状动脉病变评估工具的选择欠合理、评估不全面有关。随着SYNTAX积分的发布,多数学者认为其是冠状动脉病变评估工具中考虑较全面、较合理的工具之一。目的探讨SYNTAX积分与冠心病患者并发脑梗死的关系,以为心脑同治提供理论依据。方法选取2018年10月—2019年9月成都医学院第一附属医院老年医学科及心血管内科收治的冠心病患者532例为研究对象,根据脑梗死发生情况分为脑梗死组338例和非脑梗死组194例。比较两组患者的临床资料、SYNTAX积分及冠状动脉病变程度。采用多因素Logistic回归分析探讨冠心病患者并发脑梗死的影响因素;SYNTAX积分与冠心病患者并发脑梗死的相关性分析采用Spearman秩相关分析;绘制受试者工作特征曲线(ROC曲线)以分析SYNTAX积分对冠心病患者并发脑梗死的预测价值。结果脑梗死组患者年龄、体质指数(BMI)大于非脑梗死组,舒张压、高密度脂蛋白胆固醇(HDL-C)低于非脑梗死组,高血压、高脂血症、糖尿病、慢性肾脏病(CKD)、脑卒中发生率及同型半胱氨酸(Hcy)、SYNTAX积分高于非脑梗死组,冠状动脉病变程度重于非脑梗死组(P<0.05)。多因素Logistic回归分析结果显示:年龄〔OR=1.072,95%CI(1.047,1.099)〕、SYNTAX积分〔OR=1.159,95%CI(1.123,1.196)〕是冠心病患者并发脑梗死的独立影响因素(P<0.05)。脑梗死组<65岁、≥65岁患者SYNTAX积分均高于非脑梗死组(P<0.05)。Spearman秩相关分析结果显示,SYNTAX积分与冠心病患者并发脑梗死呈正相关(rs=0.613,P<0.001)。ROC曲线分析结果显示,SYNTAX积分预测冠心病患者并发脑梗死的曲线下面积(AUC)为0.863〔95%CI(0.831,0.895)〕,最佳截断值为11.5分,灵敏度、特异度分别为71.9%、89.2%。结论SYNTAX积分是冠心病患者并发脑梗死的独立影响因素,对冠心病患者并发脑梗死具有一定的预测价值。

Background Patients with coronary heart disease are easy to suffer cerebral infarction,most studies show that there are correlations between these two disease.However,there are still some academics hold different opinions.Choosing inappropriate tools to assess coronary artery lesions and not comprehensive to asses it may underlie the discrepancy.With the release of SYNTAX scores,most scholars believe that it is one of the more comprehensive and reasonable tools in the assessment of coronary artery disease.Objective To discuss the relationship between SYNTAX score and cerebral infarction in patients with coronary heart disease,in order to provide the theory basis for joint therapy for the heart and brain.Methods Five hundred thirty-two cases of patients with coronary heart disease admitted to the Department of Geriatrics and Cardiovascular Internal Medicine of the First Affiliated Hospital to Chengdu Medical College from October 2018 to September 2019 were selected,and they were divided into cerebral infarction group(n=338)and non-cerebral infarction group(n=194)according to the incidence of cerebral infarction.Clinical data,SYNTAX score and degree of coronary artery disease of the two groups were compared.Multiple Logistic regression analysis was used to analyze the influencing factors of incidence of cerebral infarction in patients with coronary heart disease;Spearman rank correlation analysis was used to analyze the correlation between SYNTAX score and cerebral infarction in patients with coronary heart disease;receiver operating characteristic curve(ROC curve)was drawn to analyze the predictive value of SYNTAX score on cerebral infarction of patients with coronary heart disease.Results Age and body mass index(BMI)in cerebral infarction group were higher than those in non-cerebral infarction group,diastolic blood pressure and the level of high density lipoprotein cholesterol(HDL-C)in cerebral infarction group were lower than those in non-cerebral infarction group,incidence of hypertension,hyperlipidemia,diabetes,chronic kidney disease(CKD),cerebral infarction,homocysteine(Hcy)and SYNTAX score in cerebral infarction group were higher than those in non-cerebral infarction group,degree of coronary artery disease in cerebral infarction group was more serious than that in non-cerebral infarction group(P<0.05).Multiple Logistic regression analysis showed that,age〔OR=1.072,95%CI(1.047,1.099)〕,SYNTAX score〔OR=1.159,95%CI(1.123,1.196)〕were independent factors of cerebral infarction in patients with coronary heart disease(P<0.05).In patients with<65 years old and≥65 years old,the SYNTAX score in cerebral infarction group was higher than that in non-cerebral infarction group,respectively(P<0.05).Spearman rank correlation analysis showed that SYNTAX score was positively correlated with the incidence of cerebral infarction in patients with coronary heart disease(rs=0.613,P<0.001).ROC curve analysis results showed that the AUC of SYNTAX score in predicting cerebral infarction in patients with coronary heart disease was 0.863〔95%CI(0.831,0.895)〕,the best cut-off value was 11.5 points,sensitivity and specificity were 71.9%and 89.2%,respectively.Conclusion SYNTAX score is an independent influencing factor of cerebral infarction in patients with coronary heart disease,and it has some predictive value for coronary heart disease patients complicated with cerebral infarction.