缺血性心肌病住院患者的临床特征、冠状动脉介入治疗效果和预后分析  

Analysis of clinical characteristics, coronary intervention outcome and short-term prognosis of inpatients with ischemic cardiomyopathy

作　　者：胡锋[1] 陈婷[1] Hu Feng;Chen Ting(Department of Cardiology,the First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院心血管内科,杭州310003

出　　处：《中国心血管杂志》2019年第2期115-120,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的通过调查缺血性心肌病住院患者的临床特征和冠状动脉介入治疗效果,探讨影响预后的指标。方法收集2015年12月至2016年12月在浙江大学医学院附属第一医院心血管内科住院治疗的90例缺血性心肌病患者资料,运用Gensini评分系统量化冠状动脉狭窄程度,记录患者住院期间用药和治疗情况,并随访出院后1年的症状改善和主要不良心血管事件(MACE)情况。分别根据纽约心脏病协会(NYHA)心功能分级和是否接受经皮冠状动脉介入治疗(PCI)分组,比较临床基线和预后情况。结果缺血性心肌病患者大多有明确的心肌梗死(56.7%,51/90)、心绞痛(28.9%,26/90)病史,少部分患者起病隐匿。以NYHA心功能分级分组,随着心功能恶化,患者基线情况越差,冠状动脉中重度狭窄的病变支数和Gensini总积分增加,出院后1年的心功能改善越不明显、MACE发生率越高。以是否接受PCI治疗分组,发现出院后1年PCI联合药物治疗较单纯药物治疗能更好地改善患者的心功能,MACE发生率也更低。Logistic回归分析表明,基线NYHA心功能分级(≥Ⅱ级)、左心室舒张末期内径(≥60.75 mm)、未行PCI治疗和Gensini积分(≥139分)是缺血性心肌病患者出院后1年内MACE事件发生的独立预测指标(均为P<0.05)。结论基线心功能分级、左心室舒张末期内径、PCI治疗和Gensini积分是影响缺血性心肌病患者预后的重要因素。Objective To investigate the clinical characteristics,the effect of coronary intervention,and the indicators related to short-term prognosis in hospitalized patients with ischemic cardiomyopathy(ICM).Methods Collected the general information of 90 cases with ICM,quantified the degree of coronary stenosis by using the Gensini scoring system,recorded the situation of medication and treatment of ICM during the hospitalization,and followed up of symptoms improvement and major adverse cardiovascular events(MACE)at 1 year after discharge.According to NYHA classification and whether or not accepted percutaneous coronary intervention(PCI),patients were divided into different groups and the clinical characteristics and short-term prognosis between groups were compared.Results The majority of ICM patients had definite myocardial infarction(56.7%,51/90)and angina(28.9%,26/90),a small number of patients had insidious onset.As the underlying deterioration of cardiac function,the patients'basic situation even worsen,the count of coronary moderately severe stenosis and the aggregate score of Gensini scoring increased,and the improvement of heart function was not obvious,the incidence of MACE was more higher after 1 year follow-up.ICM patients with coronary intervention combined drug therapy group PCI therapy can improve cardiac function and lower the incidence of MACE than the medicine conservative treatment.Baseline cardiac function classification(2.0 or higher),left ventricular end-diastolic diameter(LVEDD)(≥60.75 mm),Gensini score(≥139 points)and non-PCI treatment were independent predictors of MACE events after 1 year follow-up in patients with ICM(all P<0.05).Conclusions Baseline cardiac function classification,LVEDD,Gensini score and PCI treatment are important factors of MACE events after 1 year follow-up in patients with ICM.

关 键 词：心肌疾病 心力衰竭 血运重建 预后 

分 类 号：R542.2[医药卫生—心血管疾病]