急性冠状动脉综合征不同亚型的危险因素分析  

Analysis of risk factors for different subtypes of acute coronary syndrome

作　　者：张雷[1] 刘江萍 木胡牙提[1] 刘志强[1] 何鹏义[1] 杨玉春[1] 王姣[1] ZHANG Lei;LIU Jiang-ping;Muhuyati;LIU Zhi-qiang;HE Peng-yi;YANG Yu-chun;WANG Jiao(Department of Comprehensive Heart Internist,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院综合心脏内科,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国心血管病研究》2019年第11期983-988,共6页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(81760062)。

摘　　要：目的探讨急性冠状动脉综合征(ACS)患者不同亚型的危险因素差异及其与冠状动脉病变严重程度的关系.方法选取2017年1~12月我院心脏中心急诊行直接经皮冠状动脉介入治疗(PCI)的符合ACS诊断标准的患者296例,对其临床资料进行回顾性分析.根据ACS的临床特点分为三个亚型组:急性ST段抬高型心肌梗死(STEMI)组(106例)、非ST段抬高型心肌梗死(NSTEMI)组(96例)和不稳定型心绞痛(UAP)组(98例),比较ACS亚型患者危险因素及冠状动脉病变Gensini评分的差异.结果①单因素分析显示,NSTEM1组在年龄、空腹血糖、氨基末端脑钠肽前体、肌酸激酶同工酶水平均明显高于UAP组(P均<0.05);甘油三酯、低密度脂蛋白胆固醇、血浆纤维蛋白原、D-二聚体、氨基末端脑钠肽前体、高敏C反应蛋白、肌酸激酶同工酶水平均低于STEMI组(P均<0.05);UAP组合并高血压患者比例高于STEMI组(P<0.05).②Logistic多元回归分析显示,高敏C反应蛋白是NSTEMI组的独立危险因素(OR=1.976,95%CI1.953~6.999,P<0.05),低密度脂蛋白胆固醇是STEMI组的独立危险因素(OR=1.542,95%CI1.064~4.236,P<0.05).③ACS不同亚组冠状动脉狭窄程度两两比较均具有统计学意义(P均<0.05);④Gensini评分与危险因素Spearman秩相关分析显示,三个亚型组Gensini评分均与氨基末端脑钠肽前体水平呈正相关(r=0.324、0.482、0.556,P<0.05);NSTEMI组Gensini评分均与血浆纤维蛋白原、高敏C反应蛋白水平呈正相关(r=0.697、0.324,P均<0.05);STEMI组Gensini评分与D-二聚体水平呈正相关(r=0.429,P<0.05),与左心室射血分数值呈负相关(r=-0.602,P<0.05).结论ACS患者不同亚型危险因素存在显著差异,且评估及预测ACS亚型冠状动脉狭窄程度的指标也存在一定差异,明确其差异性对ACS亚型风险评估及临床治疗具有重要的指导意义.Objective To investigate the differences in risk factors between different subtypes of patients with acute coronary syndrome(ACS)and the severity of coronary lesions.Methods A total of 296 patients with ACS diagnostic criteria who underwent direct PCI in our hospital from January 2017 to December 2017 were retrospectively analyzed.According to the characteristics of ACS,the patients were divided into three subtype groups:acute ST-segment elevation myocardial infarction(STEM I)group(106 cases),non-ST-segment elevation myocardial infarction(NSTEM I)group(96 cases)and unstable angina pectoris(UAP)group(98 cases).The risk factors and the Gensini score of the coronary lesion were compared of the ACS subtype groups.Results(1)Unifactorial analysis showed that the age,levels of FBG,NT-proBNP and CK-MB in the NSTEMI group were significantly higher than those in the UAP group.TG,LDL-C,FiB,D-dimer,NT-proBNP,hs-CRP and CK-MB levels were lower than those of STEMI(all P<0.05).The proportion of patients with hypertension in UAP group was higher than that in the STEMI group(P<0.05).(2)Logistic multiple regression analysis showed that hs-CRP was the independent risk factors for NSTEMI group(OR=1.976,95%CI 1.953-6.999,P<0.05)and LDL-C was the independent risk factors for STEMI group(OR=1.542,95%CI 1.064-4.236,P<0.05).(3)Pantwise comparison o f the degree of coronary artery stenosis in different subgroups of ACS was statistically significant(P<0.05).(4)The correlation analysis between Gensini score and risk factor Spearman rank showed that Gensini score was positively correlated with NT-proBNP level in all the three subgroups(r=0.324,0.482,0.556,P<0.05).Gensini scores in the NSTEMI group were positively correlated with FiB and hs-CRP levels(r=0.697,0.324,all P<0.05).Gensini score in the STEMI group was positively correlated with D-dimer level(r=0.429,P<0.05)and negatively correlated with LVEF(r=-0.602,P<0.05).Conclusion There are significant differences in risk factors between different subtypes of ACS patients and there are some d

关 键 词：急性冠状动脉综合征 亚型 危险因素 冠状动脉病变 回顾性分析 

分 类 号：R543.3[医药卫生—心血管疾病]