女性的性别因素是否与其搭桥术后的院内死亡独立相关：一项流行病学结合循证医学研究

发布时间：2018-01-19 05:10

本文关键词： 女性的性别因素心脏搭桥院内死亡高龄因素流行病学循证医学　出处：《首都医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的目前国际上关于性别因素与搭桥术后院内死亡率的研究多数研究对象都为欧美人群,没有针对中国患者的大样本观察性研究。同时仍然缺乏强有力的循证医学证据证明女性自身的性别因素与其较高的院内死亡率独立相关。为了填补以上研究空白,我们设计了本次研究,诣在全面系统地探讨女性自身的性别因素能否成为行心脏搭桥患者,尤其是在北京地区行搭桥手术的中国患者,院内死亡的独立风险因素。方法在流行病学部分,我们连续入选从2007年1月1日到2012年12月31日所有在北京地区单独行心脏搭桥的中国患者,并同时应用多元逻辑回归以及倾向性评分探讨中国女性患者的性别因素是否与其院内死亡独立相关。在循证医学部分,我们着眼于全球,为患者的性别因素是否影响其短期预后提供循证医学证据。结果在流行病学部分,本次研究涉及到的所有连续5年在北京单独行心脏搭桥的中国患者共计35173人,其中男性患者26926人,女性患者8247人。女性患者的年龄显著高于男性患者(64.9±7.8岁vs.61.0±9.4岁,P0.0001)。相较于男性患者,女性患者大多入院伴随高血压病史(70.56%vs57.76%,P0.0001),糖尿病病史(36.15%vs 27.61%,P0.0001),不稳定性心绞痛(49.05%vs 42.30%,P0.0001),反流性食管炎(0.78%vs 0.51%,P=0.0056)。而男性患者更多入院伴随术前心肌梗死病史(21.31%vs 12.82%,P0.0001),颈动脉狭窄病史(1.21%vs 0.91%,P=0.0257)以及大隐静脉曲张(0.17%vs 0.07%,P=0.0425)。我们发现,尽管女性患者的院内死亡率高于男性患者(1.62%vs 1.30%,P=0.0248),但是女性自身的性别因素并不是导致患者院内死亡率增加的独立风险因素(OR:0.933,95%CI 0.759-1.147),而患者的年龄因素是导致患者院内死亡率增加的独立风险因素(OR:1.071,95%CI 1.058-1.083),即患者年龄越大,行搭桥手术院内死亡的风险就越高。经过倾向性评分匹配后,女性自身的性别因素依然不是导致患者院内死亡率增加的独立风险因素(OR:1.051,95%CI 0.698-1.583),而患者的年龄因素仍然是导致患者院内死亡率增加的独立风险因素(OR:1.079,95%CI 1.049-1.111)。在循证医学部分,我们一共纳入文献21篇,包含患者201,465人。研究发现女性患者搭桥术后院内死亡率比男性患者高81%(OR:1.81 95%CI:1.57-2.08,Z=8.32,P0.001),但是具有显著的异质性(I2=72.4%,P0.001)。Meta回归显示女性患者的年龄因素是异质性的重要来源。因此我们纳入65岁以上的患者,亚组分析发现高龄患者女性患者搭桥术后院内死亡率与男性患者的差异不具有统计学意义(OR:1.26 95%CI:0.98-1.65,Z=1.84,P=0.066)且不具有异质性(I2=0.0%,p=0.96)。结论无论是在北京地区行搭桥手术的中国患者,还是着眼于全球搭桥患者,女性自身的性别因素均不是影响其预后的独立风险因素,而她们的高龄因素与其术后较高的院内死亡率独立相关。
[Abstract]:Objective at present, most of the international studies on gender factors and hospital mortality after bypass grafting are conducted in Europe and the United States. There is no large sample of observational studies of Chinese patients. There is still no strong evidence-based medical evidence that women's own gender factors are independently associated with their higher hospital mortality. . We designed this study to explore comprehensively and systematically whether women's own gender factors can be used as cardiac bypass patients, especially in China who underwent bypass surgery in the Beijing area. Methods in the epidemiology section, we continued to select all Chinese patients who underwent cardiac bypass grafting in the Beijing area from January 1st 2007 to December 31st 2012. At the same time, we used multiple logic regression and tendentiousness score to explore whether the gender factors of Chinese female patients were independent of their in-hospital mortality. In the Evidence-based Medicine section, we focused on the whole world. Provide evidence-based medical evidence for whether gender factors affect short-term prognosis of patients. The results are in the epidemiology section. The study involved a total of 35173 Chinese patients, including 26926 men, who underwent cardiac bypass surgery in Beijing for five consecutive years. The age of female patients was significantly higher than that of male patients (64.9 卤7.8 years old, vs.61.0 卤9.4 years old, P 0.0001). Most female patients were admitted to hospital with a history of hypertension (70.56 vs 57.76) and diabetes mellitus (36.15 vs 27.61%). P0.0001, unstable angina pectoris 49.05 vs 42.30P0.0001, reflux esophagitis 0.78 vs 0.51%. The male patients were more likely to be admitted with preoperative myocardial infarction history (21.31 vs 12.82 P 0.0001). The history of carotid artery stenosis was 1.21 vs 0.91 and the ratio of varicose vein 0.17 to 0.07 was 0.04257.We found. Although the nosocomial mortality rate of female patients was higher than that of male patients 1.62% vs 1.30% (P < 0.0248). But women's own sex factor is not the independent risk factor that leads to the increase of hospital mortality rate of patients, or: 0.933 95 CI 0.759-1.147). The age factor of the patient was the independent risk factor for the increase in hospital mortality, OR: 1.071 / 95, CI 1.058-1.083, that is, the older the patient was. The higher the risk of death in the hospital after bypass surgery, the higher the risk of death. After the bias score was matched, women's own gender factors were still not independent risk factors for increased in-hospital mortality, OR: 1.051. 95 CI 0.698-1.583, and the patient's age is still the independent risk factor for increased hospital mortality, OR: 1.079. 95 CI 1.049-1.111. In the evidence-based medicine section, we included a total of 21 articles, including 201 patients. 465 people. The study found that the hospital mortality rate of female patients after bypass grafting was 81% higher than that of male patients. P 0.001, but with significant heterogeneity of 72.4%. The age factor of female patients was an important source of heterogeneity, so we included patients over 65 years of age. Subgroup analysis showed that there was no significant difference between the mortality rate of female patients and male patients after bypass grafting. There was no significant difference between the mortality rate of female patients and that of male patients (OR: 1.26 95 CI: 0.98-1.65). Conclusion Chinese patients undergoing bypass surgery in Beijing area have no heterogeneity (P = 0.96) and have no heterogeneity (P < 0.05). Conclusion: there is no significant difference between the two groups and there is no significant difference between the two groups. Conclusion No matter in Beijing area, there are many Chinese patients undergoing bypass surgery. However, women's gender factors were not independent risk factors for their prognosis, and their old age factors were independently related to their higher hospital mortality after surgery.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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