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急性冠脉综合征患者血清总胆红素水平与预后的关系研究
作者:钱昊1  汤成春2  鄢高亮2 
单位:1. 东南大学 医学院, 江苏 南京 210009;
2. 东南大学附属中大医院 心内科, 江苏 南京 210009
关键词:血清总胆红素 急性冠状动脉综合征 经皮冠状动脉介入治疗 主要心血管不良事件 心源性死亡 
分类号:R543.3
出版年·卷·期(页码):2019·38·第三期(406-411)
摘要:

目的:通过研究急性冠状动脉(简称冠脉)综合征(ACS)患者行经皮冠脉介入治疗(PCI)术后主要心血管不良事件(MACE)发生情况,探讨患者血清总胆红素(STB)水平与ACS预后的关系。方法:通过病历系统连续纳入行PCI的ACS患者2 850例,电话随访术后1年内的MACE发生情况。将2 770例完成随访的患者分为A组(STB水平≤ 9.6 μmol·L-1,923例)、B组(9.7 μmol·L-1-1,924例)、C组(STB水平>15.4 μmol·L-1,923例)3组。利用Cox生存分析研究3组间MACE发生率。结果:30 d内3组间MACE及心源性死亡发生率差异无统计学意义。1年内B组与C组的MACE(95%CI 0.746~1.740,P=0.546)及心源性死亡(95%CI 0.201~2.161,P=0.491)发生率差异无统计学意义;而A组与C组间MACE发生率(95%CI 1.342~2.986,P<0.001)、心源性死亡率(95%CI 1.319~8.785,P=0.011)差异均有统计学意义。结论:低血清STB水平的ACS患者PCI后远期的MACE发生率及心源性死亡率更高。

Objective:To explore the relationship between serum total bilirubin(STB) level and prognosis in acute coronary syndrome(ACS) patients through the investigation of the incidence of major adverse cardiac events(MACE) after PCI. Methods:Two thousand eight hundred and fifty ACS patients undergoing PCI were consecutively included in the study through information retrieval from the medical records system. The patients were followed up by telephone to determine the incidence of MACE within one year after PCI, and a total of 2 770 patients who completed the follow-up were divided into group A(STB ≤ 9.6 μmol·L-1,923 cases),group B (9.7 μmol·L-1-1,924 cases)and group C(STB>15.4 μmol·L-1,923 cases).The incidence of MACE in patients of the three groups was analyzed by survival analysis using the Cox proportional hazards model. Results:Results of the follow-up revealed no significant differences in the incidence of MACE and cardiac death among the three groups within 30 days after PCI. Within one year postoperatively, there were no differences between group B and C, while significant differences existed in MACE incidence(95%CI 1.342-2.986, P<0.001) and cardiac death rate(95%CI 1.319-8.785, P=0.011) between group A and C. Conclusion:Both long-term MACE incidence and cardiac death rate after PCI are higher in patients with low STB levels.

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