皖北地区高血压合并急性冠脉综合征患者临床特征、危险分层及临床预后相关性分析

蒋南; 包炳蔚; 丁丝雨; 季春斐; 钱少环; 王洪巨; 李妙男

doi:10.16766/j.cnki.issn.1674-4152.003104

皖北地区高血压合并急性冠脉综合征患者临床特征、危险分层及临床预后相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.003104

蒋南¹,
包炳蔚²,
丁丝雨²,
季春斐²,
钱少环²,
王洪巨^{1, 2},
李妙男^2, ,

1.
蚌埠医学院第一附属医院全科医学科，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院心血管内科

基金项目:

国家自然科学基金项目 81970313

蚌埠医学院512人才培育计划 by51201317

蚌埠医学院512人才培育计划 by51201105

蚌埠医学院自然科学研究重点项目 2020byzd109

安徽省教育厅自然科学研究重点项目 2022AH051477

详细信息

通讯作者:
李妙男，E-mail：524760484@qq.com

中图分类号: R544.1 R543.3
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- 文章访问数: 324
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- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-12
- 网络出版日期: 2023-09-13

Risk stratification of clinical characteristics and correlation analysis of clinical prognosis in patients with hypertension complicated by acute coronary syndrome in northern Anhui

1.
Department of General Practice, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析皖北地区高血压合并急性冠脉综合征(ACS)患者临床特征、危险分层，探讨高血压合并ACS患者高危因素，指导临床工作。方法选取皖北地区2018年10月—2019年7月于蚌埠医学院第一附属医院行冠状动脉造影确诊的ACS患者426例，根据是否合并高血压分为高血压合并ACS组(HBP组，252例)和非高血压合并ACS组(NHBP组，174例)。平均随访15个月，记录ACS组患者术后主要不良心血管事件。采用单因素分析筛选指标纳入二元logistic回归进行独立危险因素分析。结果与NHBP组患者相比，HBP组患者年龄、尿酸、肌酐、甘油三酯水平较高；早发冠心病比例较低；三支病变比例更高，Gensini评分更高(P＜0.05)。二元logistic回归显示，年龄增大(OR=1.163，95% CI：1.085~1.247，P < 0.01)、男性(OR=2.615，95% CI：1.192~5.737，P=0.016)、早发冠心病(OR=7.775，95% CI：1.772~34.113，P=0.007)、高TG(OR=1.337，95% CI：1.104~1.619，P=0.003)是高血压合并ACS患者的独立危险因素(P < 0.05)。结论年龄增大、男性、早发冠心病、高TG等因素与高血压合并ACS患者密切相关，指导临床工作中加强筛查及干预。
- 急性冠脉综合征 /
- 高血压 /
- GRACE危险评分 /
- TIMI危险评分 /
- 主要不良心血管事件
Abstract: Objective To analyze the clinical characteristics and risk stratification of hypertension patients with acute coronary syndrome (ACS) in northern Anhui, to discuss the high risk factors of hypertensive patients with ACS, and to guide the clinical work. Methods A total of 426 patients with ACS, diagnosed by coronary angiography in the First Affiliated Hospital of Bengbu Medical College from October 2018 to July 2019 in northern Anhui province. They were divided into hypertensive ACS group (HBP group, 252 cases) and non-hypertensive ACS group (NHBP group, 174 cases) according to whether they were complicated with hypertension. The average follow-up was 15 months, and major adverse cardiovascular events (MACES) were recorded in the ACS group. Multivariate logistic regression was used to analyze independent risk factors. Results Compared with the NHBP group, patients in the HBP group had higher age, uric acid, creatinine and triglyceride (TG) levels; The rate of early coronary heart disease was lower; the proportion of three-vessel lesions was higher; and the Gensini score was higher (P < 0.05). Binary logistic regression showed that, getting older (OR=1.163, 95% CI: 1.085-1.247, P < 0.01), Male (OR=2.615, 95% CI: 1.192-5.737, P=0.016), early-onset coronary heart disease (OR=7.775, 95% CI: 1.772-34.113, P=0.007), high TG (OR=1.337, 95% CI: 1.104-1.619, P=0.003) were independent risk factors for patients with hypertension combined with ACS (P < 0.05). Conclusion Getting older, male, early-onset coronary heart disease, high TG and other factors are closely related to the patients with hypertension complicated with ACS, which guide to strengthen clinical screening and intervention in clinical work.
- Acute coronary syndrome /
- High blood pressure /
- GRACE risk score /
- TIMI risk score /
- Major adverse cardiovascular events

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表 1 2组患者临床基线资料比较

Table 1. Comparison of clinical baseline data between the two groups

基线资料	HBP(n=252)	NHBP(n=174)	统计量	P值
性别[例(%)]			0.334^a	0.563
男性	145(57.5)	105(60.3)
女性	107(42.5)	69(39.7)
吸烟[例(%)]	94(37.3)	79(45.4)	2.801^a	0.094
2型糖尿病[例(%)]	78(31.0)	39(22.4)	3.767^a	0.052
心房颤动[例(%)]	10(4.0)	3(1.7)	1.752^a	0.186
脑卒中[例(%)]	36(14.3)	9(5.2)	9.048^a	0.003
UA[例(%)]	211(83.7)	140(80.5)	0.759^a	0.384
AMI[例(%)]	41(16.3)	34(19.5)	0.759^a	0.384
早发冠心病[例(%)]	53(21.0)	61(35.0)	10.331^a	0.001
年龄(x±s，岁)	66.5±9.7	62.5±10.5	-4.129^b	< 0.001
GLU[M(P₂₅, P₇₅), mmol/L]	5.23(4.59, 6.86)	5.12(4.47, 6.71)	-0.591^c	0.555
UA[M(P₂₅, P₇₅), μmol/L]	320.00(259.25, 392.75)	282.00(237.00, 328.00)	-4.888^c	< 0.001
CR[M(P₂₅, P₇₅), μmol/L]	69.00(63.25, 78.00)	67.00(59.00, 72.00)	-2.651^c	0.008
TC[M(P₂₅, P₇₅), mmol/L]	3.89(3.18, 4.95)	3.85(3.34, 4.86)	-0.648^c	0.517
TG[M(P₂₅, P₇₅), mmol/L]	1.84(1.28, 3.36)	1.46(1.11, 2.06)	-4.502^c	< 0.001
LDH[M(P₂₅, P₇₅), mmol/L]	2.20(1.71, 2.95)	2.22(1.74, 2.94)	-0.082^c	0.935
HDL[M(P₂₅, P₇₅), mmol/L]	0.90(0.76, 1.05)	0.96(0.82, 1.09)	-1.97^c	0.049
LPa[M(P₂₅, P₇₅), mg/L]	259.00(132.00, 470.50)	222.00(104.50, 462.50)	-1.616^c	0.106
CRP[M(P₂₅, P₇₅), mg/L]	2.01(0.85, 5.00)	1.90(0.70, 5.00)	-0.803^c	0.422
D-二聚体[M(P₂₅, P₇₅), mg/L]	0.32(0.21, 0.52)	0.29(0.20, 0.43)	-1.398^c	0.162
病变支数[M(P₂₅, P₇₅), 支]	3.00(2.00, 3.00)	2.00(1.00, 3.00)	-4.082^c	< 0.001
Gensini评分[M(P₂₅, P₇₅), 分]	40.00(25.00, 74.00)	25.00(10.00, 45.25)	-5.914^c	< 0.001
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组患者GRACE、TIMI评分危险分层比较(例)

Table 2. Comparison of risk stratification of GRACE and TIMI scores between the two groups(cases)

组别	例数	GRACE评分			TIMI评分
组别	例数	低危组	中危组	高危组	低危组	中危组	高危组
HBP组	252	113	124	15	31	165	56
NHBP组	174	89	71	14	28	118	28
Z值		-0.939			-1.751
P值		0.348			0.080

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表 3 2组患者冠脉造影的特点比较

Table 3. Comparison of coronary angiography characteristics between the two groups

组别	例数	Gensini评分[M(P₂₅, P₇₅), 分]	病变类型[例(%)]
组别	例数	Gensini评分[M(P₂₅, P₇₅), 分]	单支病变	双支病变	三支病变
HBP	252	40.00(25.00, 74.00)	40(15.9)	81(32.1)	131(52.0)
NHBP	174	25.00(10.00, 45.25)	49(28.2)^b	67(38.5)	58(33.3)^b
统计量		-5.914^a	17.709^c
P值		< 0.001	< 0.001
注：^a为Z值，^c为χ²值；与HBP组比较，^bP < 0.05。

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表 4 252例高血压合并急性冠脉综合征患者危险因素赋值情况

Table 4. Risk factor assignment in 252 patients with hypertension complicated with acute coronary syndrome

变量	赋值方法
因变量
MACES事件	未发生MACES事件=0，发生MACES事件=1
自变量
性别	女性=0，男性=1
年龄	以实际值赋值
早发	非早发冠心病=0，早发冠心病=1
T2DM	无=0，有=1
TC	以实际值赋值
TG	以实际值赋值
LDH	以实际值赋值
HDL	以实际值赋值
ACS类型	UA=0，AMI=1

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表 5 252例高血压合并急性冠脉综合征独立危险因素logistic回归分析

Table 5. 252 independent risk factors for hypertension complicated with acute coronary syndrome

变量	B	SE	Wald χ²	P值	OR值	95% CI
性别	0.961	0.401	5.749	0.016	2.615	1.192~5.737
年龄	0.151	0.035	18.300	< 0.001	1.163	1.085~1.247
早发	2.051	0.754	7.390	0.007	7.775	1.752~34.113
T2DM	0.217	0.374	0.335	0.563	1.242	0.596~2.587
TC	-0.299	0.203	2.167	0.141	0.741	0.497~1.104
TG	0.290	0.098	8.814	0.003	1.337	1.104~1.619
LDL	-0.186	0.214	0.757	0.384	0.830	0.546~1.263
HDL	-0.395	0.701	0.318	0.573	0.674	0.171~2.661

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参考文献(26)

[1]	陈伟伟, 高润霖, 刘力生, 等. 《中国心血管病报告2016》概要[J]. 中国循环杂志, 2017, 32(6): 521-530. doi: 10.3969/j.issn.1000-3614.2017.06.001 CHEN W W, GAO R L, LIU L S, et al. Summary of China Cardiovascular Disease Report 2016[J]. Chinese Circulation Journal, 2017, 32(6): 521-530. doi: 10.3969/j.issn.1000-3614.2017.06.001
[2]	李镒冲, 刘世炜, 曾新颖, 等. 1990—2016年中国及省级行政区心血管病疾病负担报告[J]. 中国循环杂志, 2019, 34(8): 729-740. doi: 10.3969/j.issn.1000-3614.2019.08.001 LI Y C, LIU S W, ZENG X Y, et al. Report on Burden of Cardiovascular Diseases From 1990 to 2016 in Chin[J]. Chinese Circulation Journal, 2019, 34(8): 729-740. doi: 10.3969/j.issn.1000-3614.2019.08.001
[3]	王旭. 比较不同地域行经皮冠状动脉介入治疗的急性冠脉综合征患者长期临床预后和二级预防用药的依从性[D]. 锦州: 锦州医科大学, 2020. WANG X. To compare the long-term clinical prognosis and compliance with secondary prophylactic drugs in patients with acute coronary syndrome undergoing percutaneous coronary intervention in different regions[D]. Jinzhou: Jinzhou Medical University, 2020.
[4]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志, 2019, 47(10): 766-783. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXB201709002.htm Chinese Society of Cardiology, Editorial Board of the Chinese Journal of Cardiology. 2019 Chinese Society of Cardiology (CSC) guidelines for the diagnosis and management of patients with ST-segment elevation myocardial infarction[J]. Chinese Journal of Cardiology, 2019, 47(10): 766-783. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXB201709002.htm
[5]	王娟, 范西真, 吴晓飞. 急性冠脉综合征的诊治与管理[J]. 中华全科医学, 2021, 19(7): 1073-1074. http://www.zhqkyx.net/article/id/aa90c0ac-e729-4f80-9cfa-d82edb47ae2e WANG J, FAN X Z, WU X F. Diagnosis, treatment and management of Acute Coronary Syndrome[J]. Chinese Journal of General Practice, 2021, 19(7): 1073-1074. http://www.zhqkyx.net/article/id/aa90c0ac-e729-4f80-9cfa-d82edb47ae2e
[6]	中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. doi: 10.3969/j.issn.1007-5410.2019.01.002 Writing Group of 2018 Chinese Guidelines for the Management of Hypertension, Chinese Hypertension League, Chinese Society of Cardiology, et al. Guidelines for Prevention and Treatment of Hypertension in China(Revised in 2018)[J]. Chinese Journal of Cardiovascular Medicine, 2019, 24(1): 24-56. doi: 10.3969/j.issn.1007-5410.2019.01.002
[7]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 国际内分泌代谢杂志, 2021, 41(5): 482-548. doi: 10.3760/cma.j.cn121383-20210825-08063 Chinese Diabetes Society. Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2020 edition)[J]. International Journal of Endocrinology and Metabolism, 2021, 41(5): 482-548. doi: 10.3760/cma.j.cn121383-20210825-08063
[8]	SMITH S C, J R, DOVE J T, JACOBS A K, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions[J]. Circulation, 2001, 103(24): 3019-3041. doi: 10.1161/01.CIR.103.24.3019
[9]	RAMPIDIS G P, BENETOS G, BENZ D C, et al. A guide for Gensini Score calculation[J]. Atherosclerosis, 2019, 287: 181-183. doi: 10.1016/j.atherosclerosis.2019.05.012
[10]	HALL M, BEBB O J, DONDO T B, et al. Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction[J]. Eur Heart J, 2018, 39(42): 3798-3806. doi: 10.1093/eurheartj/ehy517
[11]	薛静, 孟少华, 薛云. aVL导联T波改变与TIMI危险评分对急性冠脉综合征病人心血管终点事件的预测价值[J]. 中西医结合心脑血管病杂志, 2022, 20(19): 3606-3609. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202219026.htm XUE J, MENG S H, XUE Y. aVL lead T-wave change and TIMI risk score for acute coronary artery Predictive value of cardiovascular end events in patients with syndromes[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2022, 20(19): 3606-3609. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202219026.htm
[12]	FISCHER C, HÖPNER J, HARTWIG S, et al. Participation in disease management programs and major adverse cardiac events in patients after acute myocardial infarction: a longitudinal study based on registry data[J]. BMC Cardiovasc Disord, 2021, 21(1): 18. doi: 10.1186/s12872-020-01832-3
[13]	KONSTANTINOU K, TSIOUFIS C, KOUMELLI A, et al. Hypertension and patients with acute coronary syndrome: putting blood pressure levels into perspective[J]. J Clin Hypertens, 2019, 21(8): 1135-1143. doi: 10.1111/jch.13622
[14]	李鹏程. 齐齐哈尔市某三甲医院366例急性冠脉综合征患者病例分析[D]. 长春: 吉林大学, 2018. LI P C. Analysis of 366 Cases Patients with Acute Coronary Syndrome of a Classified 3A Hospital in Qiqihaer City[D]. Changchun: Jilin University, 2018.
[15]	NOAMAN S, DINH D, REID C M, et al. Comparison of outcomes of coronary artery disease treated by percutaneous coronary intervention in 3 different age groups (< 45, 46-65, and >65 years)[J]. Am J Cardiol, 2021, 152: 19-26. doi: 10.1016/j.amjcard.2021.05.002
[16]	郝一莼, 宋莹, 许晶晶, 等. 急性冠状动脉综合征类型对老年患者介入治疗远期预后的影响[J]. 中国分子心脏病学杂志, 2021, 21(3): 3933-3938. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGFB202103005.htm HAO Y C, SONG Y, XU J J, et al. The Impact of Acute Coronary Syndrome Types on the Long-term Prognosis of Elderly Patients Undergoing Percutaneous Coronary Intervention[J]. Molecular Cardiology of China, 2021, 21(3): 3933-3938. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGFB202103005.htm
[17]	HASIC S, KADIC D, KISELJAKOVIC E, et al. Serum uric acid could differentiate acute myocardial infarction and unstable angina pectoris in hyperuricemic acute coronary syndrome patients[J]. Med Arch, 2017, 71(2): 115-118. doi: 10.5455/medarh.2017.71.115-118
[18]	张世宇, 刘鑫, 宋冰雪, 等. 高尿酸血症对合并高血压的ACS患者冠状动脉病变严重程度及PCI术后临床预后的影响[J]. 中国动脉硬化杂志, 2022, 30(5): 416-422. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ202205007.htm ZHANG S Y, LIU X, SONG B X, et al. The effect of hyperuricemia on the severity of coronary artery disease and clinical prognosis after PCI of patients with ACS and hypertension[J]. Chinese Journal of Arteriosclerosis, 2022, 30(5): 416-422. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ202205007.htm
[19]	CASELLI C, DE CATERINA R, SMIT J M, et al. Triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina[J]. Sci Rep, 2021, 11(1): 20714. DOI: 10.1038/s41598-021-00020-3.
[20]	MATSUMOTO I, MORIYA S, KUROZUMI M, et al. Simultaneous evaluation of fatty acid and triglycerides after percutaneous coronary intervention[J]. J Cardiol, 2022, 80: 149-154. doi: 10.1016/j.jjcc.2022.02.011
[21]	李渊, 王熙, 李标, 等. 非低密度脂蛋白胆固醇对ACS患者经皮冠脉介入治疗的预后[J]. 南京医科大学学报(自然科学版), 2019, 39(12): 1795-1798. doi: 10.7655/NYDXBNS20191220 IN Y, WANG X, LI B, et al. Prognosis of non-low-density lipoprotein cholesterol in patients with ACS after percutaneous coronary intervention[J]. Journal of Nanjing Medicial University(Natural Sciences), 2019, 39(12): 1795-1798. doi: 10.7655/NYDXBNS20191220
[22]	LEE C Y, LIU K T, LU H T, et al. Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: the Malaysian national cardiovascular disease database-acute coronary syndrome (NCVD-ACS) registry[J]. PLoS One, 2021, 16(2): e0246474. DOI: 10.1371/journal.pone.0246474.
[23]	HAO Y, LIU J, LIU J, et al. Sex Differences in in-hospital management and outcomes of patients with acute coronary syndrome[J]. Circulation, 2019, 139(15): 1776-1785. doi: 10.1161/CIRCULATIONAHA.118.037655
[24]	CHHABRA S T, KAUR T, MASSON S, et al. Early onset ACS: an age based clinico-epidemiologic and angiographic comparison[J]. Atherosclerosis, 2018, 279: 45-51. doi: 10.1016/j.atherosclerosis.2018.10.017
[25]	MENEZES FERNANDES R, MOTA T, COSTA H, et al. Premature acute coronary syndrome: understanding the early onset[J]. Coron Artery Dis, 2022, 33: 456-464. doi: 10.1097/MCA.0000000000001141
[26]	周斌鹏, 张钲. 早发ACS患者冠脉病变严重程度的影响因素[J]. 北华大学学报(自然科学版), 2020, 21(2): 206-210. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYY202002015.htm ZHOU B P, ZHANG Z. Influencing Factors of Coronary Lesions Severity in Patients with Early ACS[J]. Journal of Beihua University(Natural Science), 2020, 21(2): 206-210. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYY202002015.htm