急性冠脉综合征患者住院期间并发左心室收缩功能不全的危险因素探讨  

Risk factors of left ventricular systolic dysfunction in hospitalized patients with acute coronary syndrome

作　　者：王用 刘秀玲 史云桃 邢玉龙 WANG Yong;LIU Xiu-ling;SHI Yun-tao;XING Yu-long(Gaochun People's Hospital,Nanjing 211300,China)

机构地区：[1]南京市高淳人民医院

出　　处：《岭南心血管病杂志》2019年第4期389-392,共4页South China Journal of Cardiovascular Diseases

基　　金：南京市医学科技发展资金资助(项目编号:QRX17212)

摘　　要：目的研究急性冠状动脉综合征(acute coronary syndrome,ACS)患者住院期间并发左心室收缩功能不全的危险因素,并分析各临床指标和冠状动脉血管狭窄严重程度的关系.方法选择南京高淳人民医院2015年1月至2018年1月行冠状动脉造影确诊的223例ACS患者,根据患者入院后左心室射血分数(left ventricular ejection fraction,LVEF)分为心功能正常组(154例)和心功能不全组(69例).采用单因素和多因素Logistic回归分析来分析ACS患者发生左心室收缩功能不全的危险因素;并采用Spearman相关性分析来分析各因素与ACS患者冠状动脉血管狭窄程度的相关性.结果(1)单因素Logistic回归分析结果显示,两组患者在年龄、吸烟、肌酐浓度、入院时心率、左心室舒张末期内径(left ventricular end diastolic dimension,LVEDd)、左前降支病变、三支血管病变比较,差异有统计学意义(P<0.05),是发生心功能不全的危险因素.多因素Logistic回归排除这些混杂因素影响后显示,年龄,血肌酐浓度、LVEDd、三支血管病变、Gensini分数仍是ACS患者发生左心室收缩功能不全的危险因素(P<0.01).(2)Spearman相关分析结果显示,LVEDd(r=0.22,P<0.01)、三支血管病变与Gensini积分呈正相关(r=0.15,P=0.01).结论ACS患者住院期间高龄、肾功能不全、LVEDd增大、三支血管病变,病变范围广泛是发生心功能不全的危险因素;而高龄、吸烟以及LVEDd增大的患者冠状动脉血管狭窄程度越严重.Objectives To explore the risk factors for left ventricular systolic dysfunction during hospitalization in patients with acute coronary syndrome(ACS),and the relationship between clinical indicators and severity of coronary artery stenosis was also analyzed.Methods Totally 223 patients diagnosed as ACS by coronary artery angiography were enrolled from January 2015 to January 2018 in Gaochun People's Hospital.The patients were divided into cardiac functional normal group(n=154)and cardiac functional insufficiency group(n=69)according to left ventricular ejection fraction(LVEF).Univariate and multivariate Logistic regression analysis were used to analyze the risk factors for left ventricular systolic dysfunction in patients with ACS.Spearman correlation analysis was used to analyze the correlation between various factors and coronary artery stenosis in patients with ACS.Results(1)Univariate Logistic regression analysis showed that there were statistically significant differences in age,smoking,creatinine,heart rate at admission,left ventricular end diastolic dimension(LVEDd),left anterior descending coronary artery disease and three vascular lesions between the two groups,indicating they were the risk factors of cardiac functional insufficiency in patients with ACS(P<0.05).After adjusting for the confounders,multivariate Logistic regression analysis showed that age,serum creatinine concentration,LVEDd,three vessel vascular lesions and Gensini score were still risk factors for left ventricular systolic dysfunction in patients with ACS(P<0.01).(2)Spearman rank correlation analysis showed that LVEDd(r=0.22,P<0.01),three vascular lesions(r=0.15,P=0.01)positively correlated with Gensini score.Conclusions Senility,renal insufficiency,increased LVEDd,three vessel vascular lesions and wide range of lesions are risk factors for heart functional insufficiency in patients with ACS during hospitalization duration.Coronary artery stenosis was more serious in elderly,smoking and increased LVEDd patients with ACS.

关 键 词：冠状动脉疾病 左心功能不全 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]