心血管疾病重症患者全死因死亡的危险因素分析  

Analysis of Risk Factors for All-Cause Mortality in Patients with Severe Cardiovascular Disease

作　　者：刘志玄 王羽 张换想 隋晓芳[2] 邱洪斌[1] 张艺潆[1] Liu Zhixuan;Wang Yu;Zhang Huanxiang;Sui Xiaofang;Qiu Hongbin;Zhang Yiying(School of Public Health,Jiamusi University,Jiamusi 154007,China;Health Management Physical Examination Center,The First Affiliated Hospital of Jiamusi University,Jiamusi 154007,China)

机构地区：[1]佳木斯大学公共卫生学院,佳木斯154007 [2]佳木斯大学附属第一医院健康管理体检中心,佳木斯154007

出　　处：《成都医学院学报》2023年第3期309-313,共5页Journal of Chengdu Medical College

基　　金：黑龙江省教育厅普通高等学校青年创新人才培养计划项目(No:UNPYSCT-2018113);黑龙江省博士后启动基金(No:LBH-Q21047);黑龙江省自然科学基金优秀青年项目(No:YQ2019H032)。

摘　　要：目的 探讨心血管疾病(CVD)重症患者全死因死亡的危险因素。方法 选取2002—2012年美国重症监护医学信息库数据库中含有血清铁检测指标的5 779例CVD重症患者为研究对象,根据研究结局将其分为存活组(n=5 032)和全死因死亡组(n=1 626);根据血清铁浓度按照四分位数法分为4组:G1组(50~210μg/L,n=1 473)、G2组(210~350μg/L,n=1 471)、G3组(350~590μg/L,n=1 398)、 G4组(>590μg/L,n=1 437)。通过绘制K-M生存分析曲线、Cox回归模型,分析CVD重症患者全死因死亡的危险因素及不同血清铁水平与CVD重症患者全死因死亡的关系。结果 纳入患者中,男3 007例(52%),女2 772例(48%)。与G1组比较,G4组发生全死因死亡的风险更高(P=0.008)。血清铁浓度(HR=1.131,95%CI:1.007~1.315)、男性(HR=1.200,95%CI:1.082~1.341)、高龄(HR=1.022,95%CI:1.000~1.202)、合并转移癌(HR=2.561,95%CI:1.711~3.835)、实体瘤(HR=1.591,95%CI:1.230~2.083)是影响CVD患者存活的危险因素,而白蛋白、总铁结合力、氯化物、肌酐、葡萄糖是其保护因素。结论 CVD患者血清铁浓度越高发生全死因死亡的风险越高,此外,男性、高龄等为CVD的危险因素,而白蛋白、总铁结合力等为保护因素。Objective To investigate the risk factors for all-cause mortality in patients with severe cardiovascular disease(CVD).Methods A total of 5779 severe CVD patients with serum iron(Fe)detection indexes were selected from the Medical Information Mart for Intensive Care(MIMIC).According to the study outcome,they were divided into survival group(n=5032)and all-cause mortality group(n=1626).And according to their serum Fe level,they were divided into 4 groups by quartile method:namely G1 group(50-210μg/L,n=1473),G2 group(210-350μg/L,n=1471),G3 group(350-590μg/L,n=1398),and G4 group(>590μg/L,n=1437).Kaplan-Meier(K-M)survival analysis curve and Cox regression model was used to analyze the risk factors for all-cause mortality in severe CVD patients and the correlation between different serum Fe levels and all-cause mortality in patients with severe CVD.Results Among the included cases,there were 3007 males(52%)and 2772 females(48%).The risk of all-cause death was higher in G4 group than that in G1 group(P=0.008).Serum Fe concentration(HR=1.131,95%CI:1.007-1.315),male(HR=1.200,95%CI:1.082-1.341),advanced age(HR=1.022,95%CI:1.000-1.202),concomitant metastatic cancer(HR=2.561,95%CI:1.711-3.835),and solid tumor(HR=1.591,95%CI:1.230-2.083)were risk factors for the survival of CVD patients,while albumin,total Fe binding capacity,chloride,creatinine,and glucose were protective factors for the survival of CVD patients.Conclusion The higher the serum Fe concentration in CVD patients,the higher the risk of all-cause death.In addition,male and advanced age are risk factors for CVD,while albumin and total Fe binding capacity are protective factors for CVD.

关 键 词：血清铁 心血管疾病 全死因死亡 

分 类 号：R186[医药卫生—流行病学]