青年急性冠脉综合征患者预后因素分析  

Analysis of prognosis factors for young patients with acute coronary syndrome

作　　者：何华[1] 韩福生[1] 贾平[1] 张铭[1] 崔松[1] 马临安[1] 

机构地区：[1]首都医科大学附属北京安贞医院急诊心内科,北京100029

出　　处：《临床内科杂志》2011年第6期387-390,共4页Journal of Clinical Internal Medicine

摘　　要：目的通过随访35岁以下青年急性冠脉综合征（ACS）患者研究其临床特征和预后因素。方法选取319例年龄在35岁以下的ACS患者，于住院期间行冠脉造影（CAG）证实冠脉狭窄性病变并行经皮冠脉介入术（PCI），记录相关临床资料，出院后1、3、6、12个月复查血常规、尿常规、生化、体重、糖化血红蛋白（HbAlC）、心电图、超声心动图等，随访出院后主要不良心脏事件（MACE）的发生，共随访1年并记录体重指数（BMI）、HbAlc、射血分数、左室舒张末期内径等参数。结果随访期间，共有11个MACE事件发生，其中非致死性心梗1例，反复心绞痛发作者10例，无心源性死亡。单因素分析表明合并高血压病、合并糖尿病、病变支数、BMI≥24kg／m2、术后3个月HbAlc≥6．8mmol／L与MACE发生有关，多因素分析显示合并糖尿病、多支病变、BMI≥24kg／m2、术后3个月HbAl c≥6．8mmol／L是青年ACS患者PCI术后1年内发生MACE的独立预测因素。结论超重和肥胖是影响35岁以下ACS患者长期预后的独立预测因素之一，对于合并糖尿病的青年ACS患者，术后HbAlC水平也是其独立的预后因素之一。Objectives The clinical features and prognosis factors of acute coronary syndrome （ACS） were investigated by follow up study in less than 35 years old patients with ACS. Methods There were 319 cases with ACS to be selected ,and coronary artery angiography and following percutaneous coronary intervention（PCI） were administered during in-hospital on all the selected patients younger than 35 years old with ACS,and their related clinical data was recorded. Then their blood routine, urine routine, body weight,electrogram, uhracardiography and glycosylated hemoglobin （HbAlc） were detected at one month,three months, six months and twelve months after discharge, and major adverse cardiovascular events（MACE）, body mass index （BMI）, HbAl c, ejection fraction, left ventricular end diastole diameter were recorded, and the follow-up was performed for twelve months. Results Total 11 MACE including one non-fatal infarction and ten frequent unstable angina pectoris happened during follow-up. A single-factor analysis indicated that concomitant essential hypertension, concomitant diabetes mellitus （DM）, the numbers of vessels with significant atherosclerotic stenosis, DM, BMI ≥24 kg/m2 and HbAlc ≥ 6.8 mmol/L at three months after discharge were related to the occurrence of MACE, and multi-factor analysis indicated that concomitant DM, multi-vessel significant arteriostenosis, BMI ≥ 24 kg/m2 and HbAlc ≥ 6.8 mmol/L at three months after discharge were independent predictors for MACE during twelve months after PCI in young patients with ACS. Conclusion Overweight and obesity was one of long-term independent predictors for the patients with ACS younger than 35 ,and HbAlc ≥6.8 mmol/L at three months after discharge was also an independent predictor for the young ACS patients with DM.

关 键 词：急性冠脉综合征 经皮冠状动脉介入术 体重指数 糖化血红蛋白 预后 

分 类 号：R541[医药卫生—心血管疾病]