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1.
目的 初步探讨不同程度脑白质损害(white matter lesions,WML)高龄患者的独立危险因素,为WML的进展提供预测依据.方法 根据Fazekas分级标准将151例74~93岁高龄老年人分为无白质损害组(对照组)、轻度脑白质损害组(轻度WML组)、中重度脑白质损害组(中重度WML组),采用单因素方差分析和多因素Logistic回归分析三组间认知评分、血管危险因素、脑动脉硬化和脑血流动力学、神经解剖等各项指标之间差异及独立危险因素.结果 三组间单因素方差分析显示,认知评分(F=48.595,P=0.000)、高血压(x2=7.052,P=0.029)、吸烟(x2=19.476,P=0.000)、总胆固醇(F=3.086,P=0.049)、Crouse积分(F=3.968,P=0.021)及多项脑萎缩指标差异有统计学意义.轻度WML组患者与对照组间多因素Logistic回归分析结果表明,吸烟(OR 2.031,95%CI 1.244~1.317)、腔隙性梗死(LI)数目(OR 2.031,95%CI L 316~4.015)、总胆固醇(OR 1.610,95%CI 0.972~2.668)为独立危险因素(P<0.05);中重度WML组与轻度WML组间回归分析结果表明,认知评分(OR 0.276,95%CI 0.143~0.532)、吸烟(OR 2.262,95%CI 1.260~4.059)、大脑外侧裂比(OR 1.954,95%CI 1.013~3.768)为独立危险因素(P<0.05).中重度WML组患者与对照组间回归分析结果显示,认知评分(OR 0.091,95%CI 0.030~0.273)、尾状核指数(OR 2.511,95%CI 1.147~5.499)、Crouse积分(OR 2.304,95%CI 1.127~4.712)、LI数目(OR 2.200,95%CI 1.028~4.707),为独立危险因素(P<0.05).结论 轻度WML患者在认知功能、脑动脉硬化及脑萎缩等方面改变不显著,而中重度WML患者表现显著的认知功能障碍、脑动脉硬化和脑萎缩.与对照组比较,认知评分、尾状核指数、Crouse积分、LI数目是中重度WML患者的独立危险因素.
Abstract:
Objective To investigate the independent risk factors of cerebral white matter lesions (WML) of different degrees in the elderly aged 80 years and over,and provide the evidences for forecasting the prognosis of WML.Methods Brain magnetic resonance images (MRI) findings in 151 people aged 74 to 93 years were collected and analyzed.According to the severity of WML in brain MRI using the Fazekas Scale,the persons were divided into non-WML (control) group,mildWML (grade 1 WML) group and moderate-to-severe WML (grade 2 WML) group.The cognitive score,vascular risk factors,cerebral hemodynamic and arteriosclerotic index,and radiological features were compared among the three groups.Subsequent one-way ANOVA and multivariate logistic analysis were performed to determine the statistically significant factors and the independent risk factors among groups.Results The statistically significant factors with one-way ANOVA analysis among the three groups were cognitive performance (F = 48.595,P = 0.000),hypertension (x2 =7.052,P=0.029),cigarette history (x2 = 19.476,P= 0.000),cholesterol (TC) (F= 3.086,P=0.049),Crouse score (F=3.968,P=0.021) and multiple cerebral atrophy indexes.When compared with control group,cigarette history (OR 2.031,95%CI 1.244-1.317),lacunar infarction (LI)numbers (OR 2.031,95%CI 1.316-4.015) and cholesterol (OR 1.610,95%CI 0.972-2.668) were independent risk factors in grade 1 WML group (all P<0.05).The independent risk factors between grade 1 and 2 WML group were cognitive performance (OR 0.276,95%CI 0.143-0.532),cigarette history (OR 2.262,95% CI 1.260-4.059),and sylvian fissure ratio (SFR) (OR 1.954,95% CI 1.013-3.768) (all P<0.05).The independent risk factors between the grade 2 WML group and control group were cognitive performance (OR 0.091,95%CI 0.030-0.273),bicoudate ratio (BCR)(OR 2.511,95%CI 1.147-5.499),Crouse score (OR 2.304,95%CI1.127-4.712)and LI numbers (OR 2.200,95%CI 1.028-4.707) (all P<0.05).Conclusions Mild WML patients have no significant abnormalities in cognition,brain atrophy and cerebral atherosclerosis.Moderate to severe WML patients manifest remarkable cognitive disorder,cerebral atherosclerosis and brain atrophy.Compared with the controls,cognitive performance,BCR,Crouse score,LI numbers were the independent risk factors for moderate-severe WML patients.  相似文献   

2.
目的 探讨小血管闭塞性卒中(small artery occlusion,SAO)及其2种亚型的相关危险因素.方法 从南京卒中注册系统中收集2009年12月至2010年11月注册、符合TOAST标准中大血管动脉粥样硬化性卒中(large artery atherosclcrosis,LAA)或SAO的首发急性缺血性卒中患者的临床和影像学资料.病例分为LAA组和SAO组,后者再分为腔隙性脑梗死伴缺血性白质疏松(ischaemic leukoaraiosis,ILA)亚组和单纯腔隙性梗死(isolated lacunar infarction,ILI)亚组,比较LAA组与SAO组及其亚组的危险因素,并进行多变量logistic回归分析,筛选独立危险因素.结果 共纳入291例病例,其中LAA组120例,SAO组171例(ILI亚组87例,ILA亚组84例).SAO组平均年龄大于LAA患者,高血压患者比例和血清同型半胱氨酸(homocysteine,Hcy)水平显著高于LAA患者(P均<0.05).多变量logistic分析表明,高龄[优势比(odds ratio,OR)1.041,95%可信区间(confidence interval,CI)1.02~1.06,P=0.045]、高血压(OR=2.912,95%CI 1.11~6.46,P=0.031)和血浆Hcy水平增高(OR=1.109,95%CI 1.11~1.32,P=0.001)是SAO的独立危险因素.在SAO的两亚组中,高龄(OR=1.047,95%CI 1.00~1.09,P=0.043)、高血压(OR=2.632,95%CI 1.08~6.41,P=0.033)和血浆Hcy水平增高(OR=1.211,95%CI 1.11~1.32,P<0.001)是ILA的独立危险因素,而高胆固醇血症(OR=0.136,95%CI 0.05~0.37,P<0.001)则是ILI的独立危险因素.结论 高龄、高血压和血浆Hcy水平增高可能在SAO的发病机制中起着重要作用.高胆固醇血症是ILI的独立危险因素,而高龄、高血压病和血浆Hcy水平增高是ILA的独立危险因素.
Abstract:
Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P <0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P <0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P <0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.  相似文献   

3.
Objective To investigate the independent risk factors of cerebral white matter lesions (WML) of different degrees in the elderly aged 80 years and over,and provide the evidences for forecasting the prognosis of WML.Methods Brain magnetic resonance images (MRI) findings in 151 people aged 74 to 93 years were collected and analyzed.According to the severity of WML in brain MRI using the Fazekas Scale,the persons were divided into non-WML (control) group,mildWML (grade 1 WML) group and moderate-to-severe WML (grade 2 WML) group.The cognitive score,vascular risk factors,cerebral hemodynamic and arteriosclerotic index,and radiological features were compared among the three groups.Subsequent one-way ANOVA and multivariate logistic analysis were performed to determine the statistically significant factors and the independent risk factors among groups.Results The statistically significant factors with one-way ANOVA analysis among the three groups were cognitive performance (F = 48.595,P = 0.000),hypertension (x2 =7.052,P=0.029),cigarette history (x2 = 19.476,P= 0.000),cholesterol (TC) (F= 3.086,P=0.049),Crouse score (F=3.968,P=0.021) and multiple cerebral atrophy indexes.When compared with control group,cigarette history (OR 2.031,95%CI 1.244-1.317),lacunar infarction (LI)numbers (OR 2.031,95%CI 1.316-4.015) and cholesterol (OR 1.610,95%CI 0.972-2.668) were independent risk factors in grade 1 WML group (all P<0.05).The independent risk factors between grade 1 and 2 WML group were cognitive performance (OR 0.276,95%CI 0.143-0.532),cigarette history (OR 2.262,95% CI 1.260-4.059),and sylvian fissure ratio (SFR) (OR 1.954,95% CI 1.013-3.768) (all P<0.05).The independent risk factors between the grade 2 WML group and control group were cognitive performance (OR 0.091,95%CI 0.030-0.273),bicoudate ratio (BCR)(OR 2.511,95%CI 1.147-5.499),Crouse score (OR 2.304,95%CI1.127-4.712)and LI numbers (OR 2.200,95%CI 1.028-4.707) (all P<0.05).Conclusions Mild WML patients have no significant abnormalities in cognition,brain atrophy and cerebral atherosclerosis.Moderate to severe WML patients manifest remarkable cognitive disorder,cerebral atherosclerosis and brain atrophy.Compared with the controls,cognitive performance,BCR,Crouse score,LI numbers were the independent risk factors for moderate-severe WML patients.  相似文献   

4.
Objective To investigate the independent risk factors of cerebral white matter lesions (WML) of different degrees in the elderly aged 80 years and over,and provide the evidences for forecasting the prognosis of WML.Methods Brain magnetic resonance images (MRI) findings in 151 people aged 74 to 93 years were collected and analyzed.According to the severity of WML in brain MRI using the Fazekas Scale,the persons were divided into non-WML (control) group,mildWML (grade 1 WML) group and moderate-to-severe WML (grade 2 WML) group.The cognitive score,vascular risk factors,cerebral hemodynamic and arteriosclerotic index,and radiological features were compared among the three groups.Subsequent one-way ANOVA and multivariate logistic analysis were performed to determine the statistically significant factors and the independent risk factors among groups.Results The statistically significant factors with one-way ANOVA analysis among the three groups were cognitive performance (F = 48.595,P = 0.000),hypertension (x2 =7.052,P=0.029),cigarette history (x2 = 19.476,P= 0.000),cholesterol (TC) (F= 3.086,P=0.049),Crouse score (F=3.968,P=0.021) and multiple cerebral atrophy indexes.When compared with control group,cigarette history (OR 2.031,95%CI 1.244-1.317),lacunar infarction (LI)numbers (OR 2.031,95%CI 1.316-4.015) and cholesterol (OR 1.610,95%CI 0.972-2.668) were independent risk factors in grade 1 WML group (all P<0.05).The independent risk factors between grade 1 and 2 WML group were cognitive performance (OR 0.276,95%CI 0.143-0.532),cigarette history (OR 2.262,95% CI 1.260-4.059),and sylvian fissure ratio (SFR) (OR 1.954,95% CI 1.013-3.768) (all P<0.05).The independent risk factors between the grade 2 WML group and control group were cognitive performance (OR 0.091,95%CI 0.030-0.273),bicoudate ratio (BCR)(OR 2.511,95%CI 1.147-5.499),Crouse score (OR 2.304,95%CI1.127-4.712)and LI numbers (OR 2.200,95%CI 1.028-4.707) (all P<0.05).Conclusions Mild WML patients have no significant abnormalities in cognition,brain atrophy and cerebral atherosclerosis.Moderate to severe WML patients manifest remarkable cognitive disorder,cerebral atherosclerosis and brain atrophy.Compared with the controls,cognitive performance,BCR,Crouse score,LI numbers were the independent risk factors for moderate-severe WML patients.  相似文献   

5.
目的 研究慢性心力衰竭(心衰)患者肾功能恶化的危险因素及其对预后的影响.方法 采用病例对照研究方法,分析与肾功能恶化发生有统计学关联的独立危险因素,同时观察肾功能恶化对预后的影响.结果 住院心衰患者肾功能恶化发生率31%,入院肌酐水平及心功能分级与肾功能恶化的发生独立相关,OR值分别为2.248(95%CI1.088~4.647,P=0.029)和2.485(95%CI1.385~4.459.P=0.002).发生肾功能恶化的患者住院期间病死率明显高于对照组(16.7%比2.1%,P=0.000),调整混杂因素后,肾功能恶化是死亡的独立危险因素,OR值3.824(95%CI2.452~5.137.P<0.015).结论 肾功能恶化在住院心衰患者中发生率较高,与住院期间病死率明显相关.入院肌酐水平偏高及心功能差为发生肾功能恶化的独立危险因素.
Abstract:
Objective To investigate the risk factors of worsening renal function (WRF) in patients with chronic heart failure ( CHF) and WRF influence on prognosis. Methods A case-control study were undertaken to analyze independent risk factor statistically related to incidence of WRF, and to assess the influence of WRF on prognosis. Results The independent predictors of WRF were creatinine level at admission (OR 2.248,95% CI 1.088-4.647, P = 0.029) and NYHA class on admission ( OR 2.485, 95% CI 1.3854. 459, P = 0.002). The mortality of patient with WRF was obviously higher than that of control group during hospitalization( OR 3. 824,95% CI 2. 452-5. 637 ,P <0.015). Conclusions WRF is a common complication among patients hospitalized for CHF, and is obviously associated with mortality during hospitalization. Higher creatinine level and weak heart function are independent risk factors for incidence of WRF of patients with CHF.  相似文献   

6.
AIM To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis(PSMVT) in the early stage of severe acute pancreatitis(SAP).METHODS Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography(CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic(ROC) curve was generated for the qualifying independent risk factors.RESULTS Twenty-five of the one hundred and forty(17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis(AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar's CT severity index(CTSI) scores [odds ratio(OR): 2.742; 95% confidence interval(CI): 1.664-4.519; P = 0.000], hypoalbuminemia(serum albumin level 25 g/L)(OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening(OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar's CTSI scores was 0.777(P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.CONCLUSION High Balthazar's CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.  相似文献   

7.
AIM: To compare the risk of developing advanced colorectal neoplasm(ACRN) according to age in Koreans.METHODS: A total of 70428 Koreans from an occupational cohort who underwent a colonoscopy between 2003 and 2012 at Kangbuk Samsung Hospital were retrospectively selected. We evaluated and compared odds ratios(OR) for ACRN between the young-adults(YA 50 years) and in the older-adults(OA ≥ 50 years). ACRN was defined as an adenoma ≥ 10 mm in diameter, adenoma with any component of villous histology, high-grade dysplasia, or invasive cancer.RESULTS: In the YA group, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 1.26, 95%CI: 1.02-1.55), current smoking(OR = 1.37, 95%CI: 1.15-1.63), family history of colorectal cancer(OR = 1.46, 95%CI: 1.01-2.10), diabetes mellitus related factors(OR = 1.27, 95%CI: 1.06-1.54), obesity(OR = 1.23, 95%CI: 1.03-1.47), CEA(OR = 1.04, 95%CI: 1.01-1.09) and low-density lipoprotein-cholesterol(OR = 1.01, 95%CI: 1.01-1.02) were related with an increased risk of ACRN. However, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 2.12, 95%CI: 1.68-2.68), current smoking(OR = 1.38, 95%CI: 1.12-1.71), obesity(OR = 1.34, 95%CI: 1.09-1.65) and CEA(OR = 1.05, 95%CI: 1.01-1.09) also increased the risk of ACRN in the OA group.CONCLUSION: The risks of ACRN differed based on age group. Different colonoscopic screening strategies are appropriate for particular subjects with risk factors for ACRN, even in subjects younger than 50 years.  相似文献   

8.
AIM:To investigate whether erosive esophagitis is correlated with metabolic syndrome and its components,abnormal liver function,and lipoprotein profiles.METHODS:We conducted a cross-sectional,case control study of subjects who underwent upper endoscopy during a health examination at the Health Management and Evaluation Center of a tertiary medical care facility located in Southern Taiwan.Metabolic syndrome components,body mass index(BMI),liver function,dyslipidemia,and cardiovascular risk factors,as defined by the ratio of total cholesterol to high-density lipoprotein cholesterol(HDL-C),and the ratio of low-density lipoprotein cholesterol to HDL-C were compared betweenindividuals with and without erosive esophagitis.Risk factors for erosive esophagitis were evaluated by multivariate logistic regression.RESULTS:Erosive esophagitis was diagnosed in 507of 5015 subjects who were individually age and sex matched to 507 esophagitis-free control subjects.In patients with erosive esophagitis,BMI,waist circumference,blood pressure,fasting plasma glucose,triglyceride levels,aspartate aminotransferase,alanine aminotransferase,the ratio of total cholesterol to HDL-C,and the ratio of low-density lipoprotein cholesterol to HDL-C were significantly higher and HDL-C was significantly lower compared to patients without erosive esophagitis(all P<0.05).In a multivariate analysis,central obesity(OR=1.38;95%CI:1.0-1.86),hypertension(OR=1.35;95%CI:1.04-1.76),hypertriglyceridemia(OR=1.34;95%CI:1.02-1.76),cardiovascular risk factors as defined by a ratio of total cholesterol to HDL-C>5(OR=1.45;95%CI:1.06-1.97),and aspartate aminotransferase(OR=1.59;95%CI:1.08-2.34)were significantly associated with erosive esophagitis.CONCLUSION:Metabolic syndrome,impaired liver function,and a higher ratio of total cholesterol to HDL-C were associated with erosive esophagitis.  相似文献   

9.
AIM:To investigate the risk factors for liver-related mortality in chronic hepatitis C(CHC)patients.METHODS:All deceased CHC inpatient data were collected from the Beijing 302 Hospital clinical database,which includes more than 8250 CHC inpatients during the period from 2002 to 2012.The controls were matched to cases by age(±2 years),sex and date of hospital admission(within the same year).Potential risk factors were included for the evaluation,and odds ratios(OR)and 95%CI were estimated using univariate(unadjusted)and multivariate(adjusted OR,AOR)conditional logistic regression.All statistical tests were two-sided.P values<0.05 were considered statistically significant.RESULTS:Based on examinations of 144 CHC-related deceased cases and 576 controls,we found that antiviral therapy with interferon-αwas associated with a 47%decrease in the risk of hepatic mortality(AOR=0.53,95%CI:0.28-0.99,P=0.048).Additionally,the initial diagnostic stage of the disease(AOR=2.89,95%CI:1.83-4.56 and P<0.001 for liver cirrhosis/AOR=8.82,95%CI:3.99-19.53 and P<0.001for HCC compared with CHC),diabetes(AOR=2.35,95%CI:1.40-3.95,P=0.001),hypertension(AOR=1.76,95%CI:1.09-2.82,P=0.020),alcohol consumption(AOR=1.73,95%CI:1.03-2.81,P=0.037)and HBsAg positivity(AOR=22.28,95%CI:5.58-89.07,P<0.001)were associated with a significant increase in the risk of liver-related mortality in CHC patients.CONCLUSION:This study indicates that interferon-αtreatment,the stage at the initial diagnosis of the disease and comorbidities are all independent risk factors for liver-related mortality in CHC patients.  相似文献   

10.
BACKGROUND Ulcerative colitis(UC) is an uncommon inflammatory bowel disease(IBD).However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients.AIM To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients.METHODS Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor(TNF)-α use,admission history due to acute flare-ups, frequent admission due to flare-ups,surgery associated with UC, and the clinical remission state at the latest followup] at each diagnostic interval.RESULTS The mean diagnostic interval was 223.3 ± 483.2 d(median, 69 d; 75 th percentile,195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age 60 years at diagnosis [odd ratio(OR) = 14.778, 95%confidence interval(CI): 1.731-126.121], smoking history(OR = 2.688, 95%CI:1.239-5.747, P = 0.012), and misdiagnosis of hemorrhoids(OR = 11.066, 95%CI:3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis(OR= 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay(OR = 2.599, 95%CI:1.006-4.916).CONCLUSION A diagnostic delay 24 mo was associated with increased anti-TNFα use. Age 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.  相似文献   

11.
急性心肌梗死合并心原性休克死亡危险因素分析   总被引:1,自引:0,他引:1  
目的 探讨ST段抬高的急性心肌梗死合并心原性休克(cardiogenic shock,CS)患者的近期预后和影响病死率的独立危险因素,为CS患者的死亡风险评估提供参考.方法 采用国际多中心CREATE研究的中国ST段抬高急性心肌梗死患者517例资料,平均年龄(68.5±10.3)岁,男性患者占57.6%.用单变量和多变量logistic回归分析合并CS患者的基线特征因素和治疗因素与30 d病死率的相关性.结果 517例CS患者30 d的病死率为62.3%(322例).将全部变量进行多因素logistic回归分析显示年龄(OR=1.46,95%GI:1.18~1.81)、前壁梗死(OR=2.01,95%CI:1.29~3.11)、入院基线血糖>7.8 mmol/L(OR=2.17,95%CI:1.26~3.73)、血钠<130 mmoL/L(OR=2.21,95%CI:1.21~4.04)、左心室射血分数(LVEF)<40%或重度左心功能障碍(LVD)(OR=3.78,95%CI:2.28~6.27)、未紧急血运重建(OR=3.53,95%CI:1.20~10.41)和使用利尿剂(OR=1.90,95%CI:1.21~2.97)是30 d病死率增加的独立危险因素.仅包含基线特征变量的logistic回归分析显示,上述前5项基线变量是死亡的独立基线危险因素.受试者工作特征曲线(ROC)分析两个回归模型均有较高的判别死亡高危患者的能力,ROC下面积分别为0.81(95%CI:0.77~0.86)和0.80(95%CI:0.75~0.84).结论 STEMI并发CS的患者30 d病死率超过60%,年龄等基线因素和未紧急血运重建等治疗因素是影响30 d病死率的独立危险因素.  相似文献   

12.
IntroductionThe incidence of ischemic heart disease is higher in patients with HIV/AIDS. However, the frequency of angina pectoris in these patients is still not known. Literature about this subject is still scarce.ObjectiveTo evaluate the prevalence of angina pectoris and risk factors for coronary disease and to examine the association between traditional risk factors and HIV-related risk factors and angina pectoris.MethodAn epidemiological cross-sectional study, analyzed as case-control study, involving 584 patients with HIV/AIDS. Angina pectoris was identified by Rose questionnaire, classified as definite or possible. Information regarding risk factors was obtained through a questionnaire, biochemical laboratory tests, medical records and anthropometric measures taken during consultations at AIDS treatment clinics in Pernambuco, Brazil, from June 2007 to February 2008. To adjust the effect of each factor in relation to others, multiple logistic regression was used.ResultsThere was a preponderance of men (63.2%); mean ages were 39.8 years for men, 36.8 years for women. The prevalence of definite and possible angina were 11% and 9.4%, respectively, totaling 20.4%, with independent associations between angina and smoking (OR = 2.88; 95% CI: 1.69-4.90), obesity (OR = 1.62; 95% CI: 0.97-2.70), family history of heart attack (OR = 1.70; 95% CI: 1.00-2.88), low schooling (OR = 2.11; 95% CI: 1.24-3.59), and low monthly income (OR = 2.93; 95% CI: 1.18-7.22), even after adjustment for age.ConclusionThis study suggests that angina pectoris is underdiagnosed, even in patients with medical monitoring, revealing lost opportunities in identification and prevention of cardiovascular morbidity.  相似文献   

13.
目的探讨红细胞体积分布宽度(RDW)与急性冠状动脉综合征(ACS)患者近期预后的关系。方法选择ACS患者1654例,根据基线RDW四分位数分为≤12.1%组419例、12.2%12.8%组364例、12.9%12.8%组364例、12.9%13.2%组463例和≥13.3%组408例。比较各组生化指标、1个月时心源性死亡、心力衰竭及再次心肌梗死发生率。评估RDW与1个月时恶性事件的关系。结果随着RDW逐步升高,心源性死亡、心力衰竭及再次心肌梗死发生率也逐步升高。logistic回归分析显示,RDW(OR=2.116,95%CI:1.42713.2%组463例和≥13.3%组408例。比较各组生化指标、1个月时心源性死亡、心力衰竭及再次心肌梗死发生率。评估RDW与1个月时恶性事件的关系。结果随着RDW逐步升高,心源性死亡、心力衰竭及再次心肌梗死发生率也逐步升高。logistic回归分析显示,RDW(OR=2.116,95%CI:1.4273.137,P=0.000)、B型钠尿肽>100ng/L(OR=3.510,95%CI:1.2213.137,P=0.000)、B型钠尿肽>100ng/L(OR=3.510,95%CI:1.22110.093,P=0.020)、LVEF<40%(OR=4.149,95%CI:2.00110.093,P=0.020)、LVEF<40%(OR=4.149,95%CI:2.0018.602,P=0.000)是ACS患者1个月时心源性死亡的独立危险因素。同时,RDW(OR=2.134,95%CI:1.6028.602,P=0.000)是ACS患者1个月时心源性死亡的独立危险因素。同时,RDW(OR=2.134,95%CI:1.6022.844,P=0.000)、年龄>65岁(OR=2.010,95%CI:1.1352.844,P=0.000)、年龄>65岁(OR=2.010,95%CI:1.1353.560,P=0.017)、糖尿病(OR=2.279,95%CI:1.3453.560,P=0.017)、糖尿病(OR=2.279,95%CI:1.3453.862,P=0.002)和LVEF<40%(OR=5.009,95%CI:2.6943.862,P=0.002)和LVEF<40%(OR=5.009,95%CI:2.6949.316,P=0.000)是1个月时心力衰竭及再次心肌梗死发生的独立危险因素。结论 RDW是ACS患者近期预后的独立危险因素。  相似文献   

14.
BACKGROUND: The aim of this prospective cohort study was to describe the incidence and the risk factors for the development of intraventricular conduction defects and the relationship of these defects with in-hospital major cardiac events (MACE) in unstable angina pectoris. METHODS: Two-hundred-and-seventy consecutive patients presenting with Braunwald class IIIB angina without a conduction defect at admission were included in the study and followed up during the in-hospital period. RESULTS: Fifty-one patients who developed non-ST-elevation myocardial infarction during the first day were excluded from the study. Of the remaining 219 patients, 40 (18%) had a new permanent conduction defect (group 1) and 179 (82%) did not have a conduction defect (group 2) during the in-hospital period. The patients in group 1 were significantly older (mean age of 63.5 +/- 11 years compared with 59 +/- 10 years, P = 0.01) and a history of previous coronary artery bypass grafting (CABG) was more frequent in this group (12.5% compared with 1.6%, P = 0.004). By logistic regression analysis, age (P = 0.01, odds ratio (OR) = 1.473, 95% confidence interval (CI) = 1.108-2.612) and previous CABG (P = 0.005, OR = 3.995, 95% CI = 1.811-7.383) were also found to be risk factors for the development of a conduction defect. In-hospital total MACE, death and heart failure were more frequently observed in group 1 (P = 0.005, P = 0.02, P = 0.001, respectively). The incidences of recurrent refractory angina, acute myocardial infarction and urgent revascularization were not different between the groups. ST-segment depression at admission (P = 0.009, OR = 1.654, 95% CI = 1.228-2.675) and a new-onset conduction defect (P = 0.02, OR = 1.625, 95% CI = 1.244-2.754) were found to be predictors of the development of in-hospital MACE. CONCLUSIONS: In unstable angina pectoris, patients with a new-onset conduction defect are relatively older and have more frequently undergone previous CABG. Because in-hospital MACE, death and heart failure are more common in patients with a new conduction defect, they should be considered as high risk and treated more aggressively.  相似文献   

15.
Percutaneous coronary intervention (PCI) improves anginal chest pain in most, but not all, treated patients. PCI is associated with unplanned readmission for angina and non‐specific chest pain within 30‐days of index PCI. Patients with an index hospitalization for PCI between January–November in each of the years 2010–2014 were included from the United States Nationwide Readmissions Database. Of 2 723 455 included patients, the 30‐day unplanned readmission rate was 7.2% (n = 196 581, 42.3% female). This included 9.8% (n = 19 183) with angina and 11.1% (n = 21 714) with non‐specific chest pain. The unplanned readmission group were younger (62.2 vs 65.1 years; P < 0.001), more likely to be females (41.0% vs 34.2%; P < 0.001), from the lowest quartile of household income (32.9% vs 31.2%; P < 0.001), have higher prevalence of cardiovascular risk factors or have index PCI performed for non‐acute coronary syndromes (ACS) (OR:3.46, 95%CI 3.39–3.54). Factors associated with angina readmissions included female sex (OR:1.28, 95%CI 1.25–1.32), history of ischemic heart disease (IHD) (OR:3.28, 95%CI 2.95–3.66), coronary artery bypass grafts (OR:1.79, 95%CI 1.72–2.86), anaemia (OR:1.16, 95%CI 1.11–1.21), hypertension (OR:1.13, 95%CI 1.09, 1.17), and dyslipidemia (OR:1.10, 95%CI 1.06–1.14). Non‐specific chest pain compared with angina readmissions were younger (mean difference 1.25 years, 95% CI 0.99, 1.50), more likely to be females (RR:1.13, 95%CI 1.10, 1.15) and have undergone PCI for non‐ACS (RR:2.17, 95%CI 2.13, 2.21). Indications for PCI other than ACS have a greater likelihood of readmission with angina or non‐specific chest pain at 30‐days. Readmissions are more common in patients with modifiable risk factors, previous history of IHD and anaemia.  相似文献   

16.
目的探讨急性心肌梗死(AMI)患者侧支循环发育良好的发生率、预测因素及其对预后的影响。方法研究共入选1125例成功接受经皮冠状动脉介入治疗(PCI)的AMI患者,依据Rentrop分级法分为侧支循环良好组(181例)和侧支循环较差组(944例),比较两组患者基线资料、介入相关指标与预后情况,分析影响侧支循环形成的可能因素。结果AMI患者侧支循环发育良好的比例为16.1%,侧支循环良好组患者糖尿病(23.2%vs.35.2%,P=0.002)和吸烟比例(26.5%vs.37.3%,P=0.005)显著低于侧支循环较差组,心绞痛病程显著长于侧支循环较差组(6.5±3.8 vs.4.2±2.5,P=0.024),SYNTAX评分更高(39.3±14.8 vs.32.2±12.6,P=0.039),PCI相关心肌梗死发生率更低(17.7%vs.26.7,P=0.011),其慢血流/无复流发生率更低(16.6%vs.23.8%,P=0.033)。随访1年,侧支循环良好组心力衰竭发生率(13.8%vs.22.1%,P=0.012)和总MACCE(34.3%vs.48.3%,P=0.001)显著低于侧支循环较差组。多因素回归分析显示目前吸烟(OR=1.329;95%CI:1.029~3.917,P=0.028),糖尿病(OR:2.266;95%CI:1.326~3.924,P=0.044),心绞痛病程(OR=0.769;95%CI:0.567~0.928,P=0.031),SYNTAX评分(OR=0.801;95%CI:0.608~0.937,P=0.046)是侧支循环形成的独立预测因素。结论AMI患者侧支循环发育良好者PCI相关心肌梗死和慢血流/无复流发生率更低,吸烟、糖尿病、心绞痛病程和SYNTAX评分是其独立预测因素。  相似文献   

17.
目的: 观察幽门螺杆菌(Hp)感染是否与不稳定型心绞痛(UAP)有关联。方法: 152例住院的心绞痛患者分为两组:UAP组患者114例,对照组为稳定型心绞痛(SAP)患者38例。所有患者应用ELISA法测定血清Hp-IgG浓度,测定血清高敏C反应蛋白(hsCRP)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)浓度,行冠状动脉造影检查,以Gensini冠状动脉积分评价冠状动脉狭窄程度。结果: UAP组患者的血清Hp-IgG、hsCRP、空腹血糖(FPG)水平和冠状动脉积分均高于SAP组患者(P<0.05),采用多因素Logistic回归分析表明,血清Hp-IgG(OR=5.13,95%CI 1.91-13.78,P<0.01)、hsCRP(OR=3.58,95%CI 1.32-9.65,P<0.05)和FPG(OR=6.20,95%CI 1.21-31.42,P<0.05)水平升高的3个指标与UAP有关。结论: 血清Hp-IgG水平升高与UAP有关。  相似文献   

18.
李军 《心脏杂志》2015,27(6):683-686
目的 分析影响急性ST段抬高型心肌梗死(STEMI)患者入院时心功能的危险因素。方法 将145例STEMI患者按入院时心功能分级分为心功能正常组(n=95)与心功能异常组(n=50),分别采用单因素分析与多元Logistic回归分析的方法对影响STEMI患者入院时心功能的危险因素进行分析。结果 ①经单因素分析,心功能正常组与心功能异常组在年龄、糖尿病、入院心率、舒张压、β-受体阻滞剂及IL-6水平方面的差异均具有统计学意义(P<0.05或P<0.01);②将上述经单因素分析具有统计学意义的因素进行赋值并带入至多元Logistic回归模型之中,最终确定影响STEMI患者入院时心功能的独立危险因素为:年龄(P<0.05,OR=1.83,95%CI为1.36-2.21)、糖尿病(P<0.05,OR=2.24,95%CI为1.83-3.11)、入院心率(P<0.05,OR=2.37,95%CI为1.40-4.16)、舒张压(P<0.05,OR=2.59,95%CI为2.21-3.39)及IL-6水平(P<0.05,OR=3.02,95%CI为2.87-4.16)。结论 年龄、糖尿病、入院心率、舒张压及IL-6水平为影响STEMI患者入院时心功能的独立危险因素。  相似文献   

19.
目的:筛选经皮冠状动脉介入治疗(PCI)相关心肌梗死(PMI)的危险因素,建立PMI发生风险的危险模型。方法:回顾性分析了北京大学人民医院801例择期PCI患者的临床基线特征、冠状动脉造影检查结果及PCI操作资料,并就此根据临床实际情况分为PMI组(n=113)和无PMI组(n=688)。同时利用多元Logistic回归分析筛选PMI的独立危险因素并建立危险模型。结果:PMI发生率为14.1%(113/801),经过多元Logistic回归分析发现PMI的独立危险因素包括年龄(OR=1.040,95%CI:1.015~1.065,P=0.001),多支病变(OR=1.740,95%CI:1.028~2.945,P=0.039),支架数目(OR=1.787,95%CI:1.404~2.275,P=0.000),旋磨(OR=4.046,95%CI:1.336~12.252,P=0.013),并建立了危险模型。该模型的ROC曲线下面积为0.706(95%CI:0.657~0.754)。结论:年龄、多支病变、支架数目及旋磨均为PMI发生的独立危险因素,由此建立的危险模型能够较好地指导临床工作者评估PMI风险。  相似文献   

20.
目的分析探究影响HBV相关慢加急性肝衰竭(HBV-ACLF)短期预后的危险因素。方法收集2009年1月—2019年12月西安交通大学第二附属医院收治的240例非肝移植HBV-ACLF患者的临床资料,按照入院后28 d和90 d存活情况进行分组(28 d:生存组164例,死亡组76例;90 d:生存组140例,死亡组100例)。收集患者发病诱因、肝功能指标、MELD评分、MELD-Na评分和出现的并发症等资料。计量资料用2组间比较采用Mann-Whithey U检验,计数资料2组间比较采用χ^2检验。根据ROC曲线,计算ROC曲线下面积(AUC),采用约登指数确定临界值,HBV-ACLF短期预后的危险因素分析采用logistic多因素回归分析。结果HBV-ACLF患者的诱因主要包括HBV自发激活(55.6%)、核苷类似物停药或耐药引起HBV激活(25.2%)等。依28 d存活情况分组,基线资料中年龄、PTA、NLR、血钠、MELD评分、MELD-Na评分、TBil水平2组间比较差异均有统计学意义(Z值分别为-2.400、-6.015、-5.070、-5.103、-5.044、-7.430、-6.637,P值均<0.05);依90 d生存情况分组,基线资料中年龄、PTA、NLR、血钠、MELD评分、MELD-Na评分、TBil、胆固醇水平2组间比较差异均有统计学意义(Z值分别为-2.205、-7.728、-3.335、-4.015、-6.053、-7.908、-6.655、-3.607,P值均<0.05)。logistic多因素回归分析显示,TBil>260.20 mmol/L、PTA<24.8%、NLR>5.63、血钠<130.8 mmol/L、MELD>17.84分、MELD-Na>25.1分是影响患者28 d生存的独立危险因素[OR(95%CI)分别为4.572(1.321~15.823)、8.934(3.026~26.374)、2.632(1.126~6.152)、27.467(6.113~123.423)、4.303(1.048~17.663)、3.453(1.614~7.387),P值均<0.05];TBil>260.20 mmol/L、PTA<25.5%、血钠<135.3 mmol/L、MELD>17.84分、MELD-Na>25.1分是影响患者90 d生存的独立危险因素[OR(95%CI)分别为5.148(1.918~13.822)、15.718(5.161~47.866)、10.080(3.244~31.323)、11.157(2.580~48.254)、4.391(2.057~9.372),P值均<0.05]。240例患者中160例(66.7%)90 d内发生感染,其中细菌感染140例、病毒感染12例,真菌感染8例。160例出现感染的患者其90 d病死率显著高于无感染的患者(46.3%vs 32.5%,χ^2=6.720,P=0.010)。240例患者中176例28 d内出现腹水,44例出现胸腔积液,36例发生急性肾损伤,60例发生肝性脑病,12例发生消化道出血,2组间急性肾损伤、Ⅲ~Ⅳ度肝性脑病、消化道出血所占比例比较差异均有统计学意义(χ^2值分别为64.088、29.811、7.797,P值均<0.05)。结论HBV-ACLF患者基线TBil、PTA、血钠、MELD评分、MELD-Na评分是影响患者28 d和90 d预后的独立危险因素。HBV激活引起的肝脏炎症坏死是ACLF的始动因素,而感染、急性肾损伤、肝性脑病和消化道出血是影响患者预后的主要的并发症。  相似文献   

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