中西医结合改善冠心病PCI术后患者预后前瞻性队列研究  

Prospective Cohort Study on Improving the Prognosis of Patients with Coronary Heart Disease After PCI

作　　者：闫思雨 马丽红[1] 郭彩霞[1] 陆培培[1] 苏燕妮 郭轩彤 马杰[1] 祁宇阳 YAN Si-yu;MA Li-hong;GUO Cai-xia;LU Pei-pei;SU Yan-ni;GUO Xuan-tong;MA Jie;QI Yu-yang(Department of Traditional Chinese Medicine,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037)

机构地区：[1]中国医学科学院北京协和医学院阜外医院中医科,北京100037

出　　处：《中国中西医结合杂志》2022年第11期1300-1306,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：科技创新2030“新一代人工智能”重大项目(No.2021ZD0111003);国家中医药管理局中医药科学技术研究专项(No.2016ZX04)。

摘　　要：目的观察中西医结合治疗冠心病PCI术后患者的临床疗效。方法采用前瞻性观察性队列研究方法入选冠心病PCI术后患者5942例,并随访2年,最终完成随访5453例。根据是否在常规西药治疗基础上服用半年以上中药,将患者分为单纯西药组(2932例)和中西医结合组(2521例)。根据中药剂型将中西医结合组患者分为中药汤剂组1567例,中成药组954例。主要终点指标为主要不良心血管事件(MACE),包括:再次血运重建、心肌梗死、全因死亡。结果糖尿病患者发生MACE风险更高(P=0.042)。中西医结合组患者MACE发生率低于单纯西药组[HR:0.73,95%CI(0.63,0.85),P<0.01],西药+中药汤剂组与西药+中成药组MACE发生率均低于单纯西药组[HR:0.796,95%CI(0.672,0.941),P<0.01;HR:0.644,95%CI(0.517,0.802),P<0.01]。与单纯西药组比较,中西医结合组在性别、年龄、吸烟史、冠心病病程、高血压病病史、高脂血症病史各亚组中MACE发生率均降低(P<0.05,P<0.01),正常体重、超重或肥胖人群、急性冠脉综合征介入、首次介入、无冠心病家族史、未患糖尿病亚组中MACE发生率降低(P<0.05,P<0.01)。结论中西医结合治疗可降低各亚组冠心病PCI术后患者的MACE发生率。Objective To observe the efficacy of integrated Chinese and Western medicine(ICWM)for coronary artery disease(CAD)patients after percutaneous coronary intervention(PCI).Methods Prospective observational cohort study method was used to select 5942 CAD patients after PCI,and 5453 patients completed the 2-year follow-up.According to whether using Chinese herbal medicine over half a year on the basis of conventional treatment,patients were assigned to Western medicine group(WM group,2932 cases)and ICWM group(2521 cases).The ICWM group were assigned to Chinese medicine decoction group(CMD group,1567cases)and Chinese patent medicine group(CPM group,954 cases)according to the Chinese herbal medicine formulations.The primary endpoint was major adverse cardiovascular events(MACE),including all-cause death,myocardial infarction,and revascularization.Results Diabetes patients had a higher risk of MACE(P=0.042).The cumulative incidence of MACE in ICWM group was lower than that in WM group[HR:0.73,95%CI(0.63,0.85),P<0.01],the incidence of MACE in CMD group and CPM group was lower than that in WM group[HR:0.796,95%CI(0.672,0.941),P<0.01;HR:0.644,95%CI(0.517,0.802),P<0.01].Compared with WM group,the incidence of MACE in all subgroups of gender,age,smoking history,CAD course,hypertension history,hyperlipidemia history in ICWM group decreased(P<0.05,P<0.01),the incidence of MACE in the subgroups of normal weight,overweight or obesity,acute coronary syndrome PCI,first PCI,no family history of CAD,and no diabetes in ICWM group decreased(P<0.05,P<0.01).Conclusion ICWM treatment can reduce the incidence of MACE in different subgroups of CAD patients after PCI.

关 键 词：中西医结合 中药 冠心病 经皮冠状动脉介入术后 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]