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
计量
- 文章访问数: 150
- HTML全文浏览量: 39
- PDF下载量: 8
- 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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