肾功能不全对急性心肌梗死患者长期预后影响的性别差异  

Gender difference in the prognostic value of renal dysfunction in patients with ST-segment elevation myocardial infarction

作　　者：李超[1] 胡大一[2] 李莉[1] 杨进刚[3] 宋莉[3] 马长生[4] 

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,100730 [2]北京大学人民医院心内科 [3]中国医学科学院阜外心血管病医院心脏中心 [4]首都医科大学附属北京安贞医院心脏中心

出　　处：《中华内科杂志》2015年第12期1007-1012,共6页Chinese Journal of Internal Medicine

基　　金：首都紧急医学救援（5分钟）科技工程建设研究项目[京科技发（2005）593]

摘　　要：目的评价入院时肾功能不全（renal dysfunction，RD）对急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者长期预后影响的性别差异。方法入选北京市19家医院450例发病24h内就诊并存活出院的STEMI患者，按性别分为男性组和女性组，比较两组患者基线特征、再灌注治疗时间和方法，以及6年预后情况，并使用多因素Cox回归模型分别评价RD对男性和女性患者长期预后的影响，及RD和性别是否存在交互作用。结果450例患者年龄（61．3±12．5）岁，女性108例（24％），女性RD比例高于男性（17．6％比6．7％，P=0．001）。女性年龄较大，既往有高血压、卒中病史较多，吸烟者较少。校正年龄、既往病史、急诊再灌注治疗等混杂因素后，RD不是女性患者全因死亡（HR 0．889，95％CI0．241—3．281，P=0．859）和主要不良心血管事件（MACE，HR1．508，95％CI0．616—3．693，P=0．368）的独立预测因子，但是男性患者全因死亡（HR 3．771，95％CI1．382～10．294，P=0．010）和MACE（HR2．292，95％CI1．091～4．817，P=0．029）的独立预测因子，RD和性别对6年全因死亡（HR 2．709，95％CI1．150～6．384，P=0．023）和MACE（HR 1．977，95％CI1．009～3．876，P=0．023）的影响存在交互作用。结论RD对STEMI长期预后的影响存在性别差异，对男性影响大于女性；RD与性别对STEMI长期预后的影响存在交互作用。Objective To evaluate the gender difference in the prognostic value of admission renal dysfunction （RD） for patients with acute ST-segment elevation （STEMI）. Methods This was a muhicenter, prospective cohort study. Four hundred and fifty STEMI patients within 24 h of onset and discharged successfully from 19 hospitals in Beijing were included in the study. All the patients were followed up six years later. According to gender, patients were categorized into two groups. Clinical characteristics, reperfusion therapy conditions and outcomes were analyzed. Multivariate Cox regression analysis was used to evaluate the possible gender difference in the prognostic value of RD. Results Among all the subjects, 342 were men and 108 were women with age of （61.3 ±12. 5） years. Compared to man patients, women were older （ P 〈 0. 001 ）, and more subjects were with hypertension （ 67.6% vs 49.7 %, P = 0. 005 ）, stroke （15.7% vs8.8%, P=0.039） and RD （17.9% vs 6. 7%, P=0.001）.After adjustment of age, past medical history, and acute reperfusion therapy. Cox regression analysis showed that RD was associated with the risk of all-cause mortality （HR 3. 771, 95% CI 1. 382 - 10. 294, P = 0. 010） and major adverse cardiovascular events （ MACE, HR 2. 292, 95 % CI： 1.091 - 4. 817, P = 0. 029 ） in male patients. However, the associations between RD and all-cause mortality（HR 0. 889, 95% 611 0. 241 - 3. 281, P = 0. 859） , and MACE（HR 1. 508, 95% CI O. 616 - 3. 693, P = 0. 368 ） were disappeared in women. The interaction test showed that there existed significant interactions between gender and RD in all-cause mortality （ HR 2. 709, 95%CI 1.150 -6.384, P =0.023） and MACE（HR 1.977, 95% CI 1.009 -3.876, P =0.023）. Conclusions There is a considerable gender difference in the prognostic value of RD for the outcomes in patients with STEMI. RD seemed to be an important prognostic maker in male patients.

关 键 词：心肌梗死 肾功能不全 预后 性别 

分 类 号：R542.22[医药卫生—心血管疾病]