贫血对置入支架的急性冠脉综合征合并心房颤动患者病情及预后的影响研究

发布时间：2018-03-06 08:45

本文选题：急性冠状动脉综合征　切入点：心房颤动　出处：《中国全科医学》2017年13期 　论文类型：期刊论文

【摘要】：目的探讨贫血对置入支架的急性冠脉综合征(ACS)合并心房颤动(AF)患者病情及预后的影响。方法通过检索电子病历库,选取2010-01-01至2015-01-31在首都医科大学附属北京安贞医院、中国医学科学院阜外医院、中国人民解放军总医院、中国人民解放军海军总医院等北京市12家医院置入支架的ACS合并AF患者3 156例进行多中心的回顾性研究,根据血红蛋白分为贫血组(n=865)和非贫血组(n=2 291)。收集两组患者的一般资料,包括基本信息、既往史、实验室检查、心功能超声检查;根据统一的评分标准分别进行GRACE评分、CRUSADE评分、HAS-BLED评分、CHADS2评分、CHA2DS2-VASc评分;随访截止至2016-03-20,记录主要不良心脑血管事件(MACCEs)和出血事件发生情况。结果两组年龄、住院天数、身高、体质量、体质指数(BMI)、舒张压、白细胞计数、血细胞比容、红细胞体积分布宽度、血肌酐(SCr)、血尿素(BUN)、血尿酸(SUA)、血清蛋白(ALB)、内生肌酐清除率(CCr)、凝血酶原活动度比较,差异有统计学意义(P0.05);两组心率、收缩压、红细胞计数、空腹血糖(FPG)、血钾、左心室射血分数(LVEF)、国际标准化比值(INR)比较,差异无统计学意义(P0.05)。两组性别、吸烟史、饮酒史、高血压史、糖尿病史、卒中史、既往血管病史、心功能不全发生率、肾功能不全发生率、便隐血阳性率、起搏器植入史、Killip分级、纽约心脏病协会(NYHA)分级、ACS类型、AF类型比较,差异有统计学意义(P0.05);两组既往经皮冠状动脉介入(PCI)史、冠心病史、冠心病家族史、肝功能不全发生率、高尿酸血症发生率比较,差异无统计学意义(P0.05)。两组GRACE评分、CRUSADE评分、HAS-BLED评分、CHADS2评分、CHA2DS2-VASc评分比较,差异均有统计学意义(P0.05)。两组MACCEs发生率、全因死亡率比较,差异有统计学意义(P0.05);两组非致死性心肌梗死发生率、非致死性卒中发生率、靶血管重建率比较,差异无统计学意义(P0.05)。两组大出血率、小出血率比较,差异有统计学意义(P0.05);两组大、小总出血率比较,差异无统计学意义(P0.05)。两组MACCEs、全因死亡事件的Kaplan-Meier生存曲线比较,差异有统计学意义(P0.05);两组非致死性心肌梗死事件、非致死性卒中事件、靶血管重建事件、出血事件的Kaplan-Meier生存曲线比较,差异无统计学意义(P0.05)。多因素Cox比例风险回归模型分析结果显示,白细胞计数、血红蛋白、红细胞体积分布宽度、FPG、ALB、LVEF、既往PCI史、卒中史、便隐血阳性、NYHA分级是MACCEs发生的风险因素(P0.05)。结论贫血的ACS合并AF患者有更高的MACCEs发生率和全因死亡率。贫血可作为置入支架的ACS合并AF患者MACCEs风险的预测因子。
[Abstract]:Objective to investigate the effect of anemia on the condition and prognosis of patients with acute coronary syndrome (ACSA) complicated with atrial fibrillation (AFF) implanted with stents. Methods by searching the electronic medical record database, we selected 2010-01-01 to 2015-01-31 in Beijing Anzhen Hospital, affiliated to Capital Medical University. A multicenter retrospective study was conducted in 3 156 ACS patients with AF who were implanted with stents in 12 hospitals in Beijing, including Fuwei Hospital of the Chinese Academy of Medical Sciences, General Hospital of the Chinese people's Liberation Army, General Hospital of the Chinese people's Liberation Army and General Hospital of the Chinese people's Liberation Army. According to hemoglobin, the patients were divided into anemia group (n = 865) and non-anemia group (n = 2291). The general data of the two groups were collected, including basic information, past history, laboratory examination and ultrasonic examination of cardiac function. According to the unified scoring criteria, the GRACE score and CRUSADE score and HAS-BLED score, CHA2DS2-VASc score, CHA2DS2-VASc score, follow-up to 2016-03-20, recorded the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding events. Body mass index (BMI), diastolic blood pressure (DBP), white blood cell count (WBC), hematocrit, erythrocyte volume distribution width (RBC), serum creatinine creatinine (SCR), blood urea bun (BUNA), serum uric acid (SUAA), serum albumin (ALB), endogenous creatinine clearance (CCR), prothrombin activity (PRD), and prothrombin activity were compared. There was no significant difference in heart rate, systolic blood pressure, red blood cell count, fasting blood glucose and FPGG, potassium, left ventricular ejection fraction (LVEFN) and international standardized ratio (INR) between the two groups. There was no significant difference between the two groups in terms of sex, history of smoking, and history of drinking. History of hypertension, history of diabetes, history of stroke, history of past vascular diseases, incidence of cardiac insufficiency, incidence of renal insufficiency, positive rate of occult blood, Killip grade of pacemaker implantation history, New York Heart Association (NYHA) classification ACS type and AF type were compared. There were significant differences between the two groups (P 0.05), including history of percutaneous coronary intervention (PCI), history of coronary heart disease (CHD), family history of coronary heart disease (CHD), incidence of hepatic insufficiency and hyperuricemia. There was no significant difference between the two groups in GRACE score and HAS-BLED score and CHA2DS2-VASc score. The incidence of MACCEs in the two groups was significantly higher than that in the control group (P 0.05), and the incidence of non-fatal myocardial infarction in the two groups was significantly higher than that in the control group. There was no significant difference in the incidence of non-fatal stroke and the rate of target vascular reconstruction between the two groups (P 0.05). There was significant difference between the two groups in the rate of massive hemorrhage and the rate of small hemorrhage (P 0.05). There was no significant difference between the two groups (P 0.05). The Kaplan-Meier survival curve of the two groups was significantly different from that of the death events (P 0.05), the two groups had non-fatal myocardial infarction events, non-fatal stroke events, and target vascular remodeling events. There was no significant difference in Kaplan-Meier survival curve of bleeding events (P 0.05). The results of multivariate Cox proportional risk regression analysis showed that the white blood cell count, hemoglobin, erythrocyte volume distribution width, PCI history, stroke history. The grade of fecal occult blood was the risk factor of MACCEs. Conclusion anemia with ACS with AF has a higher incidence of MACCEs and total death rate. Anemia can be used as a predictor of MACCEs risk in patients with AF and ACS with stent placement.
【作者单位】：南方医科大学第三临床医学院;中国人民解放军海军总医院心脏中心;中国人民解放军总医院;中国医学科学院阜外医院;首都医科大学附属北京安贞医院;中国人民解放军第三0五医院;首都医科大学附属北京同仁医院;北京中医药大学东直门医院;中国人民解放军总医院第一附属医院(304);中国人民解放军第306医院;
【基金】：首都临床特色应用研究与成果推广(Z151100004015205)
【分类号】：R541.4;R541.75

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