血红蛋白对经皮冠状动脉介入治疗后男性患者远期预后的影响Association of hemoglobin levels with long-term mortality in male patients undergoing percutaneous coronary interventions
刘新民,康俊萍,吕强,胡荣,聂绍平,吴嘉惠,张崟,贾长琪,刘小慧,董建增,马长生,吴学思
摘要(Abstract)：
目的探讨经皮冠状动脉(冠脉)介入治疗(PCI)前血红蛋白对男性冠心病患者术后远期预后的影响。方法药物洗脱支架对血运重建策略影响研究(DESIRE-2)为单中心回顾性注册研究,纳入2003年7月至2005年9月在我院接受PCI或冠脉旁路移植术治疗的6 005例患者。入选其中接受单纯PCI、未接受溶栓治疗、无慢性肾功能不全病史的2 641例男性患者,根据术前血红蛋白应用五分位法将患者分为5组(血红蛋白≤132.4 g/L组,血红蛋白132.5～140.9 g/L组,血红蛋白141.0～147.9 g/L组,血红蛋白148.0～155.0 g/L组,血红蛋白≥155.1 g/L组),比较各组患者的临床特点、冠脉病变特点以及远期预后,平均随访548 d。结果血红蛋白≤132.4 g/L组、132.5～140.9 g/L组、141.0～147.9 g/L组、148.0～155.0 g/L组和≥155.1 g/L组患者在年龄(分别为64.0±10.3岁、60.3±10.35岁、57.8±10.25岁、55.4±10.9岁和54.1±10.4岁,P<0.001),脑血管病史(分别为11.0%、8.2%、5.6%、5.9%和6.3%,P=0.004),血运重建史(分别为12.5%、10.2%、13.0%、13.6%和8.3%,P=0.037),左室射血分数(LVEF)(分别为58.9±11.3、60.9±10.3、61.7±10.7、61.4±10.1和60.6±10.4,P=0.001),冠脉病变支数(P=0.003)以及体质指数(BMI)(分别为25.0±3.1 kg/m2、26.0±2.8 kg/m2、25.7±2.9 kg/m2、26.2±2.9 kg/m2和26.4±2.8 kg/m2,P<0.001)、舒张压(分别为77.3±11.4 mmHg、78.0±10.3 mmHg、78.1±10.3 mmHg、79.5±11.4 mmHg和81.6±11.9 mmHg,P<0.001)、总胆固醇(分别为164.1±37.4 mg/dL、172.0±37.4 mg/dL、174.6±39.5 mg/dL、180.3±41.4 mg/dL和187.5±39.9 mg/dL,P<0.001)、低密度脂蛋白胆固醇(分别为94.7±28.3 mg/dL、100.2±31.0 mg/dL、101.5±33.2 mg/dL、105.9±32.8 mg/dL和109.5±32.6 mg/dL,P<0.001)、三酰甘油(甘油三酯,分别为132.8±86.9 mg/dL、147.1±80.7 mg/dL、159.8±98.4 mg/dL、164.8±90.3 mg/dL和194.0±138.7 mg/dL,P<0.001)水平等方面差异有统计学意义。多因素Cox回归分析,校正其他因素后,PCI术前血红蛋白是术后死亡的独立预测因素(RR0.973,95%CI0.952～0.995,P=0.016),血红蛋白最低组患者术后远期生存率明显低于其他组患者(RR2.190,95%CI1.056～4.544,P=0.035)。结论PCI术前血红蛋白是男性冠心病患者术后远期预后的独立预测因素。
关键词(KeyWords)： 血红蛋白类;血管成形术,经腔,经皮冠状动脉;预后
基金项目(Foundation): 国家重点基础研究发展规划资金资助项目(973计划,2003CB517103)
作者(Author): 刘新民,康俊萍,吕强,胡荣,聂绍平,吴嘉惠,张崟,贾长琪,刘小慧,董建增,马长生,吴学思
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