老年冠心病患者临床特点及PCI后发生MACCE的危险因素分析

发布时间：2018-05-12 18:06

本文选题：冠心病 + 老年　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]通过观察老年冠心病患者的临床资料,分析其特点及各危险因素之间的关系,并随访老年患者经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)后的短中期主要心脑血管不良事件(Major adverse cardiovascular and cerebrovascular events,MACCE)的发生情况,通过分析其PCI术后2年内的预后,预测老年人PCI治疗后发生MACCE的危险因素,以提高临床医生对老年冠心病患者PCI治疗的认识,为老年人冠心病患者PCI治疗的安全性及有效性提供参考。[方法]1、资料收集,搜集整理2015年1月1日—2016年1月1日期间,昆明医科大学第一附属医院出院病案室患者。纳入标准:a、经冠状动脉造影(Coronary Angiography,CA)确诊为冠心病,b、年龄≥65岁,c、所有患者均为首次行PCI治疗,d、每例患者均至少置入一枚药物洗脱支架。排除标准:a、其他系统的严重疾病,如恶性肿瘤、先天性心脏病、慢性呼吸系统疾病、严重肝肾功能不全、精神病等。P0.05为差异有统计学意义。资料包括:一般资料、临床资料、随访资料。所得资料均为患者PCI术前资料,通过病历获得。2、随访,通过门诊、出院病案室、电话随访三种方式获得,随访时间15个月～24个月,随访内容包括药物服用情况、再发心绞痛、心肌梗死、再次血运重建、再次因心脏事件入院、脑卒中、恶性心脏事件、全因死亡等。3、采用SPSS18.0软件进行统计分析,计数资料采用频数(百分比)描述,组间比较采用t检验、方差分析或χ2检验,多因素分析采用logsitic回归,P0.05表示差异有统计学意义。[结果]1、资料分析1.1 一般资料纳入310例患者,最大年龄86岁,最小年龄65岁,平均年龄(71.01 ±4.77)岁,65～69 岁患者(140)45.2%,70～74 岁患者(92)29.7%,75～79 岁患者(60)19.4%,≥80岁患者(18)5.8%;男性(211)68.1%,女性(99)31.9%;共置入支架562枚,全部为药物洗脱支架。1.2年龄分组将年龄分为四组发现年龄≥65岁的老年冠心病患者,合并高血压最为常见(50%),在75～79岁组甚至达到75.0%;糖尿病、高尿酸血症、血脂紊乱在年龄≥65岁的冠心病患者中发生率分别为28.7%、25.2%、28.4%,但四种疾病在各年龄分组中差异无统计学差异;年龄≥65岁的患者以心肌梗死入院比例为58.4%,年龄组差异有统计学意义;冠状动脉3支病变占总人数48.4%,发生率近单支病变和双支病变的总和,但各年龄分组中差异无统计学意义;左室射血分数50%的发生率与年龄成正相关关系,但各年龄组差异无统计学意义。1.3 Gensini评分分组随着Gensini评分分组越高,年龄呈1-3岁递增,分数随着年龄的增大而增高,各评分分组中差异有统计学意义;糖尿病的患病率随着Gensini评分增高而增高,比率依次为16.9%、23.6%、29.2%、30.3%,各评分组差异有统计学意义;血脂紊乱的患病率随着Gensini评分增高依次为21.6%、25.0%、25.0%、28.4%,但各评分组差异无统计学意义;Gensini评分与置入支架数量和冠脉病变支数呈正相关,在各积分组差异有统计学意义;Gensini评分与心肌梗死入院呈正相关,在各积分组差异有统计学意义。2、随访情况2.1药物服用情况双抗药物服用1年患者占9.1%、MACCE发生率为89.47%,差异有统计学意义;未遵医嘱服用控制血脂药物患者占36.80%,MACCE发生率为61.06%,差异有统计学意义;未遵医嘱服用控制尿酸药物的患者43.00%,MACCE发生率为88.24%,差异有统计学意义;未遵医嘱服用控制血压药物的患者占35.50%,MACCE发生率为36.70%,差异无统计学意义;未遵医嘱服用控制血糖的患者占4.49%,MACCE的发生率为100.00%,差异无统计学意义。2.2 MACCE发生情况随访结果进行单因素分析得出年龄、高血压、糖尿病、血脂紊乱、高尿酸血症、未规律服用药物(双抗药物、控制血脂药物、控制血尿酸药物)、左室射血分数50%、心功能分级高、BNP≥400pg/L、高敏C反应蛋白增高患者在术后1～2年内发生MACCE分别与无以上危险因素的患者人群相比,有明显相关性,差异均有统计学意义,χ2值依次为 23.951、6.140、4.527、4.708、13.809、(62.878、64.248、41.086)、4.954、7.913、8.792、9.327,P 值0.05。年龄、高尿酸血症、左室射血分数50%、高血脂、糖尿病是年龄≥65岁的冠心病患者PCI术后2年内发生MACCE的危险因素,OR值依次为1.117、3.206、1.944、3.874、2.461,P值0.05。[结论]1、老年冠心病患者基础疾病多,多合并高血压、糖尿病、高尿酸血症、血脂紊乱等疾病;冠状动脉病变严重,3支及多支病变比例高;以心肌梗死入院多见,病情危重,临床上应加强老年冠心病的预防及筛查,及时发现并治疗老年冠心病。2、Gensini评分可以较好的评估冠脉病变严重程度,年龄、糖尿病、血脂紊乱与Gensini评分呈正相关,说明3者对冠脉病变严重程度有促进作用,冠脉病变程度越严重,以心肌梗死入院的可能性越大。3、老年冠心病患者服用双联抗血小板药物及降血糖药物遵医嘱率高,降压药及降脂药次之,高尿酸血症药物遵医嘱率较差;双抗药物1年、未规律服药与2年内发生MACCE相关,其中双抗药物1年及未规律服用降脂药物关系最为密切,临床上应重视患者PCI后服药的依从性。4、年龄、高血压、血脂紊乱、糖尿病、高尿酸血症、心功能不全可能是老年冠心病患者PCI术后2年内发生MACCE的危险因素。
[Abstract]:[Objective] to observe the clinical data of the elderly patients with coronary heart disease, analyze the characteristics and the relationship between the risk factors, and follow up the short medium and medium-term major cardiovascular adverse events (Major adverse cardiovascular and cerebrovascular events, after percutaneous coronary intervention (Percutaneous coronary intervention), PCI). MACCE), through the analysis of the prognosis within 2 years after PCI, the risk factors of MACCE after PCI treatment in the elderly were predicted to improve the understanding of PCI treatment for the elderly patients with coronary heart disease, and to provide reference for the safety and effectiveness of PCI treatment for the elderly patients with coronary heart disease. [method]1, data collection, collection and collation in 2015 1 During the period from 1 to January 1, 2016, patients from the First Affiliated Hospital of Kunming Medical University were discharged from the hospital. The standard: A, Coronary Angiography (CA) was diagnosed as coronary heart disease, B, age 65 years old, C, all patients were treated for the first time PCI treatment, D, at least one drug eluting stent was placed in each case. Exclusion criteria: A, it The serious diseases of his system, such as malignant tumor, congenital heart disease, chronic respiratory system disease, severe liver and kidney dysfunction, and psychosis,.P0.05 were statistically significant differences. The data included general data, clinical data and follow-up data. All the data were data of preoperative PCI,.2, follow-up, outpatient and discharge disease. The follow-up period was 15 months to 24 months, followed up with three methods, including drug use, angina, myocardial infarction, revascularization, heart events, stroke, malignant heart events, all causes of death,.3, SPSS18.0 software for statistical analysis, counting data using frequency (100%). T test, variance analysis or chi 2 test, multiple factor analysis using Logsitic regression, P0.05 indicated that the difference was statistically significant. [results]1, data analysis 1.1 general data were included in 310 patients, the maximum age was 86 years, the minimum age 65 years, the average age (71.01 + 4.77) years, 65~69 years old (140) 45.2%, 70~74 years old Patients (92) 29.7%, 75~79 years old (60) 19.4%, 80 years old (18) 5.8%; male (211) 68.1%, female (99) 31.9%; total stent 562, all for the drug eluting stent.1.2 age group to divide age group to age older patients with coronary heart disease, combined hypertension most common. The incidence of diabetes, hyperuricemia and dyslipidemia were 28.7%, 25.2%, 28.4% in patients aged 65 years old, but there was no statistical difference between the four diseases in age groups. The rate of admission to patients with myocardial infarction was 58.4%, the age group was statistically significant, and 3 of the coronary arteries accounted for the total number of patients with the age of 65 years old. The total number was 48.4%, the incidence was close to the single and double branch lesions, but there was no significant difference in age groups. The incidence of left ventricular ejection fraction 50% was positively correlated with age, but there was no statistical significance in the difference of age groups with the higher group of.1.3 Gensini scores, the age was increased at 1-3 years, and the score was along with the year. The age increased, and the difference in each score group was statistically significant. The prevalence of diabetes increased with the increase of Gensini score, and the ratio was 16.9%, 23.6%, 29.2%, 30.3%. The incidence of blood lipid disorder was 21.6%, 25%, 25%, 28.4%, but the difference between the scores of blood lipid disorder was 21.6%, 25%, 25%, 28.4%. There was no statistical significance, Gensini score was positively correlated with the number of stent placement and the number of coronary lesions, and there was a significant difference in the integration group. The Gensini score was positively correlated with the admission of myocardial infarction, and there was a significant difference in the integration group.2. The follow-up case was 9.1% for 1 years of drug use, and the incidence of MACCE was 9.1%. The rate was 89.47%, the difference was statistically significant; the patients who did not obey the doctor's advice to control blood lipid were 36.80%, the incidence of MACCE was 61.06%, and the difference was statistically significant. The incidence of MACCE was 88.24%, and the difference was statistically significant; the patients who did not obey the doctor's advice to take the blood pressure drugs accounted for 35.50%, MACC The incidence of E was 36.70%, the difference was not statistically significant; the patients who did not obey the doctor's advice to control blood sugar accounted for 4.49%, and the incidence of MACCE was 100%. There was no statistically significant difference in the occurrence of.2.2 MACCE. The results of single factor analysis showed that age, hypertension, diabetes, dyslipidemia, hyperuricemia, and irregular medication (double anti drug, Control blood lipid drug, control blood uric acid drug, left ventricular ejection fraction 50%, heart function grade high, BNP more than 400pg/L, high sensitive C reactive protein patients in 1~2 years after the operation, there were significant correlation between MACCE and the patients without the above risk factors, the difference was statistically significant, the x 2 value was 23.951,6.140,4.527,4.708, 13.809, (62.878,64.248,41.086), 4.954,7.913,8.792,9.327, P value 0.05. age, hyperuricemia, left ventricular ejection fraction 50%, hyperlipidemia, and diabetes are the risk factors of MACCE within 2 years after PCI for patients with coronary heart disease more than 65 years old, OR values are 1.117,3.206,1.944,3.874,2.461, P 0.05.[conclusion]1, basic disease of elderly patients with coronary heart disease. Many diseases, such as hypertension, diabetes, hyperuricemia, dyslipidemia and other diseases, serious coronary artery disease, high proportion of 3 branches and multiple branches, most of which are hospitalized with myocardial infarction and critical condition. We should strengthen the prevention and screening of coronary heart disease in the elderly, find and treat.2 in the elderly coronary heart disease in time, and Gensini score can be used to better evaluate the crown. The severity of pulse disease, age, diabetes and dyslipidemia are positively correlated with the Gensini score, indicating that the 3 groups have a promoting effect on the severity of coronary artery disease, the more serious the coronary artery disease is, the greater the possibility of entering the hospital with myocardial infarction, the more.3, and the high rate of double anti platelet and hypoglycemic drugs in the elderly patients with coronary heart disease, and the antihypertensive drugs. The rate of hyperuricemia was poor, and the rate of hyperuricemia was poor. 1 years of double anti drug drug was associated with the occurrence of MACCE in 2 years. The relationship between the 1 years and the irregular use of lipid-lowering drugs was most closely related. The clinical attention should be paid to the compliance of the patients after PCI, age, hypertension, dyslipidemia, diabetes, hyperuricemia. Cardiac insufficiency may be a risk factor for MACCE in elderly patients with coronary heart disease within 2 years after PCI.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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