摘要
目的:探究冠心病(CHD)患者短期预后不良的影响因素及动态动脉硬化指数(AASI)联合心率变异三角指数(TI)对其的预测价值.方法:选择淮安市第二人民医院2019年1月～2022年1月期间收治的300例CHD患者,依据随访6个月期间主要不良心血管事件(MACE)发生情况分为预后良好组(210例)和预后不良组(90例).对比两组的临床资料及AASI、TI;采用多因素Logistic回归分析CHD患者随访6个月内预后不良的影响因素;采用受试者工作特征(ROC)曲线分析AASI、TI对CHD患者随访6个月内预后不良的预测价值.结果:与预后良好组比较,预后不良组的年龄、人体质量指数(BMI)、高敏C反应蛋白(hsCRP)、低密度脂蛋白胆固醇(LDL-C)、纤维蛋白原(Fg)、AASI、TI以及吸烟史、糖尿病史、多支病变比例显著升高(P均＜0.01).多因素Logistic回归分析显示,AASI(OR=5.318,95％CI 1.728～16.372,P=0.004)、TI(OR=3.463,95％CI 1.155～10.384,P=0.027)、年龄(OR=1.912,95％CI 1.046～1.990,P=0.033)、吸烟史(OR=1.791,95％CI 1.089～1.844,P=0.006)、糖尿病史(OR=1.645,95％CI 1.008～1.793,P＜0.001)、BMI(OR=1.732,95％CI 1.013～2.242,P=0.030)、hsCRP(OR=3.731,95％CI 1.466～6.454,P=0.017)、LDL-C(OR=3.732,95％CI 1.546～9.424,P=0.023)、Fg(OR=4.504,95％CI 2.253～11.012,P=0.007)以及多支病变(OR=5.054,95％CI 2.876～13.445,P=0.029)均是CHD患者随访6个月预后不良的独立危险因素.与AASI[曲线下面积(AUC)=0.828]、TI(AUC=0.844)单项检测比较,两项联合检测(AUC=0.916)对CHD患者随访6个月预后不良的预测价值显著更高(Z=2.503、2.030,P均＜0.05).结论:年龄、基础病史、炎性因子、血脂以及病变支数均会对CHD患者预后结局产生影响,AASI联合TI检测对CHD患者短期预后具有较好的预测价值.
Abstract
Objective:This article aims to explore the influencing factors of short-term poor prognosis in patients with coronary heart disease(CHD)and the predictive value of ambulatory arterial stiffness index(AASI)and heart rate variability triangular index(TI).Methods:A total of 300 CHD patients treated in Huai'an Second People's Hos-pital between January 2019 and January 2022 were selected.According to incidence of major adverse cardiovascular events(MACE)during 6-month follow-up,they were divided into good prognosis group(n=210)and poor prog-nosis group(n=90).Clinical data,AASI and TI were compared between two groups.Multivariate Logistic regres-sion was used to analyze influencing factors of poor prognosis during 6-month follow-up in CHD patients;receiv-er operating characteristic(ROC)curve was used to analyze the predictive value of AASI and TI for poor prognosis during 6-month follow-up in CHD patients.Results:Compared with patients in good prognosis group,those in poor prognosis group had significant higher age,body mass index(BMI),high sensitive C reactive protein(hsCRP),low density lipoprotein cholesterol(LDL-C),fibrinogen(Fg),AASI,TI,and proportions of smoking history,diabetes history and multi-vessel coronary disease(P＜0.01 all).Multivariate Logistic regression indicated that AASI(OR=5.318,95％CI 1.728～16.372,P=0.004),TI(OR=3.463,95％CI 1.155～10.384,P=0.027),age(OR=1.912,95％CI 1.046～1.990,P=0.033),smoking history(OR=1.791,95％CI 1.089～1.844,P=0.006),diabetes history(OR=1.645,95％CI 1.008～1.793,P＜0.001),BMI(OR=1.732,95％Cl 1.013～1.242,P=0.030),hsCRP(OR=3.731,95％CI 1.466～6.454,P=0.017),LDL-C(OR=3.732,95％CI 1.546～9.424,P=0.023),Fg(OR=4.504,95％CI 2.253～11.012,P=0.007)and multi-vessel coronary disease(OR=5.054,95％CI 2.876～13.445,P=0.029)were independent risk factors for poor prognosis during 6-month follow-up in CHD patients.Compared with single detection of AASI(AUC=0.828)and TI(AUC=0.844),their combined detection had significant higher predictive value(AUC=0.916)for poor prognosis during 6-month follow-up in CHD patients(Z=2.503,2.030,P＜0.05 both).Conclusion:Age,basic medical history,inflammatory factors,blood lipid and number of diseased vessels could all affect the prognostic outcome of CHD pa-tients.AASI combined with TI has good predictive value for short-term prognosis in CHD patients.
维普
万方数据