心肺运动测试过程血压下降冠心病患者影响预后相关因素分析

Analysis of prognostic factors of patients with coronary heart disease after blood pressure drop during cardiopulmonary ex-ercise test

目的探讨心肺运动测试(CPET)过程中血压下降冠心病患者预后的相关因素。方法选取北部战区总医院自2016年2月至2020年1月收治的5036例进行CPET的冠心病患者为研究对象。根据是否发生主要不良心血管事件(MACE)将患者分为A组(发生MACE,n=1730)与B组(未发生MACE,n=343)。比较两组患者的临床资料、化验和介入相关情况、心肺功能。采用多因素Logistic回归分析检验CPET过程血压下降冠心病患者预后的影响因素。结果B组患者男性、糖尿病、陈旧性心肌梗死、卒中史、经皮冠状动脉介入治疗(PCI)史、替格瑞洛、β受体阻断剂、质子泵抑制剂、替罗非班比例均高于A组,射血分数低于A组,差异均有统计学意义(P<0.05)。两组患者吸烟史、高血压分级比较,差异均有统计学意义(P<0.05)。B组患者N端B型钠尿肽原、血清磷酸肌酸激酶同工酶(CKMB)、SYNTAX评分及病变血管位于左主干、左前降支、左回旋支、右冠状动脉、接受PCI治疗、右冠状动脉支架比例均高于A组,高密度脂蛋白、左前降支接受PCI比例均低于A组,差异均有统计学意义(P<0.05)。B组患者峰值心率、峰值摄氧量、峰值公斤摄氧量、无氧阈摄氧量、无氧阈公斤摄氧量、峰值代谢当量均低于A组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,质子泵抑制剂、高密度脂蛋白、CKMB、左回旋支病变、右冠状动脉病变、接受PCI、左前降支病变接受血运重建、峰值心率均为CPET过程血压下降冠心病患者预后的影响因素(P<0.05)。结论病变程度与心肺功能均影响CPET过程中血压下降冠心病患者的预后。

Objective To investigate the prognostic factors of patients with coronary heart disease with decreased blood pressure during cardiopulmonary exercise test(CPET).Methods A total of 5036 patients with coronary heart disease who underwent CPET from February 2016 to January 2020 were selected as the study objects.Patients were divided into group A(with major adverse cardiovascular event,n=1730)and group B(without major adverse cardiovascular event,n=343)based on the occurrence of a major adverse cardiovascular event major adverse cardiovas cular event.Clinical data,laboratory and interventional information,cardiopulmonary function were compared between the two groups.Multivariate Logistic regression analysis was used to examine the prognostic factors of patients with coronary heart disease after blood pressure drop during CPET.Results The proportions of male,diabetes mellitus,old myocardial infarction,stroke history,percutaneous coronary intervention(PCI)history,ticagrelor,β-blocker,proton pump inhibitor and tirofiban in group B were higher than those in group A,and the ejection fraction was lower than that in group A,with statistical significance(P<0.05).There were statistically significant differences in smoking history and hypertension grade between the two groups(P<0.05).The proportions of N-terminal pro-B-type natriuretic peptide,creatine kinase MB(CKMB),SYNTAX score,diseased vessels located in the left main trunk,left anterior descending branch,left circumferential branch,right coronary artery,PCI treatment and right coronary artery stent in group B were higher than those in group A,and the proportions of high density lipoprotein and left anterior descending branch PCI were lower than those in group A.The differences were statistically significant(P<0.05).The peak heart rate,peak oxy-gen uptake,peak oxygen uptake in kg,anaerobic threshold oxygen uptake,anaerobic threshold oxygen uptake in kg and peak metabolic equivalent in group B were all lower than those in group A,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that proton pump inhibitor,high-density lipoprotein,CKMB,left circumferential branch disease,right coronary artery disease,PCI,left anterior descending branch disease receiving revascularization,peak heart rate were all influencing factors for the prognosis of coronary heart disease patients with decreased blood pressure during CPET process(P<0.05).Conclusion Both the degree of lesion and cardiopulmonary function affect the prognosis of patients with coronary heart disease with decreased blood pressure during CPET.