老年冠心病和高血压患者再发心脏事件的临床危险因素  

Clinical risk factors of recurrent heart event in elderly patients with coronary heart disease and systemic hypertension

作　　者：谢英[1] 胡旭东[1] 

机构地区：[1]安贞医院老年心内科

出　　处：《中华老年医学杂志》1996年第1期29-32,共4页Chinese Journal of Geriatrics

摘　　要：目的老年冠心病和高血压患者再发急性心肌梗死（ＡＭＩ）和心原性猝死（ＳＣＤ）等心脏事件的危险较大，我们研究这些患者的有关临床特征对再发心脏事件的影响。方法随访３９０例老年冠心病和高血压患者２～８．５年，记录年龄、性别、糖尿病、吸烟、心电图ＳＴ－Ｔ异常、总胆固醇与高密度脂蛋白胆固醇比值≥４．５、冠心病并高血压、左室肥厚、无痛性心肌缺血和复杂室性心律失常等临床特征及ＡＭＩ或ＳＣＤ发生情况。结果　共有４８例患者发生ＡＭＩ或ＳＣＤ。Ｋａｐｌａｎ－Ｍｅｉｅｒ法分析得出８年累积再发心脏事件率２１．８％。单因素分析表明，除年龄外的９个临床危险因素都使再发心脏事件率显著增加。Ｃｏｘ多因素分析表明，上述后５个危险因素是再发心脏事件的重要独立预报因素。结论为改善老年冠心病和高血压患者的预后，对上述临床危险因素应予以足够重视，并加以控制。Objective Recurrent heart events including acute myocardial infarction(AMI) and sudden cardiac death(SCD) occurring in elderly patients with coronary heart disease and systemic hypertension is very dangerous.The relation between the clinical risk factors and recurrent heart events was studied.Metbods Three hundred and ninety elderly patients with coronary heart disease and systemic hypertension were followed-up for 2-8.5 years.Ten clinical factors of the patients including age,male sex.diabetes mellitus,history of smoking,electrocardiographic ST-T abnormality,a ratio of total to high-density lipoprotein cholesterol≥4.5,coronary heart disease accompanied by hypertension,left ventricular hypertrophy,silent myocardial ischemia and complex ventricular arrhythmia were recorded and the occurrence of AMI and SCD were noted as well.Results AMI and SCD occurred in 48 patients.The recurrent heart event rate in 8 years was 21.8% as calculated from Kaplan-Meier survival curves.In an univariated analysis,with the exception of age,the other 9 factors significantly increased the chance of recurrent heart event.Cox proportional hazards regression analysis revealed that the latter 5 factors independently predicted the occurrence of recurrent heart event.Conclusions It is suggested that,in order to improve the prognosis in elderly patients with coronary heart disease and hypertension,it is necessary to pay full attention to the risk factors mentioned and to control them.

关 键 词：冠状动脉疾病 高血压 心肌梗死 死亡 老年人 

分 类 号：R541.405[医药卫生—心血管疾病]