血红蛋白水平对老年稳定性冠状动脉疾病患者介入治疗术后全因死亡风险的影响

Impact of hemoglobin on all-cause mortality risk in elderly patients with stable coronary artery disease after interventional therapy

目的探讨血红蛋白(Hb)水平对老年稳定性冠状动脉疾病(SCAD)患者经皮冠状动脉介入治疗(PCI)术后全因死亡风险的影响。方法选取2016年6月至2017年12月于南京梅山医院心血管科行PCI术的老年SCAD患者195例,进行回顾性队列研究分析,共有180例完成随访。根据Hb四分位数分为Q1组(47例):Hb≤122(108.28±12.53)g/L,Q2组(43例):122<Hb≤137(130.07±4.33)g/L,Q3组(46例):137<Hb≤148(142.67±3.10)g/L,Q4组(44例):Hb>148(158.36±8.50)g/L。收集患者一般临床资料并进行随访,随访终点为全因死亡。对4组一般临床资料进行比较,并采用Cox回归分析评估Hb水平对老年SCAD患者PCI术后发生全因死亡的影响。结果180例患者完成随访,随访时间中位数703(415,1121)d,发生全因死亡18例(10.00%)。Q1组、Q2组、Q3组及Q4组全因死亡的发生率分别为25.50%(12例)、7.00%(3例)、4.30%(2例)、2.30%(1例),差异有统计学意义(P<0.01)。单因素Cox回归分析显示,年龄为发生全因死亡的危险因素(P<0.01),Hb、体质量指数、吸烟史、血脂异常、服用阿司匹林为发生全因死亡的危险因素(P<0.05,P<0.01)。进一步行多因素Cox回归分析显示,Hb水平为发生全因死亡的危险因素(HR=0.96,95%CI:0.93~0.99,P<0.01);以Q2组作为对照组,Q1组发生全因死亡的风险是Q2组的3.68倍(HR=3.68,95%CI:1.01~13.45,P<0.05),Q3组和Q4组与发生全因死亡无相关性(P>0.05)。结论低Hb水平是老年SCAD患者PCI术后发生全因死亡的独立预测因素。

Objective To investigate the impact of hemoglobin(Hb)level on the risk of all-cause mortality in elderly patients with stable coronary artery disease(SCAD)treated by percutaneous coronary intervention(PCI).Methods A retrospective cohort study was conducted on 195elderly SCAD patients treated by PCI in our hospital from June 2016to December 2017,a total of 180 case were followed up.They were divided into four groups based on quartiles of Hb levels:Q1 group[≤122(108.28±12.53)g/L,n=47],Q2group[122<Hb≤137(130.07±4.33)g/L,n=43],Q3group[137<Hb≤148(142.67±3.10)g/L,n=46],and Q4group[>148(158.36±8.50)g/L,n=44].Their clinical data were collected and compared among the groups.All patients were followed up,with all-cause mortality as endpoint.Cox regression analysis was used to evaluate the impact of Hb level on all-cause mortality in elderly SCAD patients treated by PCI.Results For the 180patients with complete follow-up,the median follow-up time was 703(415,1121)d,and the incidence of all-cause mortality was 10.00%(totally 18deaths).And the incidence was 25.50%(12deaths),7.00%(3death),4.30%(2deaths)and 2.30%(1death)in Q1,Q2,Q3,and Q4groups,respectively,with statistically significant differences(P<0.01).Univariate Cox regression analysis showed age was a risk factor for all-cause death(P<0.01),while Hb level,BMI,smoking history,dyslipidemia,and aspirin use were a risk facotr for all-cause death(P<0.05,P<0.01).Further multivariate Cox regression analysis revealed Hb level was a risk facotr for all-cause death(HR=0.96,95%CI:0.93-0.99,P<0.01).The risk of all-cause mortality was 3.68times higher in the Q1group than the Q2group(HR=3.68,95%CI:1.01-13.45,P<0.05),and there was no correlation in the incidence between the Q3and Q4groups(P>0.05).Conclusion Low Hb level is an independent predictor for all-cause mortality in elderly SCAD patients after PCI.