血红蛋白对经皮冠状动脉介入治疗后男性患者远期预后的影响

目的探讨经皮冠状动脉（冠脉）介入治疗（PCI）前血红蛋白对男性冠心病患者术后远期预后的影响。方法药物洗脱支架对血运重建策略影响研究（DESIRE-2）为单中心回顾性注册研究,纳入2003年7月至2005年9月在我院接受PCI或冠脉旁路移植术治疗的6 005例患者。入选其中接受单纯PCI、未接受溶栓治疗、无慢性肾功能不全病史的2 641例男性患者,根据术前血红蛋白应用五分位法将患者分为5组（血红蛋白≤132.4 g/L组,血红蛋白132.5～140.9 g/L组,血红蛋白141.0～147.9 g/L组,血红蛋白148.0～155.0 g/L组,血红蛋白≥155.1 g/L组）,比较各组患者的临床特点、冠脉病变特点以及远期预后,平均随访548 d。结果血红蛋白≤132.4 g/L组、132.5～140.9 g/L组、141.0～147.9 g/L组、148.0～155.0 g/L组和≥155.1 g/L组患者在年龄（分别为64.0±10.3岁、60.3±10.35岁、57.8±10.25岁、55.4±10.9岁和54.1±10.4岁,P〈0.001）,脑血管病史（分别为11.0%、8.2%、5.6%、5.9%和6.3%,P=0.004）,血运重建史（分别为12.5%、10.2%、13.0%、13.6%和8.3%,P=0.037）,左室射血分数（LVEF）（分别为58.9±11.3、60.9±10.3、61.7±10.7、61.4±10.1和60.6±10.4,P=0.001）,冠脉病变支数（P=0.003）以及体质指数（BMI）（分别为25.0±3.1 kg/m2、26.0±2.8 kg/m2、25.7±2.9 kg/m2、26.2±2.9 kg/m2和26.4±2.8 kg/m2,P〈0.001）、舒张压（分别为77.3±11.4 mmHg、78.0±10.3 mmHg、78.1±10.3 mmHg、79.5±11.4 mmHg和81.6±11.9 mmHg,P〈0.001）、总胆固醇（分别为164.1±37.4 mg/dL、172.0±37.4 mg/dL、174.6±39.5 mg/dL、180.3±41.4 mg/dL和187.5±39.9 mg/dL,P〈0.001）、低密度脂蛋白胆固醇（分别为94.7±28.3 mg/dL、100.2±31.0 mg/dL、101.5±33.2 mg/dL、105.9±32.8 mg/dL和109.5±32.6 mg/dL,P〈0.001）、三酰甘油（甘油三酯,分别为132.8±86.9 mg/dL、147.1±80.7 mg/dL、159.8±98.4 mg/dL、164.8±90.3 mg/dL和194.0±138.7 mg/dL,P〈0.001）水平等方面差异有统计学意义。多因素Cox?

Association of hemoglobin levels with long-term mortality in male patients undergoing percutaneous coronary interventions

Objective To assess the influence of hemoglobin （Hb） concentrations on long-term mortality in male patients after percutaneous coronary interventions （PCI）. Methods The DESIRE-2 （The Second Drug-Eluting Stent Impact on Revascularization Registry） is a single-center registry of 6005 patients undergoing coronary revascularization from Jul 2003 to Sep 2005. There were a total of 2 641 PCI male patients without previous treatment with thrombolytic substances and end-stage renal failure before interventional procedure and the baseline hemoglobin data were available. Depending on their baseline hemoglobin, patients were divided in quintiles. We compared the clinical features and prognosis of all these patients. Results Significant differences were found between the quintiles regarding age （ P 〈 0. 001 ）,prior history of cerebrovascular disease（P= 0. 004） , prior history of coronary inlervention or coronary bypass surgery （ P = 0. 037 ） , angiographic teatures（ P = 0. 003 ） . Other significant diffences include left ventrieular ejection fraction （P = 0.001 ）, baseline body mass index, diastolic blood pressure, total cholesterol, low-density lipoprotein and triglyceride （P 〈0. 001 ）. After adjustment for potential eo-variates in Cox regression analysis, hemoglobin was associated with a significantly long-term higher mortality （RR 0. 973,95% CI 0. 952- 0. 995, P = 0. 016）, patients of the lowest hemoglobin quintile showed a markedly higher risk tor death （ RR 2. 190,95% C1 1. 056 - 4. 544, P = 0. 035 ）. Conclusion Low hemoglobin concentrations were associated with higher long-term mortality in male patients after percutaneous coronary interventions.