基于倾向性得分匹配分析自述失眠对冠心病心绞痛患者的预后价值

Analysis of prognostic value of self-reported insomnia in patients with angina pectoris based on propensity score matching

目的:调查冠心病心绞痛患者中自述失眠(SRI)的发病率,探讨SRI对心绞痛患者出院后6个月预后的预测价值。方法:连续纳入2017年6月—2021年3月河北医科大学第一医院心内科住院的541例冠心病心绞痛患者,按是否发生SRI分为心绞痛伴SRI组和心绞痛不伴SRI组。以出院后6个月内的全因死亡、再发心绞痛入院、再次行冠状动脉(冠脉)介入治疗或移植手术、急性心力衰竭、脑卒中的复合事件为随访终点,应用倾向性得分匹配法(PSM)对2组患者基线数据进行匹配,通过Cox回归分析SRI对心绞痛患者的预后价值,并绘制累积风险曲线。结果:入选的541例冠心病心绞痛患者中伴发SRI者189例(34.9%)。PSM前心绞痛伴发SRI组与不伴SRI组患者的年龄、男性比例、心率、血压、白细胞计数、肌酐、总胆固醇、低密度脂蛋白胆固醇、B型利钠肽、左心室射血分数和β受体阻滞剂应用比例有统计学差异;服用助睡眠药物患者比例和用药频率、匹兹堡睡眠指数(PSQI)评分均差异有统计学意义(P<0.05);Cox多因素分析结果显示,SRI组患者6个月内复合事件风险增加85.2%(HR=1.852,95%CI:11.223~2.478,P=0.039)。经PSM后,共有187对患者匹配成功,各协变量达到平衡,SRI仍为心绞痛患者6个月内不良预后的独立预测因子,校正混杂因素后复合事件风险增加50.3%(HR=1.503,95%CI:1.247~1.811,P=0.042)。结论:冠心病心绞痛中SRI的发生率为34.9%,SRI对心绞痛患者的6个月不良预后具有独立的预测价值。

Objective:To investigate the incidence of self-reported insomnia(SRI)in patients with angina pectoris and to explore the predictive value of SRI on the prognosis of patients with angina pectoris 6 months after discharge.Methods:A total of 541 patients with angina pectoris,who were hospitalized in the First Hospital of Hebei Medical University from June 2017 to March 2021,were enrolled.According to the occurrence of SRI,they were divided into angina pectoris with SRI group and angina pectoris without SRI group.The primary end point was the composite of all-cause death,recurrent angina pectoris,coronary intervention or bypass surgery,acute heart failure,or stroke during 6 months after discharge.Propensity score matching(PSM)was applied to match the baseline data of patients in the 2 groups and the cumulative risk curve was plotted.Results:Among 541 patients,189 comorbid with SRI,and the incidence of SRI was 34.9%.Before PSM,the age,male ratio,heart rate,blood pressure,white blood cells,creatinine,total cholesterol,low density lipoprotein cholesterol,brain natriuretic peptide,left ventricular ejection fraction,and the proportion of beta blockers used in the patients with and without SRI groups were different singnificantly;the number and frequency of sleep aids,and the scores of Pittsburgh Sleep Quality Index(PSQI)were statistically significant(P<0.05).Cox multivariate analysis showed that the risk of composite events within 6 months increased by 85.2%(HR=1.852,95%CI:11.223-2.478,P=0.039)in the SRI group.After PSM,187 pairs of patients were successfully matched and the covariates were balanced.The SRI remained an independent predictor of adverse outcomes for 6 months in angina patients,with an increased risk of 50.3%after adjusting for confounders(HR=1.503,95%CI:1.247-1.811,P=0.042).Conclusion:The incidence of SRI in angina pectoris of coronary heart disease is 34.9%and SRI has independent predictive value for poor prognosis in angina pectoris patients 6 months after discharge.