两性急性心肌梗死住院期间死亡风险的Logistic回归分析

目的 分析影响两性患者急性心肌梗死(AMI)住院期间死亡风险的因素,为今后针对不同性别患者急性心肌梗死的防治提供依据.方法 收集2009年1月1日-2010年12月31日因AMI住我院心内科的689例AMI患者的临床资料,按性别分成两组,其中女性214例,男性475例,分析两性患者AMI的特点并对影响住院期间死亡的因素进行Logistic回归分析.结果 整个AMI人群男女比例为2.22:1,两性患者对比有如下特点:①女性较男性平均发病年龄大约晚10年；②女性接受再灌注治疗比率(41.6％)低于男性(59.2％),P＜0.05；③女性AMI患者合并基础疾病种类较男性多,女性平均为(3.46 ±1.80)种,男性为(2.58±1.78)种,P＜0.05；④女性患者发生严重并发症的发病率较男性高(7.5％与3.4％,P＜0.05),住院期间死亡率(24.8％)也远高于男性(11.6％),P＜0.05；⑤对住院期间死亡风险的Logistic回归分析,得出两性患者住院期间死亡风险的Logistic回归模型:女性为P=e-2.452-2.73 ×TREAT+0.695×HF +3.529×COMP/1+e-2.452-2.73×TREAT+0.695×HF +3.529×COMP,男性为:P=e-5.040+1.892×COPD+2.384×CRF+1.013Xhf+5.326×COMP/1+e5.040+1.892×COPD+2.384×CRF+1.013Xhf+5.326×COMP.结论 女性急性心肌梗死患者发病年龄大,并发症多,死亡率高；本研究得出的两性急性心肌梗死住院期间死亡风险的Logistic回归模型表明,女性患者住院期间接受再灌注治疗可降低住院期间死亡风险,再灌注治疗对男性患者则未能降低死亡风险；男性患者合并慢性阻塞性肺疾病、慢性肾功能不全及并发症住院期间死亡风险显著升高,而在女性患者却无类似影响；不论男女出现并发症如心功能不全、心源性休克、恶性心律失常及机械性并发症,住院期间死亡概率明显升高.

Logistic regression model of risk of death in acute myocardial infarction patient

Objective To explore the factors which may affect the mortality of acute myocardial infarction.Methods All the subjects were in the First Municpal People＇ s Hospital of Guangzhou with acute myocardial infarction at 2009-2010,and were divided into two groups according to the gender,214 of them were female and 475 were male.General physical examination and essential auxiliary examination were executed.Analyze the gender differences after acute myocardium infarction.Results Women were older than men at presentation mean age 73.8（SD 9.9） versus 64.6（13.1） years,P 0.01];fewer women received cardiac catheterization（41.6 versus 59.2 percent）;women had a higher risk of adverse events（7.5% versus 3.4%） and mortality（24.8% versus 11.6%,P0.05） after MI than matched men.Logistic regression showed that women who receive PCI have more opportunity to live（in-hospital period）,however,there is no such effect for men.Male patients who have chronic renal dysfunction or COPD added the chance of death in hospital,but not for women.Both women and men with complications had more chance to death.Conclusion Catheterization could reduce the chance of death for women but not for men;COPD and chronic renal dysfunction could add the chance of death for men and not for women;complications could enhance the chance of death for both women and men.