联合药物治疗在冠状动脉粥样硬化患者治疗过程中的应用状况及疗效观察  

The impact and changes of combined medical therapy on prognosis of patients with coronary atherosclerosis

作　　者：王建龙[1] 王志坚[1] 史冬梅[1] 刘宇杨[1] 赵迎新[1] 秦政[1] 杨丽霞[1] 成万钧[1] 周玉杰[1] WANG Jianlong;WANG Zhijian;SHI Dongmei;LIU Yuyang;ZHAO Yingxin;QIN Zheng;YANG Lixia;CHENG Wanjun;ZHOU Yujie(Department of 12th Ward, Beifing Anzhen Hospital, Capital Medical University, Beo＇ing Institute of Heart,Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2018年第4期303-306,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医院管理局临床医学发展专项经费资助(ZYLX201303);北京市医院管理局"登峰"计划专项经费资助(DFL20150601);国家临床重点专科建设项目经费资助(2013-2014年度)

摘　　要：目的:探讨在不同冠状动脉狭窄程度的患者中联合药物治疗(CMT)率及其对临床预后的影响。方法:入选我院接受择期冠状动脉造影的患者1 490例,根据造影结果将患者分为:A组(冠状动脉狭窄超过50%,n=716),B组(冠状动脉狭窄<50%,n=448)和C组(冠状动脉未见狭窄征象,n=326)。比较患者的CMT率及CMT对预后的影响。随访主要终点为主要不良心血管事件(MACE)定义为死亡、心肌梗死或再次血运重建的复合终点。结果:随着冠状动脉狭窄程度的加重,合并症的发生率逐渐增加,MACE发生率逐渐增加(正常、冠状动脉粥样硬化及冠心病患者分别为0.9%、5.4%和11.0%,P<0.001),CMT率逐渐增加(分别为95.1%、98.2%和99.4%,P<0.001)。尽管CMT对MACE的影响随冠状动脉狭窄严重程度逐渐减弱(交互作用P=0.038),但在阻塞性冠心病和冠状动脉粥样硬化患者中,CMT均可明显改善患者MACE(冠心病,HR:0.72,95%CI:0.62~0.84,P=0.002;冠状动脉粥样硬化,HR:0.87,95%CI:0.76~0.99,P=0.046)。结论:CMT率在冠状动脉粥样硬化人群中明显低于冠心病人群。尽管在冠状动脉粥样硬化患者CMT对临床预后的影响弱于冠心病患者,但CMT仍是临床预后改善的危险因素。Objective： To investigate the prevalence of CMT in patients with various coronary stenosis severities and its impact on clinical prognosis. Methods： A total of 1490 patients undergoing invasive coronary angiography for suspected coronary artery disease（ CAD） were grouped according to coronary stenosis severity：patients with obstructive CAD（ luminal stensosis ≥50%,n = 716）,non-obstructive CAD（ stenosis 50%,n= 448） and angiographic normal patients（ n = 326）. The prevalence of CMT and its impact on prognosis were compared across three groups. The primary endpoint was the major adverse cardiovascular events,which was the composite of death,myocardial infarction,or repeat revascularization. Results： With increasing coronary severity,we observed a progressively increased prevalence of risk factors,higher risk of MACE（ MACE was0. 9% vs. 5. 4% vs. 11. 0% in patients with normal,non-obstructive and obstructive CAD,P〈0. 001）,and higher prevalence of CMT（ 95. 1% vs. 98. 2% vs. 99. 4%,P〈0. 001）. Although there was an interaction between the impact of CMT on MACE and coronary severity（ interaction P = 0. 038）,CMT was an independent predictor of improved MACE in patients with either obstructive CAD（ HR： 0. 72,95% CI： 0. 62-0. 84,P =0. 002） or non-obstructive CAD（ HR： 0. 87,95% CI： 0. 76-0. 99,P = 0. 046）. Conclusion： the prevalence of CMT is lower in patients with non-obstructive CAD compared with patients with obstructive CAD. Although the impact is weaker in non-obstructive CAD patients,CMT is an independent predictor of improved prognosis in patients with either non-obstructive or obstructive CAD.

关 键 词：冠状动脉粥样硬化 联合药物治疗 临床预后 

分 类 号：R54[医药卫生—心血管疾病]