非ST段抬高急性冠状动脉综合征的危险因素分析及早期干预  

The studies of risk factors and early intervention in patients with acute coronary syndromes without ST-segment elevation

作　　者：赵明中[1] 胡大一[1] 姜立清[2] 李田昌[2] 马长生[3] 贾三庆[4] 陈方[3] 杨明[5] 

机构地区：[1]北京大学人民医院心内科,100044 [2]首都医科大学北京同仁医院 [3]首都医科大学北京安贞医院 [4]首都医科大学北京友谊医院 [5]首都医科大学北京复兴医院

出　　处：《中华心血管病杂志》2005年第2期153-157,共5页Chinese Journal of Cardiology

基　　金：北京市科技项目 (编号:H010210330113 );卫生部属医疗机构临床学科重点项目资助 (编号:20011014)

摘　　要：目的　探讨非ST段抬高急性冠状动脉综合征(ACS)的临床高危因素及早期有创干预的价值。方法　在 2001年 10月至 2003年 10月期间连续入院的非ST段抬高的ACS患者共 545例,随机分成早期保守治疗组与早期有创干预组;随访 30天与 6个月患者的复合心血管事件 (包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复缺血性心绞痛发作住院 )发生率,将患者一般临床特征及辅助检查指标对复合心血管事件做多变量回归分析,筛查主要的高危因素;评价早期保守治疗与早期有创干预对患者预后的影响。结果　随访 513例患者, 30天与 6个月的复合心血管事件发生率分别为 14 0%与 25 7%;多变量Logistic回归分析,显示ST段压低、肌钙蛋白Ⅰ (TnI)水平升高、高敏C反应蛋白(hs CRP)增高、左室射血分数(LVEF)值下降以及心肌梗死溶栓疗法(TIMI)危险评分高分者与 6个月的复合心血管事件增高密切相关,它们分别是患者复合心血管事件危险性增加的独立预测因子;与早期保守治疗组比较,早期有创干预组随访 30天时反复心绞痛发作住院率减少,复合心血管事件减少;随访 6个月时复合心血管事件也减少 (P均 <0 05)。结论　ST段压低、TnI水平升高、hs CRP增高、LVEF值下降或TIMI危险评分增高是非ST段抬高ACS患者的高危因素,早期有创干预能?Objective To investigate the risk factors and the values of early invasive intervention in patients with acute coronary syndromes(ACS) without ST segment elevation Methods Five hundred and forty five patients of ACS without ST segment elevation were randomly assigned to an early conservative strategy or early invasive strategy who had been admitted to hospitals consecutively from Oct 2001 to Oct 2003 The combined cardiovascular events(a combination of cardiac death, nonfatal myocardial infarction, nonfatal heart failure and re hospital admission due to recurrent ischemia angina ) within 30 days and 6 months were analyzed and the primary high risk factors for combined cardiovascular events were evaluated by means of multivariate logistic regression analysis among baseline clinical characteristics and laboratory data, meanwhile, the effects of an early conservative strategy or early invasive strategy on outcomes were also investigated Results The incidences of combined cardiovascular events within 30 days and 6 months among 513 cases were 14 0% and 25 7% respectively Multivariate logistic regression analysis implied ST segment depression, elevation of troponin Ⅰ level, increased C reactive protein, lower ejection fraction of left ventricular and higher TIMI risk scores were all associated with an increases in cardiovascular events within 6 months, and they were respectively independent predictive factor for the increases of cardiovascular events Early invasive strategy was associated with a lower rate of re hospital admission due to recurrent ischemia angina within 30 days and a decreased incidences of combined cardiovascular events within 30 days and 6 months compared with early conservative strategy(all P <0 05) Conclusions ST segment depression, elevation of troponin Ⅰ level, increased C reactive protein, lower ejection fraction of left ventricular and higher TIMI risk scores are high risk factors for patients with ACS without ST segment elevation, and early invasive

关 键 词：心血管事件 患者 非ST段抬高 早期 干预 ACS 随访 水平 独立 

分 类 号：R541.4[医药卫生—心血管疾病]