冠状动脉痉挛患者的长期临床随访分析  

Long-term prognosis of followed patients with coronary spasm

作　　者：孙涛[1] 张红菊[2] 孙俊平[1] 陈顺华[1] 王苏[1] 阴成茜[1] 张京梅[1] 李志忠[1] 

机构地区：[1]首都医科大学附属北京安贞医院抢救中心十五病房,100029 [2]北京阜外心血管病医院超声科

出　　处：《中华老年心脑血管病杂志》2011年第5期410-412,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的对冠状动脉痉挛患者住院期间及院外资料进行回顾分析,了解冠状动脉痉挛患者的长期预后,探讨影响冠状动脉痉挛的原因。方法选择确诊冠状动脉痉挛患者88例,常规内科治疗,行门诊和(或)电话随访,了解患者一般情况,包括有无胸痛再发、服药状况、吸烟现状、门诊检查结果等。以有无胸痛再发为因变量对患者临床因素行logistic回归分析,探讨影响冠状动脉痉挛再发的因素。结果患者出院后进行门诊和(或)电话随访,平均随访(61±1 7)个月,其中19例(21.6%)患者出院后仍有静息或晨起胸部不适、胸痛或类似入院主诉,其中11例表现为咽部紧缩感,6例表现为胸痛、胸部压榨感,舌下喷服硝酸甘油均有效,2例因反复胸痛治疗,1例患者发生猝死。logistic回归分析显示,入院时高敏C反应蛋白(OR=0.55,95%CI:0.32～0.95,P=0.033)、吸烟(OR=0.26,95%CI:0.56～0.98,P=0.028)是冠状动脉痉挛复发的危险因素。Kaplan-Meier曲线显示,患者在1年时胸痛发生率较高,为8.0%,1年后总体发生趋向平稳。结论入院高敏C反应蛋白水平、吸烟是冠状动脉痉挛发作的危险因素,严格戒烟和规律用药后患者总体预后较好。Objective To analyze retrospectively the in-hospital and out-hospital data of the patients suffering from coronary spasm, try to uncover the potential factors influencing the prognosis of coronary spasm. Methods Eighty-eight enrolled patients were treated routinely during stay in hospital and followed in outpatient department or by telephone interview after discharge. Resuits During the 61±17 month follow-up,there was no death,19 patients（21.6%） complained of chest pain, of them, 11 showed atypical chest pain, 6 showed typical chest pain, particularly in early morning, 2 were readmitted to hospital because of recurrent attacks of chest pain. Logistic regression analysis showed that high hs-CRP on admission （OR = 0.55,95% CI： O. 32--0.95, P = 0. 033） and smoking （OR = 0.26,95% CI： O. 56-0.98, P = 0. 028） were independent risk factors for recurrent angina attack. Kaplan-Meier curves showed that the incidence of attack in the first year was 8.0 % and the incidence of attack tended to decrease after one and half year. Conclusions The results show that hs-CRP level at diagnosis and smoking after discharge are independent risk factors for recurrent angina attack. Long-term prognosis is usually good so long as the pa- tients give up smoking and are on calcium-channel blockers or nitrate.

关 键 词：冠状血管痉挛 C反应蛋白质 吸烟 冠状血管造影术 危险因素 随访研究 预后 

分 类 号：R543.3[医药卫生—心血管疾病]