75岁以上急性冠脉综合征患者近期预后因素分析

目的探讨预测75岁以上急性冠脉综合征患者30d内发生急性心血管事件的预后因素。方法选择2007年12月至2009年12月在广州医学院附属广州市第一人民医院老年科连续住院的75岁以上急性冠脉综合征患者共93例,根据就诊第30天内有无急性心血管事件发生分为事件组和无事件组,对两组患者临床特点及血清生化检测指标进行单因素分析和多因素Logistic回归分析,并对最终进入回归方程的指标进行相关性分析。结果 30d内共发生急性心血管事件27例(29.0%),事件组血清高敏C-反应蛋白[(12.16±11.24)mg/Lvs.(5.47±9.85)mg/L,P0.05]、空腹血糖[(7.67±3.96)mmol/Lvs.(5.75±1.48)mmol/L,P0.05]、心肌肌钙蛋白[(11.91±21.77)ng/Lvs.(2.07±7.02)ng/L,P0.05]浓度显著高于无事件组;多因素Logistic回归分析显示,血清高敏C-反应蛋白、空腹血糖、心肌肌钙蛋白浓度升高是75岁以上老年急性冠脉综合征近期发生心脏事件的独立危险因素;相关性分析显示,血清高敏C-反应蛋白、空腹血糖分别与心肌肌钙蛋白浓度呈显著正相关(r=0.474,P0.01;r=0.249,P0.01)。结论血清高敏C-反应蛋白、空腹血糖、心肌肌钙蛋白浓度升高是75岁以上老年急性冠脉综合征患者近期发生急性心脏事件的独立危险因素,联合检测可能对其临床预后具有更强的预测价值。

Prognostic factors in patients over 75 years of age with acute coronary syndrome

Objectives To study the prognostic factors and the risk in patients who were above 75 years of age with acute coronary syndrome （ACS）. Methods We selected 93 patients above 75 years of age who were hospitalized with an admission diagnosis of ACS. According to the main adverse cardiac events （MACE） recorded within 30 days of follow-up, the patients were divided into 2 groups. Basic characteristics, the concentrations of serum high sensitivity C-reactive protein （hs-CRP）, fasting blood glucose （FBG）, cardiac troponin I （cTNI） and other laboratory tests in the 2 groups were compared. Results MACE took place in 27 patients （29.0%）. Concentrations of serum hs-CRP [（12.16±11.24）mg/L vs.（5.47±9.85）mg/L,P〈0.05], FBG [（7.67±3.96）mmol/L vs.（5.75±1.48）mmol/L,P〈 0.05 ] and cTNI [ （ 11.91 ±21.77 ） ng/L vs. （2.07±7.02） ng/L, P〈0.05 ] were significantly higher in incident group than in non-incident group. Multiple logistic regression analysis showed hs-CRP, FBG and eTNI were independent predictive values for the 30-day MACE. Correlation analysis showed hs-CRP correlated with cTNI （r=0.474, P〈0.01 ）, FBGcorrelated with. eTNI （r=0.249, P〈0.01）. Conculsions The concentrations of Serum hs-CRP, FBG and cTNI, as prognostic factors, are closely associated with the MACE event in 30 days in ACS patients above 75 years of age.