Angiotensin Ⅱ in Predicting the In-hospital Prognosis of Patients Undergoing Elective Percutaneous Coronary Intervention
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摘要:
目的 探讨血浆血管紧张素Ⅱ水平对行择期经皮冠状动脉介入治疗患者院内预后的预测作用。 方法 连续纳入2012年7月至2013年7月在北京协和医院心内科住院行择期经皮冠状动脉介入治疗的患者645例, 测定其血浆血管紧张素Ⅱ水平并记录其发生院内主要心血管不良事件情况。院内主要心血管不良事件定义:全因死亡、非致死性心肌梗死、新发非致死性卒中(缺血性及出血性)、非计划再次血管重建。分析血管紧张素Ⅱ水平与院内心血管不良事件的相关性。 结果 645例患者中共有68例(10.54%)发生院内心血管不良事件, 发生院内心血管不良事件者血浆血管紧张素Ⅱ水平显著高于未发生院内心血管不良事件者[41.42(28.73, 57.07)ng/L比35.66(22.84, 48.22)ng/L, P=0.009]。多因素Logistic回归分析显示血管紧张素Ⅱ为院内心血管不良事件的独立危险因素(比值比1.018, 95% CI:1.004~1.032, P=0.012)。 结论 血浆血管张素Ⅱ水平与择期经皮冠状动脉介入治疗患者的院内不良预后相关, 具有重要的预测价值。 -
关键词:
- 血管紧张素Ⅱ /
- 经皮冠状动脉介入治疗 /
- 预后
Abstract:Objective To investigate the effect of angiotensin Ⅱ in predicting the in-hospital prognosis of patients who received elective percutaneous coronary intervention. Methods From July 2012 to July 2013, 645 consecutive patients receiving elective percutaneous coronary intervention in Department of Cardiology in Peking Union Medical College Hospital were selected. Plasma level of angiotensin Ⅱ was measured in these patients, and in-hospital adverse cardiac events (including all-cause death, nonfatal myocardial infarction, new nonfatal ischemic stroke, new nonfatal hemorrhagic stroke, and unplanned vessel revascularization) were recorded. The relationship between angiotensin Ⅱ level and incidence of in-hospital adverse cardiac events was analyzed. Results Among the 645 patients, 68 (10.54%) developed in-hospital adverse cardiac events. Plasma level of angiotensin Ⅱ was significantly higher in the patients who had in-hospital adverse cardiac events compared with those who did not[41.42 (28.73, 57.07)ng/L vs. 35.66 (22.84, 48.22)ng/L, P=0.009]. Multivariate logistic regression analysis showed that plasma level of angiotensin Ⅱ was an independent risk factor of in-hospital adverse cardiac events (OR 1.018, 95% CI:1.004~1.032, P=0.012). Conclusion Plasma level of angiotensin Ⅱ may be correlated with poor in-hospital prognosis of patients who received elective percutaneous coronary intervention, hence it may have important predictive value. -
Key words:
- angiotensin Ⅱ /
- percutaneous coronary intervention /
- prognosis
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表 1 患者基本临床资料及血管紧张素Ⅱ水平
临床资料 无院内心血管不良事件(n=577) 有院内心血管不良事件(n=68) 统计量 P值 男性[例(%)] 418(72.40) 50(73.50) χ2= 0.036 0.849 年龄(x±s, 岁) 61.53±0.41 63.76±1.16 t=-1.760 0.073 高血压病史[例(%)] 435(72.70) 46(67.60) χ2= 1.115 0.291 糖尿病病史[例(%)] 240(41.60) 26(38.20) χ2= 0.283 0.595 吸烟史[例(%)] 343(59.40) 42(61.80) χ2= 0.136 0.712 早发冠心病家族史[例(%)] 102(17.70) 15(22.10) χ2= 0.786 0.375 体重指数[M(Q1, Q3), kg/m2] 25.39(23.25, 27.80) 26.00(23.70, 28.20) Z=-1.159 0.247 总胆固醇(x±s, mmol/L) 4.19±0.82 3.88±0.12 t= 1.297 0.195 甘油三酯[M(Q1, Q3), mmol/L] 1.39 (1.02, 2.14) 1.50 (1.09, 1.88) Z=-0.304 0.761 低密度脂蛋白胆固醇(x±s, mmol/L) 2.21±0.40 2.14±0.10 t= 0.518 0.605 高密度脂蛋白胆固醇[M(Q1, Q3), mmol/L] 1.02 (0.85, 1.24) 0.93 (0.80, 1.21) Z=-2.093 0.036 左室射血分数(x±s, %) 66.08±0.32 68.12±0.74 t=-2.068 0.157 冠脉三支及以上病变[例(%)] 253 (43.80) 47(69.10) χ2=19.052 0.000 入院前ACEI/ARB使用[例(%)] 219(38.00) 25(36.80) χ2= 0.037 0.848 血管紧张素Ⅱ[M(Q1, Q3), ng/L] 35.66(22.84, 48.22) 41.42(28.73, 57.07) Z=-2.606 0.009 ACEI:血管紧张素转换酶抑制剂;ARB:血管紧张素Ⅱ受体阻滞剂 表 2 多因素Logistic回归分析冠心病患者院内心血管不良预后的影响因素
影响因素 OR 95% CI P值 血管紧张素Ⅱ 1.018 1.004~1.032 0.012 年龄 1.006 0.972~1.041 0.725 性别 1.038 0.444~2.431 0.931 高血压病史 0.515 0.265~1.001 0.050 糖尿病病史 0.588 0.317~1.090 0.092 吸烟史 1.222 0.598~2.496 0.583 早发冠心病家族史 1.165 0.562~2.418 0.681 体重指数 1.060 0.992~1.133 0.085 总胆固醇 0.986 0.539~1.804 0.963 甘油三酯 0.926 0.699~1.226 0.590 低密度脂蛋白胆固醇 0.860 0.424~1.743 0.675 高密度脂蛋白胆固醇 0.521 0.210~1.294 0.160 冠脉病变支数 2.428 1.575~3.744 0.000 左室射血分数 1.075 1.025~1.127 0.003 入院前ACEI/ARB使用 0.965 0.507~1.839 0.914 ACEI、ARB:同表 1 -
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