老年稳定性冠心病合并急性下呼吸道感染近期心血管事件和死亡风险评价  

Short-term cardiovascular events and mortality in elderly patients with stable coronary artery disease complicating acute lower respiratory tract infection: a risk review

作　　者：赵晓茜[1] 骆雷鸣[1] 叶平[1] 杜瑞雪[1] 肖铁卉[1] 

机构地区：[1]解放军总医院南楼心血管科,北京100853

出　　处：《中国循证心血管医学杂志》2015年第2期202-206,210,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：军队保健专项科研课题(2012-12BJZ34)

摘　　要：目的探讨老年稳定性冠状动脉粥样硬化性心脏病（冠心病）患者,合并急性下呼吸道感染近期（90 d）心血管事件（CVEs）及全因死亡的发生情况及相关危险因素。方法采用前瞻性队列观察研究方法,连续入选2011年1月至2013年12月在解放军总医院因急性下呼吸道感染（ALRTI）住院的稳定性冠心病（s CAD）老年患者,作为感染组,同期住院的稳定性s CAD患者作为非感染组。随访两组近期阶段的7 d（D7）、30 d（D30）、90 d（D90）发生CVEs及全因死亡情况。结果共有426例老年s CAD患者纳入最终分析。其中,感染组257例,非感染组169例,平均年龄88±5岁。随访阶段的D7、D30、D90期间,整个队列的CVEs发生率分别为7.5%、15.0%和24.6%,全因死亡的发生率分别为0.7%,2.6%和8.7%。感染组与非感染组发病后三个不同阶段的CVEs和全因死亡的发生率比较,CVEs发生率在D7（10.9%vs.2.4%,P=0.001）、D30（20.6%vs.6.5%,P〈0.001）和D90（31.9%vs.13.6%,P〈0.001）均明显高于非感染组;全因死亡发生率在D7（1.2%vs.0%,P=0.28）、D30（3.9%vs.0.6%%,P=0.021）和D90（13.2%vs.1.8%,P〈0.001）阶段也显著高于非感染组。感染组的CVEs多集中在感染后的30 d之内,其中冠脉事件则集中在2周内,非感染组的事件无时间规律。多因素回归分析显示：急性下呼吸道感染（OR=2.162,95%CI：1.023~4.569,P=0.043）、慢性肾脏病（OR=2.086,95%CI：1.085~4.013,P=0.028）、入院时呼吸≥24次/min（OR=1.093,95%CI：1.006~1.187,P=0.036）和入院时心率≥125次/分（OR=1.018,95%CI：1.000~1.037,P=0.045）与90 d CVEs及全因死亡的复合终点风险增加独立相关。发生CVEs的患者,近期死亡率明显高于未发生CVEs者（P=0.004）。结论老年s CAD患者,发生急性下呼吸道感染后,显著增加近期多种心血管事件和全因死亡风险。有效预防和积极治疗下呼吸道感染,有望可能减少老年冠心病患者的心血管事件和死亡。Objective To discuss the incidence and risk factors of short-term （within 90 d） cardiovascular events （CVEs） and all-cause mortality in elderly patients with stable coronary artery disease （sCAD） complicating acute lower respiratory tract infection （ALRTI）.Methods The elderly patients with sCAD hospitalized due to acute lower respiratory tract infection （infection group） and sCAD patients without acute lower respiratory tract infection （non-infection group） were chosen from Jan. 2011 to Dec. 2013. The incidences of CVEs and all-cause mortality were followed up for 7 d （D7）, 30 d （D30） and 90 d （D90）.Results There were totally 426 elderly sCAD patients included the analysis, among them 257 in infection group and 169 in non-infection group （average age=885）. During follow-up period, the incidence of CVEs was 7.5% at D7, 15.0% at D30 and 24.6 % at D90, and incidence of all-cause mortality was 0.7% at D7, 2.6% at D30 and 8.7% D90 in whole cohort. The incidence of CVEs （10.9%vs. 2.4%,P=0.001） at D7, （20.6%vs. 6.5%,P〈0.001） at D30 and （31.9%vs. 13.6%,P〈0.001） at D90 was higher in infection group than those in non-infection group, and all-cause mortality （1.2%vs. 0%,P=0.28） at D7, （3.9%vs. 0.6%,P=0.021） at D30 and （13.2%vs. 1.8%,P〈0.001） at D90 was also higher in infection group than those in non-infection group. In infection group, CVEs occurred centrally within 30 d and sCAD occurred centrally within 2 w, and there were no time laws in non-infection group. The multi-factor regression analysis showed that acute lower respiratory tract infection （OR=2.162, 95%CI： 1.023~4.569,P=0.043）, chronic kidney disease （OR=2.086, 95%CI：1.085~4.013,P=0.028）, admission respiratory rate≥24 time/min （OR=1.093, 95%CI： 1.006~1.187,P=0.036） and admission heart rate≥125 time/min （OR=1.018, 95%CI： 1.000~1.037,P=0.045） were independently correlated to risk increase of composite end-point of CVEs and all-cause mortality at D90. The short-term mor

关 键 词：下呼吸道感染 炎症 心血管事件 全因死亡 

分 类 号：R541.4[医药卫生—心血管疾病]