摘要
目的 探讨基线血红蛋白(Hb)水平对老年冠心病(CHD)患者远期临床预后的影响。方法 纳入2008年1月~2016年12月在我院确诊为CHD的患者3 024例,根据Hb水平最佳截断值将其分为Hb低值组(Hb<131 g/L,1 097例)和Hb高值组(Hb≥131 g/L,1 927例)。收集所有患者的一般资料、临床资料、实验室检查结果及随访情况并进行组间比较。生存分析采用Kaplan-Meier曲线,生存率比较采用log-rank检验。采用多因素cox回归分析评估影响老年CHD患者随访结局的危险因素。结果 Hb低值组糖尿病及高血压病、急性冠脉综合征(ACS)患者比例、年龄及总胆固醇(TC)水平均高于Hb高值组,男性、吸烟及饮酒、慢性冠脉综合征(CCS)患者比例、尿酸水平均低于Hb高值组,全因死亡(ACM)及心源性死亡(CM)发生率均高于Hb高值组(P<0.05)。Kaplan-Meier生存曲线单因素分析结果显示,Hb低值组患者ACM和CM的累积生存率较Hb高值组均显著下降(P<0.05)。多因素cox回归分析结果显示,年龄、心率、Gensini积分均是老年CHD患者发生ACM的独立危险因素,心率、Gensini积分均是其发生CM的独立危险因素,性别、心率及Gensini积分均是其发生主要不良心脑血管事件(MACCE)、主要心血管不良事件(MACE)的独立危险因素(P<0.05)。与Hb高值组相比,Hb低值组ACM发生风险增加1.456倍,MACCE发生风险增加1.292倍,MACE发生风险增加1.300倍(P<0.05)。结论 基线Hb水平降低是老年CHD患者发生ACM、MACCE、MACE的独立预测因子。
Objective To investigate the influence of baseline hemoglobin(Hb)level on the long⁃term prognosis of elderly patients with coronary heart disease(CHD).Methods A total of 3024 patients diagnosed with CHD in our hospital from January 2008 to December 2016 were included and divided into low Hb value group(Hb<131 g/L,1097 cases)and high Hb value group(Hb≥131 g/L,1927 cases)according to the optimal cutting point value of Hb level.General data,clinical data,laboratory results and follow⁃up of all patients were collected and compared between groups.Kaplan⁃Meier curve was used to survival analysis,and log⁃rank test was used to survival comparison.Multifactor cox regression analysis was used to evaluate the risk factors inflencing the follow⁃up outcome of elderly patients with CHD.Results The proportion of patients with diabetes and hypertension,acute coronary syndrome(ACS),age and total cholesterol(TC)level in low Hb value group were higher than those in high Hb value group,the proportion of patients with male,smoking and drinking,chronic coronary syndrome(CCS)and uric acid level were lower than those in high Hb value group,the incidences of all⁃cause cholesterold death(ACM)and cardiac death(CM)were all higher than those in high Hb value group(P<0.05).Kaplan⁃Meier survival curve univariate analysis showed that the cumulative survival rate of ACM and CM in low Hb value group decreased significantly than those in high Hb value group(P<0.05).Multivariate cox regression analysis showed that age,heart rate and Gensini score were independent risk factors for ACM in elderly patients with CHD,heart rate and Gensini score were independent risk factors for CM,gender,heart rate and Gensini score were independent risk factors for major adverse cardiovascular and cerebrovascular events(MACCE)and major adverse cardiac events(MACE,P<0.05).Compared with high Hb value group,low Hb value group had a 1.456 fold increased risk of ACM,a 1.292 fold increased risk of MACCE,and a 1.300 fold increased risk of MACE(P<0.05).Conclusion The decrease of baseline Hb level is an independent predictor of ACM,MACCE and MACE in elderly patients with CHD.
作者
李双双
马依彤
吴婷婷
郑颖颖
谢翔
Li Shuangshuang;Ma Yitong;Wu Tingting;Zheng Yingying;Xie Xiang(Department of Respiratory,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)
出处
《临床内科杂志》
CAS
2023年第9期598-602,共5页
Journal of Clinical Internal Medicine
基金
国家自然科学基金面上项目(82170345)。
关键词
基线
血红蛋白
老年
冠心病
远期预后
Baseline
Hemoglobin
Elderly
Coronary Heart Disease
Long⁃term Prognosis
