睡眠障碍对急性冠脉综合征经皮冠状动脉介入治疗患者预后的影响  

Effects of sleep disorders on prognosis of patients with acute coronary syndrome after percutaneous coronary intervention

作　　者：王娟[1] 韩冷[1] WANG Juan;HAN Leng(Department of Cardiology,The First People′s Hospital of Changshu,Changshu,Jiangsu 215500,China)

机构地区：[1]常熟市第一人民医院心内科,江苏常熟215500

出　　处：《岭南心血管病杂志》2019年第1期28-32,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨睡眠障碍对行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性冠状动脉综合征(acute coronary syndrome,ACS)患者预后的影响。方法连续入选2015年1月至2017年4月在常熟市第一人民医院心内科首次行PCI治疗的ACS患者310例,记录患者的各项临床资料,应用匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评估患者睡眠质量,随访1年主要不良心脑血管事件(majoradverse cardiovascular and cerebrovascular events,MACCE),采用多因素Logistic回归分析分析ACS患者PCI治疗后发生MACCE的危险因素,受试者工作特征曲线(receiver operating characteristic curve,ROC)确定PSQI预测MACCE发生的最佳阈值。结果 (1)成功随访302例(随访率97.4%),45例(14.9%)发生MACCE;(2)MACCE组患者PSQI总分显著高于非MACCE组,差异有统计学意义[(10.39±3.50)分vs.(6.80±2.71)分,P<0.001];(3)睡眠障碍组患者MACCE发生率明显高于无睡眠障碍组,差异有统计学意义(P<0.05);(4)多因素Logistic回归分析显示睡眠障碍(PSQI总分>7分)是ACS患者PCI治疗后1年内MACCE发生的独立预测因子;(5)PSQI总分对MACCE预测的ROC曲线下面积为0.763,当PSQI总分为9分时,其预测MACCE的敏感性为68.9%,特异性为75.1%。结论睡眠障碍可作为ACS患者PCI治疗后远期预后的预测指标,改善睡眠障碍可能改善ACS患者PCI治疗后的预后。Objectives To investigate the effect of sleep disorders on the prognosis of patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods A total of 310 patients with ACS who underwent PCI for the first time in the Department of Cardiology,the First People′s Hospital of Changshu,from January 2015 to April 2017 were consecutively enrolled.The clinical data of patients were recorded,and the Pittsburgh sleep quality index(PSQI)was used to assess the quality of sleep.The primary endpoint of the present study was the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)during one year follow-up.Multivariate Logistic regression was used to find the risk factors for MACCE in ACS patients undergoing PCI.Receiver operating characteristic curve(ROC)was performed to evaluate the threshold value of PSQI.Results(1)A total of 302 patients(97.4%)received the clinical follow-up successfully,and 45 cases(14.9%)suffered from MACCE during one year follow-up;(2)Patients in MACCE group had significantly higher PSQI scores than those in non-MACCE group(10.39±3.50 vs.6.80±2.71,P<0.001);(3)The incidence of MACCE was significantly higher in patients with sleep disorders than in those without sleep disorders(P<0.05);(4)Multivariate Logistic regression analysis showed that sleep disorders(PSQI total score >7)was an independent predictor of one-year MACCE occurrence in ACS patients undergoing PCI;(5)The area under ROC of the total PSQI score for MACCE was 0.763,and the optimal cutoff value of total PSQI score predicting one-year MACCE was 9(sensitivity:68.9%,and specificity:75.1%).Conclusions Sleep disorders can be used as a predictor of long-term prognosis of ACS patients undergoing PCI.Improvement of sleep disorders may improve the prognosis of patients with ACS after PCI.

关 键 词：冠状动脉疾病 睡眠障碍 急性冠脉综合征 血管成形术 经腔 经皮冠状动脉 主要不良心脑血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]