摘要
目的探讨急性冠状动脉综合征（ACS）患者住院期间发生出血的相关危险因素。方法收集3807例2001年3月至2007年12月中国多省市ACS注册研究（SINO—GRACE）入选患者的临床特征和诊治特点。其中出血组57例，为病例组，在其余未发生出血的3750个病例中按照地域因素（研究中心）进行分层随机抽样，筛选出234例作为对照组。筛选出血的相关因素，应用单因素logistic回归分析找出可能与出血相关的因素；再采用逐步回归法进行多因素条件logistic回归分析，因素入选的判定标准设为P〈0．1，分析ACS患者住院期间发生出血的预测因素。结果（1）与对照组比较，出血组患者年龄较大（P=0．01）；进行冠状动脉旁路移植术（CABG）治疗的患者比例较高（P=0．01）；既往有出血史、肾功能衰竭史、心力衰竭史的ACS患者住院期间发生出血的比例较高（P〈0．05）；应用氯吡格雷和（或）糖蛋白（GP）Ⅱb／Ⅲa受体拮抗剂的患者出血的发生率较高（P〈0．01）。（2）单因素logistic回归分析显示发病年龄、年龄〉70岁、既往有出血史、肾功能衰竭史、心力衰竭史、应用氯吡格雷、GPⅡb／Ⅲa受体拮抗剂与出血相关（OR均〉1．00，P均〈0．05）。诊断为非ST段抬高型心肌梗死、下壁、侧壁心肌梗死、进行CABG手术治疗与出血相关（OR均〉1．00，P均〈0．05）。（3）多因素logistic回归分析显示肾功能衰竭史（OR=19．77，95％CI4．38～89．18，P〈0．01）、应用氯吡格雷（OR=45．94，95％CI9．82—214．96，P〈0．01）、GPⅡb／Ⅲa受体拮抗剂（OR=343．57，95％CI40．39～999．99，P〈0．01）与出血相关；出血病史虽然进入方程，但P值未达到统计学意义（OR=4．77，95％C10．92～24．72，P=0．06）。结论既往有肾功能衰竭史及应用氯吡格雷、糖蛋白Ⅱb／Ⅲa受体拮抗剂可能是ACS患者住院期间发生出血的�
Objective To analyze the risk factors related to in-hospital bleeding for patients with acute coronary syndrome （ACS） . Methods Clinical and therapeutic data of 3807 patients who were registered with acute coronary syndrome in SINO-GRACE in China from March 2001 to December 2007 were reviewed. A total of 57 patients were grouped to bleeding group and 234 out of the remaining 3750 patients without bleeding were randomly chosen and served as non-bleeding group. Hemorrhage-related factors were screened and compared between the two groups. Unitary logistic regression analysis was performed to detect the possible factors related to hemorrhage. Factors with P 〈 0. 1 were further analyzed by stepwise regression method and muhivariate conditional logistic regression analyses. Results （ 1 ） Age, history of coronary artery bypass graft （ CABG）, previous hemorrhage, renal failure and heart failure as well incidence of acute coronary syndrome were significantly higher in bleeding group than in non-bleeding group （all P≤0. 05）. Patients were more often treated with clopidogrel and glycoprotein （GP） Ⅱb/Ⅲa receptor antagonist in bleeding group than in non-bleeding group. （2） Single factor logistic regression analysis showed that age 〉 70 years, history of previous bleeding, renal failure, heart failure, clopidogrel and GP Ⅱb/Ⅲa receptor antagonists use, non-ST-segment elevation myocardial infarction, inferior wall, lateral myocardial infarction, CABG were risk factors for bleeding （ all P 〈 0. 05）. （3） Multivariate logistic regression analysis showed that history of renal failure （ OR = 19. 77,95% CI 4. 38 - 89. 18, P 〈 0. 01 ） and clopidogrel （ OR = 19. 77, 95% CI 4. 38 - 89. 18, P 〈 0. 01 ） and GP Ⅱb/Ⅲa receptor antagonist （ OR = 343.57,95% CI 40. 39 - 999.99, P 〈 0.01 ） use were the independent risk factors for bleeding. Conclusion Our results show that renal failure history and clopidogrel and GP Ⅱb/Ⅲa receptor antagonist use are independent risk fact
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第11期902-907,共6页
Chinese Journal of Cardiology
