NSTE-ACS合并心律失常患者预后Cox比例风险回归模型分析  

Cox proportional hazards regression model for prognosis in patients with non-ST-segment elevationacute coronary syndrome complicated by arrhythmia

作　　者：胡志平 马丽君 严亚林[2] Hu Zhiping;Ma Lijun;Yan Yalin(Department of Cardiology,People's Hospital,Huangzhou District,Huanggang 438000,China)

机构地区：[1]黄州区人民医院心内科,黄冈438000 [2]武汉亚洲心脏病医院心内科,武汉430022

出　　处：《中国循证心血管医学杂志》2021年第7期819-822,830,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：湖北省黄冈市级一般项目科研(XQYF2020000056)。

摘　　要：目的基于Cox比例风险回归模型分析非ST段抬高型急性冠脉综合征(NSTE-ACS)合并心律失常患者预后的影响因素。方法纳入2016年10月至2019年10月于黄州区人民医院心内科就诊的NSTE-ACS合并心律失常患者,均接受随访,随访截至2020年10月31日,以全因死亡为随访终点。根据随访预后分为死亡组和存活组,采用Cox比例风险回归模型分析患者死亡的影响因素。结果最终298例患者完成随访,中位随访时间28个月(6~48个月);死亡42例(14.09%)。多因素Cox回归分析显示:总体模型系数的似然比检验χ^(2)=148.941、P<0.05,对数似然比检验χ^(2)=124.799、P<0.05,模型构建成立;年龄>70岁(HR=4.010,95%CI:1.132~14.199)、Killip心功能Ⅲ~Ⅳ级(HR=2.884,95%CI:1.364~6.101)、不稳定型室性心律失常(HR=3.552,95%CI:1.758~7.179)、GRACE评分>118分(HR=3.166,95%CI:1.061~9.447)、肌酐每增加1μmol/L(HR=1.011,95%CI:1.004~1.018)、D-二聚体每增加0.1 mg/L(HR=1.929,95%CI:1.294~2.876)是NSTE-ACS合并心律失常患者死亡的独立危险因素(P<0.05)。结论年龄>70岁、Killip心功能Ⅲ~Ⅳ级、不稳定型室性心律失常、GRACE评分>118分、肌酐、D-二聚体增高的NSTE-ACS合并心律失常患者发生死亡的危险性更大。Objective To analyze the influence factors of prognosis based on Cox proportional hazards regression model in patients with non-ST-segment elevation-acute coronary syndrome(NSTE-ACS)complicated by arrhythmia.Methods The patients with NSTE-ACS complicated by arrhythmia were chosen from Department of Cardiology in People’s Hospital of Huangzhou District and followed up from Oct.2016 to Oct.2019,and the follow-up was ended on Oct.31,2020.All patients were divided,according to follow-up prognosis,into death group and survival group.The influence factors of death were analyzed by using Cox proportional hazards regression model.Results There were finally 298 patients with complete follow-up and the median follow-up time was 28 months(6 to 48 months),and there were 42(14.09%)died.The results of Cox regression analysis showed that likelihood ratio test of the overall model coefficient showed χ^(2)=148.941 and P<0.05 and log likelihood ratio test showed χ^(2)=124.799 and P<0.05,and the model was established.Age>70(HR=4.010,95%CI:1.132~14.199),gradesⅢtoⅣof Killip classification(HR=2.884,95%CI:1.364~6.101),unstable ventricular arrhythmias(HR=3.552,95%CI:1.758~7.179),GRACE scores>118(HR=3.166,95%CI:1.061~9.447),each incretion of serum creatinine by 1μmol/L(HR=1.011,95%CI:1.004~1.018)and each incretion of D-dimer by 0.1 mg/L(HR=1.929,95%CI:1.294~2.876)were independent risk factors of death in patients with NSTE-ACS complicated by arrhythmia(P<0.05).Conclusion The patients with NSTE-ACS complicated by arrhythmia have higher death risk when they are aged over 70 with grades III to IV of Killip classification,unstable ventricular arrhythmias,GRACE scores>118 and increases of serum creatinine and D-dimer.

关 键 词：非ST段抬高型急性冠脉综合征 心律失常 预后 影响因素 

分 类 号：R541.7[医药卫生—心血管疾病]