基于中医体质类型的冠心病合并急性心衰患者发生心源性死亡情况及其影响因素分析

Analysis of Cardiogenic Death and Its Influencing Factors in Patients with Coronary Heart Disease and Acute Heart Failure Based on the Constitution of Traditional Chinese Medicine

目的探究冠心病合并急性心衰患者发生心源性死亡情况,并对其影响因素进行定量分析。方法回顾性分析本院2017年1月至2018年12月期间收治的冠心病合并急性心衰的623例患者的临床资料,并在患者出院后第3、6、12个月进行随访,观察发生心源性死亡的情况,对计数资料使用Pearson卡方检验,并绘制出Kaplan-Meier生存分析曲线,同时以患者病历资料信息为自变量,结合生存时间做逐步Cox回归分析,探究冠心病合并心力衰竭患者发生心源性死亡的影响因素。结果纳入的患者均接受12个月的随访,有76例(12.20%)患者随访时间内发生心源性死亡,有547(87.80%)例患者随访结束时仍存活;Cox回归分析显示,年龄<65岁发生心源性死亡的风险是年龄≥65岁的0.555倍(P <0.05);将NYHA分级Ⅱ级设置为亚变量,NYHA分级Ⅲ级和Ⅱ级比较无统计学差异(P> 0.05),Ⅳ级发生心源性死亡的风险是Ⅱ级的1.781倍(P <0.05);无糖尿病的患者发生心源性死亡的风险是糖尿病患者的0.568倍(P <0.05);无肾功能不全的患者发生心源性死亡的风险是肾功能不全患者的0.592倍(P <0.05);左心室射血分数>40%发生心源性死亡的风险是左心室射血分数≤40%的0.504倍(P <0.05);血肌酐每增加1μmol/L,其发生心源性死亡的风险增高1.052倍(P <0.05);血红蛋白每增加1 g/L,其发生心源性死亡的风险下降0.981倍(P <0.05);将中医体质为平和质设置为亚变量,气虚质发生心源性死亡的风险是平和质的5.496倍(P <0.05),阳虚质发生心源性死亡的风险是平和质的5.174倍(P <0.05),阴虚质发生心源性死亡的风险是平和质的6.068倍(P <0.05),痰湿质发生心源性死亡的风险是平和质的3.638倍,湿热质发生心源性死亡的风险是平和质的3.681倍(P <0.05),血瘀质、气郁质、特禀质与平和质比较无统计学差异(P> 0.05)。结论年龄、心肾功能、糖尿病、贫血和体质等因素与冠心病合并急性心衰患者心源性死亡的发生关系密切,未来临床诊疗时应注重控制上述危险因素,从而降低冠心病合并急性心衰患者的死亡率。

Objective:To explore the occurrence of cardiogenic death in patients with coronary heart disease and acute heart failure,and to quantitatively analyze its influencing factors. Methods:The clinical data of 623 patients with coronary heart disease and acute heart failure admitted to the hospital from January 2017 to December2018 were retrospectively analyzed,and the patients were followed at the 3 rd,6 th,and 12 th month after discharge.The occurrence of cardiogenic death was observed. Pearson chi-square test was applied on the count data,and the Kaplan-Meier survival analysis curve was drawn. The patient′s medical record information was used as the independent variable,and a stepwise Cox regression analysis was conducted combined with the survival time to explore the influencing factors of cardiogenic death in patients with coronary heart disease and heart failure. Results:The included patients were all followed for 12 months. Among the included 623 patients with coronary heart disease and acute heart failure,76 case(12.20%) had cardiogenic death during the follow-up period,and 547 case(87.80%)survived at the end of the follow-up. Cox regression analysis showed that the risk of cardiogenic death of patient age < 65 years old was 0.555 times that of age ≥65 years old(P < 0.05). By setting NYHA grade Ⅱ as a dummy variable,there was no statistical difference between NYHA grade Ⅲ and grade Ⅱ(P > 0.05),while the risk of cardiogenic death in grade Ⅳ was 1.781 times that of grade Ⅱ(P < 0.05). The risk of cardiac death in patients without diabetes was 0.568 times that of patients with diabetic(P < 0.05);the risk of cardiac death in pa-tients without renal insufficiency was 0.592 times that of patients with renal insufficiency(P < 0.05);the risk of car-diogenic death in patients with left ventricular ejection fraction >40% was 0.504 times that of left ventricular ejec-tion fraction ≤40%(P < 0.05). For every increase of 1μmol/L in blood creatinine,the risk of cardiogenic death in-creases by 1.052 times(P < 0.05);for every increase in hemoglobin by 1 g/L,The risk of cardiogenic death was re-duced by 0.981 times(P < 0.05). By setting the peaceful constitution in TCM constitution as a dummy variable,therisk of cardiac death in qi-deficiency constitution was 5.496 times that of peaceful constitution(P < 0.05),yang-de-ficiency constitution was 5.174 times of that of peaceful constitution(P < 0.05),yin-deficiency constitution was6.068 times that of peaceful constitution(P < 0.05),phlegm-dampness constitution was 3.638 times of that ofpeaceful constitution(P < 0.05),and damp-heat constitution was 3.681 times that of the peaceful constitution(P <0.05). There was no statistical difference in blood stasis constitution,qi-stagnation constitution,the specific endow-ment constitution and peaceful constitution. Conclusion:Age,heart and kidney function,diabetes,anemia,consti-tution and other factors are closely related to the occurrence of cardiogenic death in patients with coronary heartdisease and acute heart failure. Future clinical diagnosis and treatment should focus on controlling the above riskfactors to reduce the death rate in patients with coronary heart disease and acute heart failure.