老年ST段抬高型心肌梗死患者入院时高密度脂蛋白胆固醇水平对出院后不良心血管事件的影响研究  

Effect of Administrative HDL-C Level on Adverse Cardiovascular Events After Discharge in Elder Patients With ST-segment Elevation Myocardial Infarction

作　　者：刘永[1] 葛华[1] 房玲[1] 

机构地区：[1]沈阳医学院附属中心医院循环内科,辽宁省沈阳市110024

出　　处：《中国循环杂志》2014年第9期674-677,共4页Chinese Circulation Journal

摘　　要：目的:探讨分析老年ST段抬高型心肌梗死(STEMI)患者入院时高密度脂蛋白胆固醇(HDL-C)水平对出院后心血管不良事件发生情况的影响。方法:选取我院于2010-04至2012-07收治的325例老年STEMI患者,根据患者的HDL-C水平将其分为HDL-C高组(139例)与HDL-C低组(186例)。对比分析两组患者基线资料、临床资料、在院期间所接受的治疗、死亡情况、随访期间药物使用情况及不良心血管事件发生情况。结果:HDL-C低组入院后接受再灌注治疗的比例高于HDL-C高组(P<0.05),其中HDL-C低组紧急PCI的比例高于HDL-C高组(P<0.05);随访6个月及随访1年中,HDL-C高组患者β受体阻滞剂的使用率均低于HDL-C低组(P<0.05);HDL-C高组随访6个月及1年内非致死性心肌梗死、不良心血管事件发生率及因不良心血管事件再次入院的比例均低于HDL-C低组(P<0.05);Cox风险回归分析的结果显示低HDL-C水平[危险比(HR)=0.558,P=0.024)],糖尿病(HR=1.528 P=0.040)是STEMI患者出院后发生不良心血管事件的危险因素,而紧急经皮冠状动脉介入治疗[PCI,HR=0.471,P=0.001)]是保护因素。结论:入院时HDL-C水平低的STEMI患者出院后发生不良心血管事件的风险更高。Objective： To investigate the effect of administrative HDL-C （high density lipoprotein cholesterol） level on adverse cardiovascular events after discharge in elder patients with ST-segment elevation myocardial infarction （STEMI）. Methods： A total of 325 STEMI patients treated in our hospital from 2010-04 to 2012-07 were retrospectively studied. According to administrative HDL-C level, the patients were divided into 2 groups as High HDL-C group, n=139 and Low HDL-C group, n=186. The basic and clinical conditions, in-hospital treatment, death and the medication, adverse cardiovascular events during 6 and 12 months follow-up period were compared between 2 groups. Results： The patients with in-hospital reperfusion therapy was higher in Low HDL-C group, and Low HDL-C group had the higher ratio of emergent PCI treatment, all P〈0.05. During follow-up period, High HDL-C group had less patients with β-receptor blocker treatment, less non- fatal MI, adverse cardiovascular events and re-hospitalization, all P〈0.05. Cox regression analysis showed that low HDL-C level （HR=0.558, P=0.024） and diabetes mellitus （HR=1.528, P=0.040） were the risk factors of adverse cardiovascular events, while emergent PCI （HR=0.47, P=0.001） was the protective factor in STEMI patients after discharge. Conclusion： The lower administrative HDL-C level in elder patients with STEMI had the higher risk of adverse cardiovascular events after discharge.

关 键 词：ST段抬高型心肌梗死 高密度脂蛋白胆固醇 不良心血管事件 

分 类 号：R541[医药卫生—心血管疾病]