早发冠心病患者发生院外主要不良心血管事件的影响因素分析  

Influencing Factors of Out-of-Hospital Major Adverse Cardiovascular Events in Patients with Premature Coronary Artery Disease

作　　者：张舒贤 王红雷[1,2] ZHANG Shuxian;WANG Honglei(School of Clinical Medicine,Henan University of Science and Technology,Luoyang 471000,China;Department of Cardiovascular Medicine,the First Affiliated Hospital of Henan University of Science and Technology/Henan Provincial Key Laboratory of Cardiovascular Disease Medicine/Luoyang Municipal Key Laboratory of Cardiovascular Science,Luoyang 471000,China)

机构地区：[1]河南科技大学临床医学院,河南省洛阳市471000 [2]河南科技大学第一附属医院心血管内科河南省心血管疾病医学重点实验室洛阳市心血管科学重点实验室,河南省洛阳市471000

出　　处：《实用心脑肺血管病杂志》2025年第6期6-10,17,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河南省医学科技攻关计划项目(LHGJ20240443)。

摘　　要：目的分析早发冠心病(PCAD)患者发生院外主要不良心血管事件(MACE)的影响因素。方法选取2019年1月—2022年12月于河南科技大学第一附属医院心血管内科住院的PCAD患者421例为研究对象。通过医院电子病历系统收集患者的临床资料。患者出院后对其进行电话或门诊随访2年,记录患者院外MACE发生情况。采用单因素、多因素Logistic回归分析探讨PCAD患者发生院外MACE的影响因素。结果随访期间共24例患者失访,剩余397例患者中,发生院外MACE者106例(MACE阳性组),未发生院外MACE者291例(MACE阴性组)。MACE阳性组与MACE阴性组脂蛋白(a)〔Lp(a)〕、全身炎症反应指数(SIRI)、载脂蛋白B(ApoB)/载脂蛋白A(ApoA)、甘油三酯-葡萄糖(TyG)指数、C反应蛋白(CRP)、胱抑素C(CysC)、左心室前后径、左心室射血分数(LVEF)、病变血管数量比较,差异有统计学意义(P<0.05)。单因素Logistic回归分析结果显示,Lp(a)、SIRI、ApoB/ApoA、CRP、CysC、LVEF、病变血管数量可能是PCAD患者发生院外MACE的影响因素(P<0.05)。多因素Logistic回归分析结果显示,Lp(a)〔OR=1.002,95%CI(1.001~1.003)〕、SIRI〔OR=1.294,95%CI(1.124~1.488)〕、CRP〔OR=1.022,95%CI(1.011~1.032)〕、LVEF〔OR=0.939,95%CI(0.906~0.973)〕、病变血管数量〔双支:OR=1.432,95%CI(1.077~1.904);多支:OR=1.581,95%CI(1.215~2.059)〕是PCAD患者发生院外MACE的独立影响因素(P<0.05)。结论Lp(a)、SIRI、CRP升高及双支、多支血管病变是PCAD患者发生院外MACE的危险因素,而LVEF升高是其保护因素。Objective To analyze the influencing factors of out-of-hospital major adverse cardiovascular events(MACE)in patients with premature coronary artery disease(PCAD).Methods A total of 421 PCAD patients who were hospitalized in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Henan University of Science and Technology from January 2019 to December 2022 were selected as subjects.Clinical data of the patients were collected through the hospital's electronic medical record system.After discharge,patients were followed up by telephone or outpatient visits for 2 years,and the occurrence of out-of-hospital MACE of patients was recorded.Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of out-of-hospital MACE in patients with PCAD.Results During the follow-up period,a total of 24 patients were lost to follow-up.Among the remaining 397 patients,106 cases(MACE positive group)experienced out-of-hospital MACE,and 291 cases(MACE negative group)did not experience out-of-hospital MACE.There were significant differences in lipoprotein(a)[Lp(a)],systemic inflammatory response index(SIRI),apolipoprotein B(ApoB)/apolipoprotein A(ApoA),triglyceride-glucose(TyG)index,C-reactive protein(CRP),cystatin C(CysC),anterior and posterior left ventricular diameter,left ventricular ejection fraction(LVEF),and the number of diseased vessels between MACE positive group and MACE negative group(P<0.05).The results of univariate Logistic regression analysis showed that Lp(a),SIRI,ApoB/ApoA,CRP,CysC,LVEF,and the number of diseased vessels may be the influencing factors of out-of-hospital MACE in patients with PCAD(P<0.05).The results of multivariate Logistic regression analysis showed that Lp(a)[OR=1.002,95%CI(1.001-1.003)],SIRI[OR=1.294,95%CI(1.124-1.488)],CRP[OR=1.022,95%CI(1.011-1.032)],LVEF[OR=0.939,95%CI(0.906-0.973)],and the number of diseased vessels[double vessels:OR=1.432,95%CI(1.077-1.904);multiple vessels:OR=1.581,95%CI(1.215-2.059)]were independent influencing f

关 键 词：冠心病 早发冠心病 主要不良心血管事件 影响因素分析 

分 类 号：R541.4[医药卫生—心血管疾病]