冠状动脉临界病变患者药物治疗后发生远期主要不良心血管事件的影响因素  

Influencing factors for long-term major adverse cardiovascular events in patients with coronary border⁃line lesion after medical treatment

作　　者：郑翔 潘娜娜[1] 谭丽娟[1] ZHENG Xiang;PAN Na-na;TAN Li-juan(Department of Cardiology,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China)

机构地区：[1]青岛大学附属医院心内科,山东青岛266000

出　　处：《岭南心血管病杂志》2020年第3期253-257,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的分析冠状动脉临界病变患者药物治疗后发生远期主要不良心血管事件(major adverse cardiovascular event,MACE)的影响因素。方法选择2015年9月至2017年10月在青岛大学附属医院就诊的212例冠状动脉临界病变患者为研究对象,随访1年,根据有无发生MACE,将患者分成MACE组(n=33)和无MACE组(n=179)。对两组患者的基线资料和药物治疗等情况进行单因素分析,对两组差异有统计学意义的单因素进行非条件Logistic多因素回归分析,探究冠状动脉临界病变患者发生MACE的危险因素并建立预测模型,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)判定其预测价值。结果两组患者在年龄、体质量指数、吸烟史、饮酒史、原发性高血压(高血压)史、血清低密度脂蛋白胆固醇(low-density lipoproteincholesterol,LDL-C)、糖化血红蛋白(glycosylated hemoglobin,HbA1C)、高敏C反应蛋白(high-sensitivity C reactive protein,hs-CRP)浓度,狭窄程度和急性冠状动脉综合征(ACS)患者比例比较,差异有统计学意义(P<0.05);而两组患者在性别、随访时间和靶血管数、氯吡格雷、拜阿司匹林、瑞舒伐他汀及适量运动等比较,差异无统计学意义(P>0.05)。经Logistic回归分析,LDL-C(OR=2.646,95%CI:0.724~9.665)、HbA1C(OR=3.397,95%CI:0.490~23.558)、hs-CRP(OR=1.087,95%CI:0.097~12.131)为MACE的危险因素。Logistic回归模型:logit(P)=-15.209+0.973X1+1.223X2+0.083X3,其中X1代表LDL-C,X2代表HbA1C,X3代表hs-CRP。根据ROC分析可得,LDL-C诊断的临界值为2.52 mmol/L,其对应的灵敏度为73.15%,特异度为64.00%,ROC曲线下面积为0.713(95%CI:0.654~0.781);HbA1C诊断的临界值为6.12 mmol/L,其对应的灵敏度为75.00%,特异度为69.00%,ROC曲线下面积为0.754(95%CI:0.689~0.819);hs-CRP诊断的临界值为3.11 mmol/L,其对应的灵敏度为64.81%,特异度为75.00%,ROC曲线下面积为0.645(95%CI:570~0.720)。在最佳临界切点时,LDL-C、HbA1C、hs-CRP联合检测的灵Objectives To analyze the influencing factors of long-term major adverse cardiovascular event(MACE)in patients with coronary artery critical lesions after medical treatment.Methods Totally 212 patients with coronary borderline lesion from September 2015 to October 2018 in Affiliated Hospital of Qingdao University were selected as study objectives.According to the occurrence of MACE,the patients were divided into MACE group(n=33)and no MACE group(n=179).The basic information and treatment of the two groups were compared for single factor analysis,and the significantly different single factors were analyzed by non-conditional Logistic regression analysis.Risk factors for MACE and the forecast model were established.Receiver operating characteristic curve(ROC)was used to determine its predictive value.Results There were significant differences on age,body mass index,smoking history,drinking history,hypertension history,low-density lipoprotein cholesterol(LDL-C),glycosylated hemoglobin(HbA1C),highsensitivity C reactive protein(hs-CRP),stenosis degree and acute coronary syndrome patients between the two groups(P<0.05).There were no significant differences on gender,follow-up duration,target vessels,clopidogrel,aspirin,rosuvastatin and moderate exercise between the two groups(P>0.05).Logistic regression analysis indicated that LDL-C(OR=2.646,95%CI:0.724-9.665),HbA1C(OR=3.397,95%CI:0.490-23.558)and hs-CRP(OR=1.087,95%CI:0.097-12.131)were risk factors for MACE.Logistic regression model:logit(P)=-15.209+0.973X1+1.223X2+0.083X3,of which X1 represents LDL-C,X2 represents HbA1C and X3 represents hs-CRP.According to the ROC analysis,critical diagnosis value of LDL-C was 2.52 mmol/L,corresponding sensitivity was 73.15%,specificity was 64.00%and the area under the curve(AUC)was 0.713(95%CI:0.654-0.781).Critical diagnosis value of HbA1c was 6.12 mmol/L,corresponding sensitivity was 75%,specificity was 69.00%and the AUC was 0.754(95%CI:0.689-0.819).Critical diagnosis value of hs-CRP was 3.11 mmol/L,corresponding sensitivity was 6

关 键 词：冠状动脉临界病变 主要不良心血管事件 影响因素 

分 类 号：R541.4[医药卫生—心血管疾病]