多病共存与急性心肌梗死患者远期心力衰竭的相关性研究

陈芷倩; 叶鑫瑛; 钱焱; 龚开政; 赵培

doi:10.16766/j.cnki.issn.1674-4152.003148

多病共存与急性心肌梗死患者远期心力衰竭的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003148

陈芷倩^{1, 2, 3},
叶鑫瑛^{1, 2, 3},
钱焱^{1, 2, 3},
龚开政¹,
赵培^1, ,

1.
扬州大学附属医院心血管内科, 江苏扬州 225000
2.
扬州大学附属医院全科医学科
3.
大连医科大学研究生院，辽宁大连 116000

基金项目:

国家自然科学基金资助项目 81970225

详细信息

通讯作者:
赵培，E-mail: zhaopei@yzu.edu.cn

中图分类号: R542.22 R541.6
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- 文章访问数: 164
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- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-15
- 网络出版日期: 2023-10-19

Correlation between multiple chronic conditions and long-term heart failure after acute myocardial infarction

CHEN Zhiqian^{1, 2, 3},
YE Xinying^{1, 2, 3},
QIAN Yan^{1, 2, 3},
GONG Kaizheng¹,
ZHAO Pei^{1
, ,}

1.
Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, China

摘要

摘要: 目的分析急性心肌梗死(AMI)患者远期心力衰竭(HF)的发生情况，并探讨多病共存(MCC)与其相关性。方法选择2016年1月—2018年12月在扬州大学附属医院心内科住院的AMI患者355例，根据结局分为心衰组(149例)和非心衰组(206例)，中位随访时间为43.0个月。回顾性分析2组患者的基线资料；使用Kaplan-Meier分析和Cox回归分析评估MCC在AMI患者远期HF发生中的作用；运用Cochran-Armitage检验分析共存疾病数与AMI患者远期HF发生率的关系。结果 (1) 心衰组患者年龄更大，左心室射血分数更低，GRACE评分及MCC占比更高。心衰组MCC发生率为非心衰组的1.6倍；(2)年龄(HR=1.024，95% CI: 1.003~1.045)、低左室射血分数(HR=0.963，95% CI: 0.946~0.980)、GRACE评分(HR=1.011，95% CI: 1.004~1.018)及MCC(HR=1.517，95% CI: 1.073~2.146)是AMI患者远期HF的独立影响因素；(3)MCC患者AMI后远期HF的发生率明显高于非MCC患者(P＜0.05)；(4)AMI患者远期HF发生率与共存疾病数呈正相关关系(P＜0.05)。结论 MCC是AMI患者远期HF的独立危险因素，对AMI患者远期HF的发生具有预测价值，且远期HF发生率随共存疾病数的增加而增高。
- 多病共存 /
- 心肌梗死 /
- 心力衰竭 /
- 相关性分析 /
- 病例对照研究
Abstract: Objective To analyze the incidence of long-term heart failure (HF) in patients with acute myocardial infarction (AMI), and explore the correlation between multiple chronic conditions (MCC) with it. Methods An analysis was performed on 355 patients with AMI hospitalized in the Department of Cardiology of Affiliated Hospital of Yangzhou University from January 2016 to December 2018. Patients were divided into HF group (149 cases) and non-HF group (206 cases) according to the outcome, with a median follow-up of 43.0 months. The baseline data of the two groups were retrospectively analyzed. Kaplan-Meier analysis and Cox regression analysis were used to evaluate the role of MCC in long-term HF in patients with AMI. The Cochran-Armitage trend test was used to analysis the relationship between the number of coexisting diseases and the incidence of long-term HF in AMI patients. Results (1) Patients in the HF group were older, with lower left ventricular ejection fraction, and had higher GRACE scores and proportion of MCC. The proportion of MCC in the HF group was 1.6 times higher than that in the non-HF group. (2) Age (HR=1.024, 95% CI: 1.003-1.045), low left ventricular ejection fraction (HR=0.963, 95% CI: 0.946-0.980), GRACE scores (HR=1.011, 95% CI: 1.004-1.018) and MCC (HR=1.517, 95% CI: 1.073-2.146) were independent influence factors for long-term HF in AMI patients. (3) The cumulative incidence of HF after AMI was significantly higher in patients with MCC than that in patients without MCC (P < 0.05). (4) There was a positive correlation between the incidence of distant HF and the number of coexisting diseases in AMI patients (P < 0.05). Conclusion MCC is an independent risk factor for long-term HF in patients with AMI, which has predictive value for the occurrence of long-term HF in AMI patients, and the incidence of long-term HF after AMI increases with the number of coexisting diseases.
- Multiple chronic conditions /
- Myocardial infarction /
- Heart failure /
- Correlation analysis /
- Case-control studies

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图 1 MCC对AMI患者远期HF发生率的影响

注：A为非多病共存组与多病共存组的远期HF发生率比较；B为无合并症组、一个合并症组和多个合并症组的远期HF发生率比较，其中，与多个合并症组比较，^aP＜0.05，^bP < 0.01。

Figure 1. Effect of MCC on the incidence of long-term HF in AMI patients

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表 1 心衰组与非心衰组患者临床资料比较

Table 1. Comparison of clinical data between HF group and non-HF group

项目	非心衰组(n=206)	心衰组(n=149)	统计量	P值
人口学特征
年龄[M(P₂₅, P₇₅)，岁]	60.0(51.0, 67.0)	70.0(61.0, 76.5)	-6.361^a	< 0.001
性别(男性/女性，例)	169/37	113/36	2.035^b	0.154
临床特征
心率[M(P₂₅, P₇₅)，次/min]	72.0(64.8, 80.3)	75.0(66.0, 85.5)	-2.321^a	0.020
收缩压[M(P₂₅, P₇₅)，mmHg]	135.5(120.0, 150.0)	130.0(120.0, 150.0)	-1.094^a	0.274
舒张压[M(P₂₅, P₇₅)，mmHg]	80.0(74.8, 94.3)	80.0(70.0, 90.0)	-2.239^a	0.025
GRACE评分(x±s)	137.8±31.1	167.2±31.2	8.765^c	< 0.001
实验室及器械检查
红细胞(x±s，×10¹²/L)	4.70±0.53	4.60±0.58	-1.707^c	0.089
血红蛋白[M(P₂₅, P₇₅)，g/L]	147.0(136.8, 157.0)	140.0(130.0, 154.0)	-2.815^a	0.005
血小板[M(P₂₅, P₇₅)，×10⁹/L]	184.5(156.0, 226.0)	178.0(149.5, 213.5)	-1.208^a	0.227
白细胞[M(P₂₅, P₇₅)，×10⁹/L]	8.6(7.3, 10.9)	9.1(7.2, 11.2)	-0.920^a	0.358
血钾[M(P₂₅, P₇₅)，mmol/L]	4.0(3.7, 4.2)	3.9(3.7, 4.3)	-0.256^a	0.798
白蛋白[M(P₂₅, P₇₅)，g/L]	41.7(39.4, 44.5)	40.5(37.5, 44.1)	-2.450^a	0.014
总胆红素[M(P₂₅, P₇₅)，μmol/L]	8.9(4.5, 13.5)	8.1(4.2, 14.7)	-0.382^a	0.702
谷草转氨酶[M(P₂₅, P₇₅)，U/L]	44.0(27.0, 91.3)	45.0(28.9, 92.5)	-0.808^a	0.419
血糖[M(P₂₅, P₇₅)，mmol/L]	7.5(6.1, 10.3)	8.3(6.4, 12.2)	-2.077^a	0.038
肌酐[M(P₂₅, P₇₅)，μmol/L]	72.8(62.0, 85.3)	75.0(63.0, 89.1)	-1.362^a	0.173
甘油三酯[M(P₂₅, P₇₅)，μmol/L]	1.8(1.3, 2.6)	1.4(1.1, 2.0)	-4.662^a	< 0.001
LDL-C[M(P₂₅, P₇₅)，mmol/L]	2.3(1.9, 2.8)	2.3(1.9, 2.8)	-0.101^a	0.919
D二聚体[M(P₂₅, P₇₅)，mg/L]	0.2(0.1, 0.4)	0.4(0.2, 0.6)	-5.302^a	< 0.001
LVEF[M(P₂₅, P₇₅)，%]	67.0(62.0, 70.0)	61.0(55.0, 67.0)	-5.803^a	< 0.001
既往史[例(%)]
吸烟史	104(50.5)	64(43.0)	1.968^b	0.161
高血压史	139(67.5)	114(76.5)	3.446^b	0.063
糖尿病史	37(18.0)	48(32.2)	9.646^b	0.002
冠心病史	26(12.6)	36(24.2)	7.988^b	0.005
脑卒中史	20(9.7)	30(20.1)	7.766^b	0.005
高脂血症史	20(9.7)	7(4.7)	3.089^b	0.079
MCC	66(32.0)	78(52.3)	14.793^b	< 0.001
院内治疗
PCI治疗[例(%)]	177(85.9)	115(77.2)	4.526^b	0.003
注：^a为Z值，^b为χ²值, ^c为t值。LDL-C为低密度脂蛋白胆固醇。1 mmHg=0.133 kPa。

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表 2 AMI患者远期HF影响因素的单因素Cox回归分析

Table 2. Univariate Cox regression analysis of long-term HF influencing factors in AMI patients

项目	B	SE	Wald χ²	P值	HR值	95% CI
年龄	0.046	0.007	42.046	＜0.001	1.048	1.033~1.062
心率	0.012	0.005	5.218	0.022	1.012	1.002~1.023
舒张压	-0.012	-0.006	4.556	0.033	0.988	0.977~0.999
LVEF	-0.052	0.008	42.236	＜0.001	0.949	0.934~0.964
血红蛋白	-0.012	0.004	10.706	0.001	0.988	0.981~0.995
白蛋白	-0.051	0.018	7.960	0.005	0.950	0.917~0.984
血糖	0.036	0.017	4.434	0.035	1.036	1.002~1.071
甘油三酯	-0.285	0.085	11.135	0.001	0.752	0.636~0.889
GRACE评分	0.018	0.002	71.379	＜0.001	1.018	1.014~1.022
D-二聚体	0.026	0.025	1.121	0.290	1.027	0.978~1.078
PCI治疗	-0.302	0.196	2.384	0.123	0.739	0.504~1.085
冠心病史	0.704	0.193	13.311	＜0.001	2.021	1.385~2.950
糖尿病史	0.625	0.176	12.558	＜0.001	1.867	1.322~2.638
脑卒中史	0.718	0.207	12.025	0.001	2.049	1.366~3.074
MCC	0.668	0.165	16.376	＜0.001	1.950	1.411~2.696

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表 3 AMI患者远期HF影响因素的多因素Cox回归分析

Table 3. Multivariate Cox regression analysis of long-term HF influencing factors in AMI patients

项目	B	SE	Wald χ²	P值	HR值	95% CI
年龄	0.024	0.011	2.268	0.023	1.024	1.003~1.045
心率	0.005	0.006	0.803	0.422	1.005	0.993~1.017
舒张压	0.011	0.007	1.549	0.121	1.011	0.997~1.025
LVEF	-0.038	0.009	-4.192	＜0.001	0.963	0.946~0.980
血红蛋白	-0.002	0.005	-0.278	0.781	0.998	0.988~1.009
白蛋白	0.013	0.019	0.677	0.499	1.013	0.976~1.050
血糖	0.019	0.019	1.030	0.303	1.019	0.983~1.058
甘油三酯	-0.150	0.089	-1.684	0.092	0.861	0.724~1.025
GRACE评分	0.011	0.004	2.984	0.003	1.011	1.004~1.018
MCC	0.417	0.177	2.358	0.018	1.517	1.073~2.146

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