冠状动脉粥样硬化性心脏病患者病情进展重复住院的影响因素分析

目的探讨冠状动脉粥样硬化性心脏病(以下简称冠心病)患者病情进展和重复住院的影响因素,以期为临床诊疗提供依据。方法采用临床评估和冠状动脉造影Gensini积分综合分析连续两次非计划重返住院冠心病患者的临床及冠状动脉造影资料,根据二次重返住院是否急性心梗再发和/或第2次住院(LM/LAD、RCA、LCX)冠状动脉病变加重而行冠状动脉介入治疗/第2次住院冠脉造影检查冠脉血管病变加重(Gensini积分增加),分为病情进展组116例和非病情进展组200例,两组平均年龄分别为(61.23±10.32)岁、(60.06±10.06)岁。结果首次心梗后第2次因再发急性心梗而重返入院的冠心病患者22例(6.96%);病情进展组与非病情进展组糖尿病病程、三支血管病变严重程度(Gensini积分)、冠状动脉有无弥漫病变、是否完全闭塞病变、是否放置支架比较,差异有统计学意义(P<0.05)。病情进展组较非病情进展组糖尿病病程更长、血管病变更严重、甘油三酯水平更高,冠状动脉出现完全闭塞、弥漫病变、放置支架的比例更高(P<0.05)。两组性别、年龄、高血压病程、低密度脂蛋白胆固醇水平、是否有支架内狭窄、血栓形成、钙化病变、放置支架的直径和长度、是否需择期手术、是否遵医嘱服药比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,糖尿病病程、冠状动脉弥漫病变为冠心病患者病情进展和重复住院的独立危险因素(P<0.05)。结论积极地控制血糖达标、有效管控糖尿病的病程可减缓冠状动脉病变的进程,及早干预冠状动脉弥漫病变可减少患者重复住院。

Factors influencing the progression and repeated hospitalization of patients with coronary heart disease

【Objective】To explore the influencing factors of disease progression and repeated hospitalization in patients with coronary heart disease(CHD),so as to provide basis for clinical diagnosis and treatment.【Methods】Clinical evaluation and Gensini score of coronary angiography were used to comprehensively analyze the clinical and coronary angiography data of patients with coronary heart disease who had been hospitalized for two consecutive unplanned return visits.The patients were divided into progressive group(116 cases)and nonprogressive group(200 cases),and the average age of the two groups were 61.23±10.32 years and 60.06±10.06 years,respectively.【Results】After the first myocardial infarction,22 patients(6.96%)were admitted to the hospital for the second time due to recurrent acute myocardial infarction;there were significant differences in the course of diabetes,the severity of three vessel disease(Gensini score),the presence or absence of diffuse vessels,complete occlusion and stent placement between the two groups(P<0.05).Compared with nonprogressive group,progressive group had longer duration of diabetes,severe changes in vascular disease and higher triglyceride levels,with a higher ratio of coronary artery occlusion,diffuse lesions and stent placement(P<0.05).There was no statistically significant difference in gender,age,course of hypertension,low-density lipoprotein cholesterol level,stent stenosis,thrombosis,calcification,diameter and length of stent placement,elective surgery and taking drugs according to doctor’s advice between the two groups(P>0.05).Multivariate logistic regression analysis showed that duration of diabetes mellitus and diffuse coronary artery disease were independent risk factors for disease progression and repeated hospitalization in patients with coronary heart disease(P<0.05).【Conclusion】Active control of blood glucose and effective control of the course of diabetes can slow down the process of coronary artery disease,and early intervention of diffuse coronary artery disease can reduce repeated hospitalization.