摘要
背景年龄是急性非ST段抬高型心肌梗死(NSTEMI)发病及预后不良的独立危险因素。然而,在我国高龄患者接受冠状动脉再灌注治疗比例远低于发达国家,且理论上年龄不是介入治疗的限制因素。所以,进一步分析我国这部分特殊患者目前治疗现状及相关影响因素是非常必要的。目的分析高龄NSTEMI患者介入治疗情况及其影响因素。方法收集2016年11月至2019年8月于河北省人民医院入院诊断为NSTEMI患者536例为研究对象,根据患者年龄分为≥75岁组(152例)和<75岁组(384例),并进行倾向性评分匹配,在≥75岁组中按是否接受介入治疗分为介入治疗组及保守治疗组。收集患者年龄、性别、Killip>Ⅱ级、入院时收缩压及舒张压、心率、既往病史〔陈旧性心肌梗死、经皮冠状动脉介入治疗(PCI)史、高血压≥2级、糖尿病、高脂血症、慢性肾功能不全、贫血、脑血管病〕、吸烟、饮酒。记录患者GRACE评分、射血分数、白细胞计数、血红蛋白、血小板计数、白蛋白、空腹血糖、肌酐、肾小球滤过率、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白以及治疗策略选择情况。采用多因素Logistics回归分析探讨高龄NSTEMI患者选择介入治疗的影响因素。结果倾向评分后<75岁组介入治疗比例高于≥75岁组(P<0.05)。与保守治疗组比较,介入治疗组的GRACE评分、肌酐水平降低,总胆固醇、白蛋白水平升高(P<0.05)。多因素Logistics回归分析显示,收缩压〔OR=1.022,95%CI(1.002,1.044),P=0.034〕、GRACE评分〔OR=1.015,95%CI(1.001,1.030),P=0.031〕、白蛋白水平〔OR=0.86,95%CI(0.763,0.969),P=0.013〕、肌酐水平〔OR=1.018,95%CI(1.000,1.035),P=0.044〕是选择介入治疗的影响因素。结论高龄NSTEMI患者介入治疗率低,低血压及高白蛋白是介入治疗的促进因素,高GRACE评分、高肌酐水平是其阻碍因素。
Background Older age is an independent risk factor of the onset and poor prognosis of acute non-STsegment elevation myocardial infarction(NSTEMI)patients.Although older age is not alimitingfactor for reperfusion therapy theoretically,the prevalence of reperfusion therapy in Chinese older NSTEMI patients is far lower than that of those in developed countries,so it is necessary to analyze the factors associated with inability to receive reperfusion therapy in such patients.Objective To analyze the prevalence and associated factors of invasive therapy in patients aged 75 and over with NSTEMI.Methods Five hundred and thirty-sixcases with an admission diagnosis of NSTEMI were selected from Hebei General Hospital from November 2016 to August 2019.The following variables were collected,including age,sex,Killip class>Ⅱ,admission blood pressure and heart rate,medical history(including history of old myocardial infarction,PCI history,grade 2-3hypertension,diabetes,hyperlipidemia,chronic kidney disease,anemia),smoking,drinking,GRACE score,left ventricularejection fraction,white blood cell count,hemoglobin,platelet count,albumin,fasting blood glucose,serum creatinine,glomerular filtration rate,total cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein and treatment strategies.The differences between patients under 75 years of age and those aged 75 and over were compared after being matched using the propensity score.Subgroup differences were analyzed between those with interventional therapy and with conservative treatment in the 75-and-over age group.Multivariate Logistic regression analysis was used to explore the influencing factors of invasive treatment.Results After propensity-score matching,it was found that patients under 75 years of age had higher prevalence of interventional therapy(P<0.05).Compared with conservative treatment subgroup,interventional therapy subgroup had decreased GRACE score and serum creatinine,and elevated total cholesterol and albumin(P<0.05).Multivariate logistic regressi
作者
吕晓
李树仁
申泽雪
郝潇
陈佳伦
孟阳
罗飞
白玉豪
苑智慧
LYU Xiao;LI Shuren;SHEN Zexue;HAO Xiao;CHEN Jialun;MENG Yang;LUO Fei;BAI Yuhao;YUAN Zhihui(Graduate School,North China University of Science and Technology,Tangshan 063210,China;No.1 Cardiovascular Department,Hebei General Hospital,Shijiazhuang 050051,China;Graduate College,Hebei Medical University,Shijiazhuang 050017,China)
出处
《中国全科医学》
CAS
北大核心
2021年第35期4463-4468,共6页
Chinese General Practice
基金
河北省自然科学基金资助项目(C2015307019)
2018年度河北省医学科学研究重点课题计划(20180071)。
