摘要
目的探讨陈旧性心肌梗死(OMI)患者心肺运动试验(CPET)相关指标特征及其对预后的预测价值。方法选取北部战区总医院心血管内科自2015年11月至2021年9月收治的3800例出院前完成CPET的冠心病患者为研究对象。根据是否存在OMI将患者分为A组(不存在OMI,n=3119)与B组(存在OMI,n=681)。经倾向性评分匹配后两组患者分别为678例。记录并比较两组患者匹配前后的基线资料、住院资料、CPET结果、临床结局事件发生率。采用多因素COX回归分析评估OMI对冠心病患者心肺功能及预后的影响。结果匹配后,B组患者饮酒史、既往经皮冠状动脉介入比例均高于A组,收缩压、舒张压、射血分数、高血压2级比例均低于A组,差异均有统计学意义(P<0.05)。匹配后,B组患者低密度脂蛋白、高密度脂蛋白、总胆固醇、使用氯吡格雷、钙通道阻滞剂比例均低于A组,N端B型钠尿肽原、使用替格瑞洛、血管紧张素受体拮抗剂、利尿剂比例均高于A组,差异均有统计学意义(P<0.05)。匹配后,B组患者峰值代谢当量、无氧阈代谢当量、峰值公斤摄氧量、无氧阈公斤摄氧量、峰值氧脉搏、运动中峰值收缩压均低于A组,氧通气当量(VE/VO_(2))、二氧化碳通气当量(VE/VCO_(2))、VE/VCO_(2)斜率均高于A组,差异均有统计学意义(P<0.05)。在总体人群中,OMI、高血压分级、吸烟史、SYNTAX评分、肌酸激酶同工酶、峰值摄氧量、VE/VO_(2)均与预后相关(P<0.05)。在存在OMI患者中,性别、高血压分级、吸烟史、SYNTAX评分、峰值摄氧量、VE/VCO_(2)、Borg评分均与预后相关(P<0.05)。在不存在OMI患者中,高血压分级、吸烟史、SYNTAX评分、肌酸激酶同工酶、VE/VO_(2)均与预后相关(P<0.05)。匹配后,两组临床结局事件发生率比较,差异无统计学意义(P>0.05)。结论峰值摄氧量、VE/VCO_(2)与Borg评分均可评估OMI冠心病患者的预后情况。
Objective To investigate the characteristics of cardiopulmonary exercise testing(CPET)and its prognostic value in pa-tients with old myocardial infarction(OMI).Methods A total of 3800 patients with coronary heart disease who completed CPET be-fore discharge were selected from Department of Cardiology of General Hospital of Northern Theater Command from November 2015 to September 2021.Patients were divided into group A(no OMI,n=3,119)and group B(presence of OMI,n=681)according to the presence or absence of OMI.There were 678 patients in the two groups after matching by propensity score.Baseline data,hospitaliza-tion data,CPET results,and incidence of clinical outcomes before and after matching were recorded and compared between the two groups.Multivariate COX regression analysis was used to evaluate the effects of OMI on cardiopulmonary function and prognosis in pa-tients with coronary heart disease.Results After matching,the proportion of alcohol consumption history and previous percutaneous coronary intervention in group B was higher than that in group A,and the systolic blood pressure,diastolic blood pressure,ejection frac-tion and the proportion of grade 2 hypertension in group B were lower than those in group A,with statistical significance(P<0.05).After matching,the proportions of low density lipoprotein,high density lipoprotein,total cholesterol,clopidogrel and calcium channel blockers in group B were all lower than those in group A,and the proportions of N-terminal pro-B-type natriuretic peptide,ticagrelor,angiotensin receptor antagonist and diuretic were all higher than those in group A,with statistical significance(P<0.05).After matc-hing,the peak metabolic equivalent,anaerobic threshold metabolic equivalent,peak oxygen uptake in kg,anaerobic threshold oxygen uptake in kg,peak oxygen pulse and peak systolic blood pressure during exercise in group B were all lower than those in group A,and ventilatory equivalent for O_(2)(VE/VO_(2)),carbon dioxide ventilation equivalent(VE/VCO_(2))and VE/VCO_(2) slope were all higher than those in group A.The differences were statistically significant(P<0.05).In the general population,OMI,hypertension grade,smoking history,SYNTAX score,creatine kinase isoenzyme,peak oxygen uptake,VE/VO_(2) were all correlated with prognosis(P<0.05).In pa-tients with OMI,gender,hypertension grade,smoking history,SYNTAX score,peak oxygen uptake,VE/VCO_(2) and Borg score were cor-related with prognosis(P<0.05).In patients without OMI,hypertension grade,smoking history,SYNTAX score,creatine kinase isoenzyme,VE/VO_(2) were correlated with prognosis(P<0.05).After matching,there was no significant difference in the incidence of clinical outcome events between the two groups(P>0.05).Conclusion Peak oxygen uptake,VE/VCO_(2) and Borg score can all eval-uate the prognosis of OMI patients with coronary heart disease.
作者
韩冰
李宇珊
任强
韩帆
王圣熠
张伊
王艳霞
张剑
梁延春
张权宇
HAN Bing;LI Yu-shan;REN Qiang;HAN Fan;WANG Sheng-yi;ZHANG Yi;WANG Yan-xia;ZHANG Jian;LIANG Yan-chun;ZHANG Quan-yu(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2023年第10期1013-1017,1023,共6页
Clinical Journal of Medical Officers
基金
辽宁省科学技术计划项目(2022JH2/101500028)。
关键词
冠心病
陈旧性心肌梗死
心肺运动试验
心脏康复
Coronary heart disease
Old myocardial infarction
Cardiopulmonary exercise testing
Cardiac rehabilitation
