左室射血分数降低的冠心病患者临床特点及其预后分析  

Clinical characteristics of coronary artery disease patients with reduced left ventricular ejection fraction and their prognostic analysis

作　　者：李全[1] 高阅春[1] 何继强[1] 姜腾勇[1] 任学军[1] 陈方[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科和心肺咀管研究所,100029

出　　处：《中国危重病急救医学》2012年第12期734-738,共5页Chinese Critical Care Medicine

基　　金：首都医学发展科研基金项目（2009-2074）

摘　　要：目的探讨冠心病患者左室射血分数（LVEF）降低与其临床特点的关系，评价LVEF降低对冠心病患者心血管事件的预测作用。方法选择经冠状动脉（冠脉）造影明确诊断为冠心病的住院患者677例，记录其临床资料，测定LVEF、超敏C-反应蛋白（hs—CRP）水平、白细胞计数（wBc）及心血管病危险因素。对患者进行随访，记录心脑血管主要不良事件（MACCE，包括全因死亡、靶血管血运重建、非致死心肌梗死、脑卒中或一过性脑缺血、需要住院治疗的不稳定型心绞痛和心功能衰竭等终点事件）发生情况。结果677例患者平均随访时间为（15±12）个月。根据LVEF水平将患者分为正常LVEF（≥0．50）组C585例）和低LVEF（〈0．50）组（92例）。与正常LVEF组比较，低LVEF组患者冠脉狭窄程度更重[Gensini评分（分）：62．85±41．45比47．68±33．26，P〈O．05]，wBC（×109／L）及hs—CRP（mg／L）明显升高（WBC：7．60±2．71比7．09±2．13，hs—CRP：5．68±3．97比3．97±3．75，均P〈0．05）。随访期间共146例患者发生MACCE，MACCE组患者LVEF水平明显低于无MACCE组（0．576±0．113比0．603±0．101，P〈0．05），hs—CRP、Gensini评分明显高于无MACCE组（hs—CPR：5．26±3．99比3．91±3．72，Gensini评分：53．72±35．50比48．63±34．59。均P〈0．05）。COX回归分析显示LVEF是预测冠心病患者MACCE的独立危险因素[单因素：相对危险度（RR）=0．974，95％可信区间（95％CI）为（0．960，0．988），P=0．000；多因素：RR=0．979，95％CI（0．961，0．998），P=0．033]。Kaplan—Meier曲线显示，LVEF水平降低患者的MACCE发生率明显高于LVEF正常者（x。=14．56，P〈0．05）。结论LVEF水平与冠心病患者的冠脉病变严重程度及不良预后有密切联系。Objective To explore the relationship between reduced left ventricular ejection fraction （LVEF） and characteristics of coronary artery disease （CAD） and investigate the association between reduced LVEF and cardiovascular prognosis. Methods A total of 677 hospitalized patients with angiographic CAD were enrolled. All patients＇ clinical data were recorded. LVEF were measured, high sensitive C-reactive protein （hs-CRP）, white blood cell （WBC） and classic cardiovascular risk factors were recorded after admission. All patients were followed up from admission. The primary end point was combination occurrence of major adverse cardiovascular and cerebral events （MACCE）, including death, targeted vascular revaseularization, non-fatal myocardial infarction and rehospitalization due to unstable angina or heart failure, transient ischemic attack or stroke. Results All patients were tracked for （ 15 ± 12） months, and patients were divided into normal LVEF group （LVEF 〉 0.50, n =585） and reduced LVEF group （LVEF〈0.50, n=92） according to LVEF level. Compared with normal LVEF group, reduced LVEF group had more severe coronary stenosis （Gensini score： 62.85 ± 41.45 vs. 47.68 ± 33.26, P〈O.05 ）, a higher level of WBC （ 109/L） and hs-CRP （rag/L, WBC： 7.60 ± 2.71 vs. 7.09 ± 2.13, hs-CRP： 5.68 ± 3.97 vs. 3.97 ± 3.75, both P〈O.05）. A total of 146 MACCE occurred during follow-up periods. Compared with no-MACCE group, LVEF levels were significantly lower in MACCE group （0.576 ± 0.113 vs. 0.603 ± 0.101 ） and there were a higher level of hs-CRP and Gensini score in MACCE group （hs-CRP： 5.26 ± 3.99 vs. 3.91 ± 3.72, Gensini score： 53.72 ± 35.50 vs. 48.63 ± 34.59, all P〈0.05）. Moreover, both of univariate and multivariate Cox regression analysis indicated LVEF be an independent predictor of MACCE in patients with CAD ±univariate： relative risk （RR）=0.974, 95% confidence interval （95%CI） 0.960 to 0.988, P=0.000; multivariate ： RR =0.979, 95% 0

关 键 词：冠心病 左室射血分数 高脂血症 心脑血管主要不良事件 预后 

分 类 号：R541.4[医药卫生—心血管疾病]