摘要
目的探讨血清总胆红素(STB)对心绞痛患者经皮冠状动脉介入治疗(PCI)后的预后价值。方法选取2009年7月—2011年8月在郑州大学第一附属医院心内科成功行PCI的心绞痛患者。排除急诊心肌梗死、合并心力衰竭、慢性肾脏疾病、慢性肝脏疾病、肿瘤、自身免疫性疾病、感染和其他可引起胆红素升高疾病的患者。收集患者临床及介入相关资料,采用门诊、电话和查阅再次住院病历的方法进行随访。按照入院时STB中位数(4.9 mg/L)将患者分为两组:STB≥4.9 mg/L为高STB组,STB<4.9 mg/L为低STB组。计量资料组间比较采用独立样本t检验,计数资料的比较采用χ2检验。采用Kaplan-Meier方法绘制生存曲线,应用Log-rank检验进行组间比较。采用Cox回归分析确定全因死亡和主要心血管不良事件(MACE)的独立预测因子。以P<0.05为差异有统计学意义。结果共入选患者1 545例,完成随访1 419例(91.8%),随访时间为(29±8)个月。两组患者院内死亡和心肌梗死的发生率间差异无统计学意义(P>0.05)。随访期间低STB组MACE发生率高于高STB组,差异有统计学意义(P<0.05),而两组全因死亡、心源性死亡、非致死性心肌梗死、非致死性卒中、血运重建和支架内再狭窄的发生率间差异无统计学意义(P>0.05)。Cox多元回归分析显示,低STB是MACE的独立预测因子(P<0.05)。低STB组无MACE生存率低于高STB组,差异有统计学意义(P<0.05)。结论低STB是心绞痛患者PCI后长期不良临床预后的独立预测因子。
Objective To evaluate the prognostic value of serum total bilirubin （STB） in patients with angina pectoris undergoing percutaneous coronary intervention （PCI） . Methods All patients with angina pectoris who had undergone PCI successfully in the First Affiliated Hospital of Zhengzhou University from July 2009 to August 2011 were included in the study with the exception of those who presented with acute myocardial infarction （AMI）, with known heart failure, autoimmune disease, neoplastic disease, chronic kidney disease, chronic hepatic disease, chronic or current infections, and any other diseases that could cause elevated bilirubin concentrations. For those meeting the inclusive criteria, their clinical and related angiographic materials were collected and they were followed up by outpatient interviews, telephone interviews and re - admission medical records review. Patients were divided into 2 groups according to the median baseline STB （4.9 mg/L in this cohort）, which was measured before the PCI ： high STB group with STB 34. 9 mg/L and low STB group with STB 〈 4. 9 mg/L. Independent t - test was used for group comparison of measurement data and X2 test was used for comparison of enumeration data. Cumulative survival was constructed using the Kaplan - Meier method. Log - rank tests were used to compare curves. Cox regression analysis was performed to identify independent predictors of death and major adverse cardiovascular event （MACE） . Results There were a total of 1 545 patients enrolled in the analysis and 1 419 finished the follow - up lasting （ 29± 8 ） months of with a rate of 91.8%. The incidence of in -hospital mortality and myocardial infaction was not significantly different between the two groups （P 〉 0. 05 ） . During follow - up, the incidence of MACE was significantly higher in low STB group compared with that in high STB group with statistical significance （ P 〈 0. 05 ）, but no statistical difference was found in the incidence of all - cause death, cardiac death, nonfatal myocardial infarction, nonfatal stroke, revaseularization and in - stent restenosis （P 〉 0. 05） . Multivariate Cox regression analysis showed that low STB was an independent predictor of MACE （ P 〈 0.05 ） . The cumulative survival rate free from MACE was lower in low STB group than that in high STB group with significance （P 〈 0.05 ） . Conclusion Low STB level is an independent predictor of long term adverse clinical prognosis in patients with angina pectoris.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第4期408-412,共5页
Chinese General Practice
基金
2012年度河南省医学科技攻关计划项目(201203035)
2012年度郑州市科技攻关计划项目(340600531704)
关键词
胆红素
经皮冠状动脉介入术
心绞痛
预后
Bilirubin
Percutaneous coronary intervention
Angina pectoris
Prognosis
