代谢综合征对急性冠脉综合征PCI术预后的影响  

The predictive value of metabolic syndrome in patients with acute coronary syndrome afterpercutaneous coronary intervention

作　　者：孙同文[1] 徐青艳[1] 张晓娟[1] 吴琼[1] 彭飞[1] 杨飞[1] 马尚超[1] 路喃喃[1] 姚海木[2] 张金盈[2] 张竞超[3] 阚全程[4] 关方霞[5] 郝雪琴[6] 

机构地区：[1]郑州大学第一附属医院综合ICU,郑州450052 [2]郑州大学第一附属医院心内科 [3]郑州大学第一附属医院心外科 [4]郑州大学第一附属医院药剂科 [5]河南省医学科学院郑州大学生物工程学院 [6]河南科技大学动物科技学院

出　　处：《中华急诊医学杂志》2012年第10期1147-1152,共6页Chinese Journal of Emergency Medicine

基　　金：河南省高校科技创新人才专项基金（2012HASTIT001）;2012年度河南省科技成果转化项目（122102310584）;2012年度河南省医学科技攻关计划（201203027）;河南省卫生科技创新人才工程专项基金

摘　　要：目的探讨代谢综合征（metabolic syndromes,MS）对于急性冠脉综合征（acutecoronary syndromes,ACS）患者经皮冠状动脉介入（percutaneous coronary intervention,PCI）术后预后的影响。方法连续选取2009年9月至2010年6月于郑州大学第一附属医院心内科住院的ACS患者660例为研究对象。人选标准：冠脉造影显示至少一支血管狭窄程度为75%以上，成功接受PCI手术治疗且资料完整者。排除标准：肝肾功能损伤或患有肿瘤、心脏瓣膜病。记录患者人院时的临床资料及生化检查结果，于2011年3月至6月进行门诊和电话随访，记录心脏不良事件的发生情况。根据是否合并MS将患者分为MS和非MS组，并进行临床特征的比较。组间率的比较应用X2检验，多因素Logistic回归模型探索与预后相关的因素，Kaplan-Meier生存曲线比较两组无心脏不良事件的生存率。以P〈0.05为差异具有统计学意义。结果①成功随访605例（随访率91.7%），随访时间为（14.3±1.7）个月。95例患者发生心脏不良事件（发生率15.7%）。②符合MS诊断患者有393例，占64.96%。MS组患者除具有体质量指数高、收缩压高、舒张压高、血糖高、血脂紊乱（P〈0.05）外，男性患者所占比例稍低（P=0.016），目前仍吸烟者较少（P=0.008）,血小板计数升高（P=0.037）。MS和非MS组心脏不良事件的发生率分别为17.81%和11.79%,差异无统计学意义（P〉0.05）。③多因素Logistic分析显示：与心脏不良事件发生相关的危险因素为年龄（0R=2.628,95%可信区间，C7）：1.395-4.954,P=0.003）,纽约心脏病学会（NewYorkHeartAssociation,NYHA）心功能分级3=3级（0fl=2.310,95%CI1.095-4.870,P=0.028）和左心室射血分数（leftventricularejectionfraction,LYEF）（OR=4.328,95%CI：1.955-9.580,P〈0.001）,而MS与预后无相关性（0R=1.170，95%CI0.583-2.345,P=0.659）。④Kaplan-Meier生存曲线分析显示两组无心脏事件的累积生�Objective To investigate the predictive value of metabolic syndrome in patients with acute coronary syndrome （ ACS） after percutaneous coronary intervention （ PCI）. Methods A total of 660 patients with ACS admited to cardiovascular department, first affiliated hospital of zhengzhou university were enrolled in this study from January 2009 to June 2010. The enrollment criteria were： the stenosis degree were above 75% in at least one coronary artery by coronary angiography and successful PCI procedure. Exculsion criteria were： liver and renal insufficiency, malignancies and valvular heart diseases. The relevant clinical data and labtory examination were recorded after admission. The patients were followed up by outpatients interview or telephone from March to June 2011 and adverse cardiovascular events were recorded. The patients were divided into MS and non-MS groups, and basic clinical data were compared between two groups. The proportion difference between two groups were tested by chi square. Multivariate logistic regression was established to analyze the factors related to progonosis. The survival ratio was estimated using the Kaplan-Meier method. Statistical significance was established at a P value of less than 0. 05. Results ①A total of 606 （91. 7% ） patients successfully accepted follow-up. Mean follow-up time were （ 14. 3 土 1.7） months. 95 patients experienced adverse cardiovascular events （ 15. 7% ）.②There were 393 patients （64. 96% ） satisfied the definition of metabolic syndrome. The patients in MS group were with higher BMI, SBP, DBP, blood glucose and disordered lipid （ all P 〈0. 05）,with less fale patients （P = 0. 016）,less current somking （ P = 0. 008 ） and with higher platelet （ P = 0. 037 ）. The incidence of adverse cardiovascular events in two groups were 17. 81% and 11.79% （ P 〉0.05）.③ Multivarite logistic regression revealed that the predictors of adverse cardiovascular events were age [ OR = 2. 628, 95% confidence interval （ Cl） 1

关 键 词：急性冠脉综合征 血管成形术 经皮冠状动脉介入 代谢综合征 胰岛素抵抗 心 脏不良事件 预后 

分 类 号：R541.4[医药卫生—心血管疾病]