影响冠心病患者PCI术后预后的因素及预后预测模型建立

Analysis of the Prognosis Factors in the Patients with Coronary Artery Disease after Coronary Artery Reconstruction and Establishment of Prediction Model

为寻找更为准确的评估冠心病患者冠状动脉重建术(PCI)后预后的预测指标,构建冠心病患者PCI术后预后的评分模型,为预防及治疗术后病情恶化提供指导。收集急性冠脉综合征PCI术后患者临床病例资料,采用COX模型分析甘油三酯(TG)、胆固醇(TC)及身体质量指数(BMI)等指标对冠心病患者PCI术后预后的影响。COX模型单因素分析结果显示,与TG/HDL比值低的PCI术后患者比较,TG/HDL比值高的患者发生再次梗塞的风险更高(HR=2.702,95%CI:1.110~6.579,P=0.049);与TC/HDL比值低的患者相比,TC/HDL比值高的患者发生再次梗塞的风险更高(HR=2.493,95%CI:0.982~6.330,P=0.042)。多因素分析表明,TG/HDL比值和TC/HDL比值是独立的预后因素(TG/HDL比值:HR=2.306,95%CI:0.914~5.858,P=0.050;TC/HDL比值:HR=2.355,95%CI:0.926~5.991,P=0.048)。另外,分析结果显示TG和TC值均低的患者与TG和TC值均高的患者比较,后者再次狭窄、梗塞的风险更高(HR=3.765,95%CI:1.298~10.921,P=0.012),同时也发现,TC、TG和BMI值均低的患者与TC、TG和BMI值均高的患者比较,后者具有更高的风险(HR=7.040,95%CI:1.914~15.693,P=0.001)。冠心病预后评分模型显示,与评分小于2分的患者比较,评分大于3分的患者中死亡例数更多,评分大于3分的患者死亡16例(16/45),评分小于2分的患者死亡7例(7/62),且评分大于3分的患者生存期较短(Log rankχ^(2)=7.888,P=0.005)。研究得出结论:(1)除TG/HDL比值外,TC/HDL比值也可作为判断预后的指标;(2)将TG/HDL比值、TC/HDL比值及BMI联合分析作为评估冠心病患者冠状动脉重建术后预后的指标,其预测作用明显增强;(3)成功构建了冠心病患者PCI术后预后评分模型,对临床工作有一定的指导意义,自建预测模型可在临床进行推广。

In order to find a more accurate predictor of the prognosis after percutaneous coronary intervention(PCI)in patients with coronary heart disease,a scoring model of the prognosis after coronary artery reconstruction in patients with coronary heart disease was constructed to provide guidance for the prevention and treatment of postoperative deterioration.The clinical data of patients with acute coronary syndrome after coronary artery reconstruction were collected.Cox model was used to analyze the effects of triglycerides,cholesterol and body mass index on the prognosis of patients with coronary heart disease after coronary artery reconstruction.The clinical data of patients with acute coronary syndrome after coronary artery reconstruction were collected.The effects of triglyceride,cholesterol and body mass index on the prognosis of patients with coronary artery reconstruction were analyzed by Cox model.Univariate analysis of Cox model showed that patients with high TG/HDL ratio had higher risk of reinfarction than those with low TG/HDL ratio(HR=2.702,95%CI:1.110-6.579,P=0.049);patients with high TC/HDL ratio had higher risk of reinfarction than those with low TC/HDL ratio(HR=2.493,95%CI:0.982-6.330,P=0.042).Multivariate analysis showed that TG/HDL ratio and TC/HDL ratio were independent prognostic factors(HR=2.306,95%CI:0.914-5.858,P=0.050 for TG/HDL ratio;HR=2.355,95%CI:0.926-5.991,P=0.048 for TC/HDL).When TG and TC were combined as prediction indexes,the prediction effect was enhanced(HR=3.765,95%CI:1.298-10.921,P=0.012).When combined BMI analysis,the prediction effect was stronger(HR=7.040,95%CI:1.914-15.693,P=0.001).The model of prognosis score of coronary heart disease showed that compared with patients with score less than 2,the number of deaths in patients with score greater than 3 was more,16 patients with score greater than 3(16/45),7 patients with score less than 2(7/62),and the survival period of patients with score greater than 3 was shorter(log rankχ^(2)=7.888,P=0.005).The study shows that:(1)in addition to TG/HDL ratio,T/HDL ratio can also be used as a prognostic indicator.(2)the combined analysis of TG/HDL ratio,TC/HDL ratio and body mass index can be used as a prognostic indicator for patients with coronary artery disease after coronary artery reconstruction,and its predictive effect is significantly enhanced.(3)the successful construction of the prognosis scoring model of patients after coronary artery reconstruction has certain guiding significance for clinical work.