老年稳定性冠心病患者心率减速力发展轨迹刻画及影响因素

徐金娟; 吴丽萍; 董国丽; 王刚

doi:10.16766/j.cnki.issn.1674-4152.004240

老年稳定性冠心病患者心率减速力发展轨迹刻画及影响因素

doi: 10.16766/j.cnki.issn.1674-4152.004240

杭州市临平区中西医结合医院全科老年科，浙江杭州 311100

基金项目:

浙江省医药卫生科技计划项目 2024XY128

详细信息

通讯作者:
徐金娟，E-mail：yjp18072889033@yeah.net

中图分类号: R541.4
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出版历程
- 收稿日期: 2024-11-21
- 网络出版日期: 2026-01-07

Development trajectory of heart rate deceleration force in elderly patients with stable coronary heart disease and its influencing factors

Department of General Geriatrics, Linping District Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou, Zhejiang 311100, China

摘要

摘要: 目的基于潜类别增长模型(LCGM)分析老年稳定性冠心病(SCAD)患者心率减速力(DC)发展轨迹，并探究影响其发展的因素，为今后老年SCAD治疗方案的制定提供参考依据。方法选取2020年2月—2023年2月就诊于杭州市临平区中西医结合医院的185例老年SCAD患者作为研究对象。收集患者临床资料和DC值，分析不同时间点患者DC值水平差异，采用LCGM探究患者DC值潜在变化轨迹亚组，同时采用单因素和多因素分析影响变化轨迹亚组的因素。结果随着随访时间的延长，患者DC值逐渐升高，且各时间点DC值差异有统计学意义(F=182.301，P < 0.001)。LCGM共识别出DC值-快速升高组(亚组1)、中DC值-持续稳定组(亚组2)、低DC值-缓慢升高组(亚组3)3条DC值潜在变化轨迹。3个亚组冠心病病程、病变支数、冠脉狭窄程度评分(Gensini评分)、空腹血糖(FBG)、同型半胱氨酸(Hcy)、甘油三酯(TG)、趋化素(Chemerin)、脂联素(APN)比较差异均有统计学意义(P＜0.05)。相较于亚组1，亚组3和亚组2的主要影响因素为病变支数、Gensini评分、TG、Chemerin、APN(P＜0.05)。结论老年SCAD患者DC值具有不同变化轨迹，建议基于老年SCAD患者DC值变化轨迹的同质群体有针对性地进行评估和干预，以期获得更优的预后。
- 稳定性冠心病 /
- 潜类别增长模型 /
- 老年 /
- 心率减速力 /
- 发展轨迹 /
- 影响因素
Abstract: Objective Based on the latent category growth model (LCGM), this study analyzed the development trajectory of heart rate deceleration force (DC) in elderly patients with stable coronary heart disease (SCAD) and explored factors affecting its development, thereby providing a reference for future treatment strategies for elderly SCAD patients. Methods A total of 185 elderly patients with SCAD who were treated in Linping District Integrated Traditional Chinese and Western Medicine Hospital from February 2020 to February 2023 were selected as the research objects. Clinical data and DC values of patients were collected. The differences in DC values of patients at different time points were analyzed. LCGM was applied to explore the potential trajectory subgroups of patients' DC values, and the factors affecting the trajectory subgroups were analyzed by univariate and multivariate analysis. Results With the extension of follow-up time, DC value increased gradually, and there were significant differences in DC value at each time point (F=182.301, P < 0.001). LCGM consensus identified three potential change paths of DC value-rapid increase group (subgroup 1), medium DC value-sustained stability group (subgroup 2), and low DC value-slow increase group (subgroup 3). Significant differences in the duration of coronary heart disease, number of lesions, Gensini score, FBG, Hcy, TG, Chemerin, and APN among the 3 subgroups (P < 0.05). Compared with subgroup 1, the main influencing factors for subgroup 3 and subgroup 2 were the number of lesions, Gensini score, TG, Chemerin, and APN (P < 0.05). Conclusion Elderly patients with SCAD exhibit different trajectories of DC value change. It is recommended to conduct targeted assessment and intervention based on the homogenous group of elderly patients with SCAD DC value change trajectories to improve patient prognosis.
- Stable coronary heart disease /
- Latent category growth model /
- Old age /
- Heart rate deceleration force /
- Development trajectory /
- Influencing factor

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图 1 老年SCAD患者DC值变化轨迹

Figure 1. LGMM trajectory of DC values in elderly SCAD patients

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表 1 185例老年SCAD患者一般情况

Table 1. General characteristics of 185 elderly patients with stable coronary artery disease (SCAD)

项目	例(%)	项目	例(%)
性别		硝酸酯类药物	84(45.41)
男性	112(60.54)	抗血小板药物	134(72.43)
女性	73(39.46)	ARB	43(23.24)
年龄		β受体阻滞剂	84(45.41)
＜70岁	98(52.97)	病变支数
≥70岁	87(47.03)	单支	78(42.16)
家庭人均月收入		双支	62(33.51)
＜3 000元	56(30.27)	3支	45(24.32)
3 000~5 000元	80(43.24)	Gensini评分
＞5 000元	49(26.49)	≤24分	85(45.94)
受教育年限		25~49分	65(35.14)
＜9年	74(40.00)	≥50分	35(18.92)
9~12年	48(25.95)	FBG
＞12年	63(34.05)	＜6.1 mmol/L	107(57.84)
居住地		≥6.1 mmol/L	78(42.16)
城市	76(41.08)	Hcy
城镇	35(18.92)	＜15.39 μmol/L	113(61.08)
农村	74(40.00)	≥15.39 μmol/L	72(38.92)
BMI		TC
＜25	123(66.49)	＜5.2 mmol/L	135(72.97)
≥25	62(33.51)	≥5.2 mmol/L	50(27.03)
吸烟史		LDL-C
有	90(48.65)	＜3.37 mmol/L	131(70.81)
无	95(51.35)	≥3.37 mmol/L	54(29.19)
饮酒史		TG
有	92(49.73)	＜5.18 mmol/L	105(56.76)
无	93(50.27)	≥5.18 mmol/L	80(43.24)
冠心病病程		Chemerin
＜4年	107(57.84)	＜45.75 mg/L	106(57.30)
≥4年	78(42.16)	≥45.75 mg/L	79(42.70)
口服药物情况		APN
ACEI	40(21.62)	＜5.46 mg/L	87(47.03)
他汀类药物	151(81.62)	≥5.46 mg/L	98(52.97)

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表 2 LCGM不同模型间拟合评价指标结果比较(n=185)

Table 2. Comparison of fitting evaluation index results among different LCGM models (n=185)

类别数	AIC	BIC	aBIC	Entropy	P值		类别概率
类别数	AIC	BIC	aBIC	Entropy	LRT	BLRT	类别概率
1	4 582.723	4 596.463	4 572.342				1.000
2	4 578.834	4 595.146	4 571.569	0.869	< 0.001	< 0.001	0.683/0.371
3	4 575.453	4 596.389	4 570.638	0.968	< 0.001	< 0.001	0.514/0.283/0.223
4	4 574.325	4 597.612	4 569.843	0.839	0.536	0.469	0.269/0.049/0.241/0.422

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表 3 不同DC值变化轨迹亚型老年SCAD患者的单因素分析[例(%)]

Table 3. Univariate analysis of elderly SCAD patients across different DC-value trajectories[case (%)]

项目	亚组1 (n=54)	亚组2 (n=52)	亚组3 (n=79)	统计量	P值
冠心病病程				7.683^a	0.022
＜4年	39(72.22)	30(57.69)	38(48.10)
≥4年	15(27.78)	22(42.31)	41(51.90)
病变支数				31.570^b	< 0.001
单支	36(66.67)	22(42.30)	20(25.32)
双支	17(31.48)	18(34.62)	27(34.18)
3支	1(1.85)	12(23.08)	32(40.51)
Gensini评分				16.064^b	< 0.001
≤24分	35(64.81)	20(38.46)	30(37.97)
25~49分	18(33.33)	19(36.54)	28(35.44)
≥50分	1(1.85)	13(25.00)	21(26.58)
FBG				7.691^a	0.021
＜6.1 mmol/L	38(70.37)	32(61.54)	37(46.84)
≥6.1 mmol/L	16(29.63)	20(38.46)	42(53.16)
Hcy				6.852^a	0.033
＜15.39 μmol/L	39(72.22)	34(65.38)	40(50.63)
≥15.39 μmol/L	15(27.78)	18(34.62)	39(49.37)
TG				9.323^a	0.009
＜5.18 mmol/L	40(74.07)	26(50.00)	39(49.37)
≥5.18 mmol/L	14(25.93)	26(50.00)	40(50.63)
Chemerin				13.405^a	0.001
＜45.75 mg/L	42(77.78)	27(51.92)	37(46.84)
≥45.75 mg/L	12(22.22)	25(48.08)	42(53.16)
APN				9.445^a	0.009
＜5.46 mg/L	16(29.63)	27(51.92)	44(55.70)
≥5.46 mg/L	38(70.37)	25(48.08)	35(44.30)
注：^a为χ²值，^b为H值；表中仅列出差异有统计学意义的项目。

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表 4 老年SCAD患者DC值变化轨迹亚型的多分类logistic回归分析

Table 4. Multinomial logistic regression analysis of DC value change trajectory subtypes in elderly SCAD patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
亚组3 vs. 亚组1
病变支数	1.684	0.418	16.230	< 0.001	5.387	3.406~7.368
Gensini评分	1.343	0.387	12.133	< 0.001	3.850	2.425~5.274
TG	0.945	0.358	6.968	0.005	2.573	1.179~3.967
Chemerin	1.176	0.378	9.994	< 0.001	3.241	1.589~4.894
APN	1.021	0.367	7.740	< 0.001	2.776	1.237~4.315
亚组2 vs. 亚组1
病变支数	1.186	0.369	10.330	< 0.001	3.274	1.790~4.758
Gensini评分	1.315	0.379	12.039	< 0.001	3.725	2.438~5.012
TG	0.896	0.338	7.027	0.003	2.450	1.033~3.867
Chemerin	1.042	0.342	9.283	< 0.001	2.835	1.240~4.421
APN	1.284	0.379	11.478	< 0.001	3.611	2.053~5.169
注：表中仅列出差异有统计学意义的变量。

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