查尔森合并症指数对急性冠状动脉综合征患者预后的临床评价  

Prognostic value of Charlson Comorbidity Index for acute coronary syndrome

作　　者：徐敏[1] 孙宝迪[1] 孙兆瑞[1] 刘红梅[1] 邵旦兵[1] 张炜[1] 林金锋[1] 任艺[1] 唐文杰[1] 聂时南[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)急救医学科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2015年第2期161-165,共5页Journal of Medical Postgraduates

基　　金：南京军区医药卫生科研基金(12Z32)

摘　　要：目的急性冠状动脉综合征（acute coronary syndrome,ACS）患者常伴有各种慢性合并症,严重影响预后。文中通过评估单个及权重分配后合并症的影响,探讨查尔森合并症指数（Charlson Comorbidity Index,CCI）评价急性冠状动脉综合征患者预后的预测辨别能力。方法回顾性分析2010年1月至2014年3月入住南京军区南京总医院1096例ACS患者的临床资料,查阅并记录入院时的一般资料、临床表现、合并症,并计算CCI分值及入院前后的治疗情况,以住院病死率作为判断预后的指标。结果 1所有患者中男性占73%,年龄（64.2±12.9）岁;女性占27%,年龄（72.1±12.6）岁。46.8%的患者伴有合并症。CCI评分系统纳入的疾病中,心肌梗死病史患者最多（18.0%）,其次为糖尿病患者（14.7%）,再者为中重度肾疾病（7.1%）、脑血管疾病（6.0%）、慢性肺部疾病（6.0%）。单因素分析表明ACS住院患者的临床各指标,包括冠状动脉病史、高血压病史、出现症状至入院所用时间、血流动力学、药物治疗和再灌注治疗等,CCI不同分值组组间比较的差异有统计学意义（P〈0.05）。2采用Logistic回归分析显示,CCI评分系统中,心脏衰竭（OR=1.88,95%CI：1.57~2.25）、转移性肿瘤（OR=2.25,95%CI：1.60~3.19）、肾疾病（OR=1.84,95%CI：1.60~2.11）和糖尿病（OR=1.35,95%CI：1.19~1.54）是预测ACS患者住院病死率较强的因素。3受试者工作特征曲线（receiver operating characteristic,ROC）分析表明,CCI分别合并年龄、年龄及性别的预测能力均优于单独CCI评分,ROC曲线下面积依次为0.761（95%CI：0.748~0.773）、0.756（95%CI：0.743~0.768）和0.670（95%CI：0.656~0.685）。结论心脏衰竭、糖尿病、肾疾病和转移性肿瘤严重影响ACS患者住院病死率,CCI合并年龄及性别可较好的判断ACS住院患者的预后。Objective Acute coronary syndrome（ ACS） is frequently accompanied by chronic comorbidities,which may seriously affect its prognosis. This study aims to investigate the value of the Charlson Comorbidity Index（ CCI） in predicting the outcome of ACS by assessing the impact of individual and post-weighted-assignment comorbid conditions of the disease. Methods We retrospectively analyzed the clinical data on 1 096 cases of ACS treated in Jinling Hospital from January 2010 to March 2014. We reviewed their general information,clinical presentations,complications,and previous treatments,calculated CCI,and used in-hospital mortality as the index for judging the prognosis. Results Of the 1 096 patients,73% were males（ aged 64. 2 ± 12. 9 years）,27% were females（ aged 72. 1 ± 12. 6 years）,and 46. 8% had comorbidities.Of the diseases included in the CCI system,previous myocardial infarction was the most frequent comorbidity（ 18. 0%）,followed by diabetes mellitus（ 14. 7%）, moderately to severe renal disease（ 7. 1%）,cerebrovascular disease（ 6. 0%）,and chronic lung disease（ 6. 0%）. Single factor analysis revealed statistically significant differences between different CCI groups in such clinical indicators as history of coronary artery disease,history of hypertension,time between symptom onset and admission,hemodynamics,drugs administered（ aspirin,P2Y12 blockers,ACEI/ARB or statins）,and reperfusion therapy（ P〈0. 05）. Logistic regression analysis showed the strongest predictors of in-hospital mortality were heart failure（ OR 1. 88,95% CI： 1. 57- 2. 25）,metastatic tumor（ OR 2. 25,95%CI： 1. 60- 3. 19）,renal disease（ OR 1. 84,95% CI： 1. 60- 2. 11）,and diabetes mellitus（ OR 1. 35,95% CI： 1. 19- 1. 19）.Receiver operating characteristic curve analysis manifested that either CCI with age or CCI with age and gender was superior to CCI alone in predicting in-hospital mortality of ACS patients（ AUC 0. 761 [95% CI 0. 748- 0. 773]and 0. 756 [95% CI： 0. 743- 0. 768]vs

关 键 词：查尔森合并症指数 急性冠脉综合征 预后 预测能力 

分 类 号：R541.4[医药卫生—心血管疾病]