心肌梗死患者随访期间终点事件发生情况的亚组分析:回顾性队列研究  

A Subgroup Analysis of the Occurrence of End-point Events During the Follow-up Period of Patients with Myocardial Infarction:A Retrospective Cohort Study

作　　者：王宁 杨旭 戴国华[3] 马婷[4] 张成博 WANG Ning;YANG Xu;DAI Guo-hua;MA Ting;ZHANG Cheng-bo(Scientific Research Department,Shandong University of Traditional Chinese Medicine,Jinan 250355;The First Clinical Medical College of Shandong University of Traditional Chinese Medicine,Jinan 250355;Department of Geriatrics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250011;School of Rehabilitation,Shandong University of Chinese Medicine,Jinan 250355;Retirement Office of Shandong University of Traditional Chinese Medicine,Jinan 250355)

机构地区：[1]山东中医药大学科研处,济南250355 [2]山东中医药大学第一临床医学院,济南250355 [3]山东中医药大学附属医院老年医学科,济南250011 [4]山东中医药大学康复医学院,济南250355 [5]山东中医药大学离退休工作处,济南250355

出　　处：《中国中西医结合杂志》2023年第7期808-816,共9页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金资助项目(No.81774047);山东省中医药科技发展计划项目(No.2019-0039)。

摘　　要：目的 探讨中医药干预心肌梗死不同亚组患者的真实世界疗效。方法 采用回顾性队列研究设计,根据患者随访期间是否使用中医药及使用时间分为暴露组和非暴露组。暴露组包括高强度暴露组(出院后应用中医药治疗时间≥6个月者)、中强度暴露组(3个月≤出院后应用中医药治疗时间<6个月者)和低强度暴露组(1个月≤出院后应用中医药治疗时间<3个月者)。非暴露组为出院后应用中医药治疗时间<1个月,或未服用中药者。共收集心肌梗死合并高血压患者高暴露组246例、中暴露组150例、低暴露组69例、非暴露组166例;心肌梗死合并2型糖尿病患者高暴露组165例、中暴露组118例、低暴露组124例、非暴露组157例;心肌梗死合并血脂异常患者高暴露组160例、中暴露组81例、低暴露组96例、非暴露组105例。随访患者出院后的中药使用情况和终点事件发生情况。运用多元Logistic回归分析随访期间中医药干预与心肌梗死不同亚组患者终点事件发生的相关性。结果 随访期间中成药应用前3位的依次为复方丹参滴丸、麝香保心丸和速效救心丸。中药汤剂应用前3位的依次为生脉散、桃红四物汤、瓜蒌薤白半夏汤。多元Logistic回归分析结果显示,中医药干预、降脂治疗是心肌梗死合并高血压患者心源性死亡终点事件的正相关因素(P<0.05);中医药干预是心肌梗死合并高血压患者再梗死和脑卒中复合终点事件的正相关因素(P<0.05);中医药干预、降脂治疗是心肌梗死合并高血压患者急性心力衰竭终点事件的正相关因素(P<0.05)。中医药干预是心肌梗死合并2型糖尿病患者心源性死亡终点事件的正相关因素(P<0.05);中医药干预是心肌梗死合并2型糖尿病患者再梗死和脑卒中复合终点事件的正相关因素(P<0.05);中医药干预、降脂治疗是心肌梗死合并2型糖尿病患者急性心力衰竭终点事件的正相关Objective To explore the real world effect of Chinese medicine(CM) on different subgroups of patients with myocardial infarction.Methods A retrospective cohort study design was adopted,and patients were assigned to exposed group and non-exposed group according to whether they used CM during the follow-up period and the use time.The exposure group includes the high-intensity exposure group(who have been treated with CM for≥6 months after discharge),the medium-intensity exposure group(who have been treated with CM for less than 6 months after discharge)and the low-intensity exposure group(who have been treated with CM for less than <3 months after discharge).The non-exposed group was treated with CM for less than 1 month after discharge,or did not take CM.There were 246 cases in the high exposure group,150 cases in the middle exposure group,69 cases in the low exposure group,and 166 cases in the non-exposed group of patients with myocardial infarction and hypertension.There were 165 cases in the high exposure group,118cases in the medium exposure group,124 cases in the low exposure group,and 157 cases in the non exposure group of patients with myocardial infarction and diabetes.There were 160 cases in the high exposure group,81cases in the middle exposure group,96 cases in the low exposure group,and 105 cases in the non-exposed group of patients with myocardial infarction and dyslipidemia.Follow up the use of CM and the occurrence of endpoint events.Multivariate Logistic regression was used to analyze the correlation between the intervention of CM and the occurrence of endpoint events in different subgroups of patients with myocardial infarction during the follow-up period.Results During the follow-up period,the top 3 Chinese patent drugs were Compound Danshen Dropping Pills,Musk Heart Protecting Pills and Quick Effect Heart Saving Pills.The top 3 Chinese herbal decoction applications are Shengmai Powder,Taohong Siwu Decoction,Gualou Xiebai Banxia Decoction.The results of multiple Logistic regression analysis sho

关 键 词：心肌梗死 终点事件 亚组分析 LOGISTIC回归分析 中医药 临床疗效评价 

分 类 号：R542.22[医药卫生—心血管疾病]