冠心病患者消化道出血后远期心血管不良事件危险因素分析及评分系统的评价

Risk Factors and Scoring System Evaluation of Long-Term Cardiovascular Adverse Events after Bleeding among Patients with Coronary Heart Disease

【目的】探讨冠心病患者消化道出血后远期发生心血管不良事件的危险因素及AIMS65、GlasgowBlatchford(GBS)评分系统预测远期心血管不良事件的能力。【方法】回顾性分析2014年至2016年于湘雅二医院住院的冠心病合并消化道出血病人的临床资料,根据随访时是否发生心血管不良事件分组,分析两组的临床特点、发生终点事件的危险因素及评估两种评分预测效能。【结果】219例病人中,70人(31.9%)发生心血管不良事件,AIMS65及GBS评分系统预测心血管不良事件的ROC分别为0.59(P=0.035)及0.51(P=0.039),单因素分析中年龄、糖尿病、既往心梗、血红蛋白浓度、住院期间是否使用PPI、输血有意义(P<0.05),经多因素分析后血红蛋白浓度、糖尿病病史、心梗病史有统计学意义。【结论】现有的GBS评分系统及AIMS评分系统对冠心病合并消化道出血患者的远期预后的预测功能一般,并且贫血、高血压、糖尿病是这部分病人心血管不良事件发生的独立危险因素。

【Objective】To investigate the risk factors of long-term adverse cardiovascular outcomes for coronary artery disease patients after gastrointestinal bleeding and evaluate the value of AIMS65 score and Glasgow-Blatchford score(GBS)for predicating these outcomes among those patients.【Methods】All coronary artery disease patients with gastrointestinal bleeding were enrolled in the study from 2014 to 2016. All demographic data and clinical data for hospitalized coronary artery disease patients with gastrointestinal bleeding were retrospectively analyzed and all patients were divided into two groups according to whether the main outcomes occurred or not in order to detect their clinical features,risk factors,and the prediction value of two score systems.【Results】Seventypatients showed the adverse cardiovascular outcomes among all patients. The area under the curve(AUC)that AIMS65 and GBS predicate the main outcomes were0.59(P=0.035)and 0.51(P=0.039),respectively. The result of univariate analysis showed that age,diabetes,prior myocardial infarction,hemoglobin,prior proton-pump inhibitor use during hospital stay and blood transfusion were the risk factors. After multivariate analysis,anemia,high blood pressure and diabetes are independent risk factors.【Conclusions】 The GBS and AIMS65 both have a low specificity and sensitivity.Anemia,high blood pressure and diabetes are independent risk factors of adverse cardiovascular outcomes after gastrointestinal bleeding.