经皮冠状动脉介入治疗和衰弱对老年冠心病患者不良预后的交互作用

方中; 徐晓东; 王丽华; 严婷婷; 马超; 张芸

doi:10.16462/j.cnki.zhjbkz.2021.07.019

经皮冠状动脉介入治疗和衰弱对老年冠心病患者不良预后的交互作用

doi: 10.16462/j.cnki.zhjbkz.2021.07.019

247000 池州，池州市人民医院心血管内科

基金项目:

安徽省重点研究和开发计划项目 1804h08020274

详细信息

通讯作者:
徐晓东，E-mail：xiaodongxu@sina.com

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2021-02-04
- 修回日期: 2021-03-22
- 网络出版日期: 2021-08-13
- 刊出日期: 2021-07-10

Interaction effcet of percutaneous coronary intervention and frailty on poor prognosis among elderly patients with coronary heart disease

Department of Cardiology, Chizhou People's Hospital, Chizhou 247000, China

Funds:

Key Research and Development Projects in Anhui Province 1804h08020274

More Information

Corresponding author: XU Xiao-dong, E-mail: xiaodongxu@sina.com

摘要

摘要: 目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)和衰弱对老年冠心病患者近期死亡率以及心源性再住院率的交互作用。方法选取池州市人民医院2018年4月1日至2019年11月30日期间在心血管内科住院的老年冠心病患者作为研究对象，收集患者的临床资料，使用衰弱量表对每位患者进行衰弱评估。随访患者出院后的全因死亡情况和心源性再住院情况。采用Kaplan-Meier法生存分析、χ²检验、t检验进行数据分析。结果共计273例住院老年冠心病患者纳入研究，76例符合衰弱标准，占比27.84%，160例行PCI，占比58.61%。衰弱相对于非衰弱发生死亡的比例增大到2.77(95% CI：1.41~7.04)倍、发生全因死亡/心源性再住院增大到2.73(95% CI：1.90~3.93)倍。其中，在PCI患者中，衰弱相对于非衰弱组发生死亡和全因死亡/心源性再住院的RR值分别增加到3.02(95% CI：1.32~6.93)和2.96(95% CI：1.89~4.62)。Kaplan-Meier法生存分析的结果显示，衰弱组患者随访期间全因死亡率、全因死亡/心源性再住院率高于非衰弱组(均有P＜0.05)。然而，在非PCI患者中，衰弱组患者随访期间全因死亡率与非衰弱组的差异无统计学意义(χ²=1.95, P=0.163)。结论 PCI增加了衰弱对老年冠心病患者的近期不良预后的发生风险，PCI与衰弱对老年冠心病患者的不良预后可能存在交互作用。
- 冠心病 /
- 衰弱 /
- 衰弱量表 /
- 预后
Abstract: Objective To investigate the interaction effect of percutaneous coronary intervention (PCI) and frailty on the short-term mortality and cardiogenic readmission rates in elderly patients with coronary heart disease (CHD). Methods From April 1, 2018 to November 30, 2019, the elderly patients with CHD were selected as the research objects, who were hospitalized in the Department of Cardiology of Chizhou people's hospital. The clinical data of the patients were collected. The frailty of each patient was evaluated with the frail scale. All-cause death and cardiogenic readmission after discharge were followed up. Kaplan-Meier method, Chi-square test, and t-test were used to analyze the data. Results A total of 273 hospitalized elderly patients with CHD were included in the study. 76 (27.84%) of them met the fattening criteria. 160 (58.61%) of them received PCI. The incidence of death due to frailty among frailly patients increased to 2.77 (95% CI: 1.41-7.04) times higher than that among non-frailly patients. The incidence of all-cause death/cardiogenic readmission among frailly patients increased to 2.73 (95% CI: 1.90-3.93) times higher than that among non-frailly patients. Among patients treated with PCI, the RR for death and all-cause death / cardiogenic readmission in the frailty group increased to 3.02 (95% CI: 1.32-6.93) and 2.96 (95% CI: 1.89-4.62) times higher than those in the non-frailty group respectively. The results of Kaplan-Meier survival analysis showed that all-cause mortality and all-cause death / cardiogenic readmission rates were significantly higher in the frail group than that in the non-frail group (all P < 0.05). However, among patients without PCI, there was no significant difference in all-cause mortality between the frailty group and the non-Frailty group (χ²=1.95, P=0.163). Conclusion PCI increases the risk of poor short-term prognosis in frailly elderly patients with CHD, and there may be an interact effect of PCI and frailty on the poor prognosis in elderly patients with CHD.
- Coronary heart disease /
- Frailty /
- FRAIL Scale /
- Prognosis

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图 1 衰弱组和非衰弱组患者发生全因死亡的Kaplan-Meier生存曲线

Figure 1. Kaplan-Meier survival curves for all cause deaths in the frailty and non-frailty groups

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图 2 衰弱组和非衰弱组患者全因死亡/心源性再住院的Kaplan-Meier生存曲线

Figure 2. Kaplan-Meier survival curves for all-cause death/cardiogenic readmission in the frailty and non-frailty groups

下载: 全尺寸图片幻灯片

图 3 行PCI的衰弱组和非衰弱组患者发生全因死亡的Kaplan-Meier生存曲线

Figure 3. Kaplan-Meier survival curves of all-cause deaths in the frailty and non-frailty groups treated with PCI

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图 4 行PCI的衰弱组和非衰弱组患者全因死亡/心源性再住院的Kaplan-Meier生存曲线

Figure 4. Kaplan-Meier survival curves of all-cause death/cardiogenic readmission in the frailty and non-frailty groups with PCI

下载: 全尺寸图片幻灯片

图 5 未行PCI的衰弱组和非衰弱组患者发生全因死亡的Kaplan-Meier生存曲线

Figure 5. Kaplan-Meier survival curves of all-cause death in the frailty and non-frailty groups without PCI

下载: 全尺寸图片幻灯片

图 6 未行PCI的衰弱组和非衰弱组患者全因死亡/心源性再住院的Kaplan-Meier生存曲线

Figure 6. Kaplan-Meier survival curves of all-cause death/cardiogenic readmission in the frailty and non-frailty groups without PCI

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表 1 2018年4月1日-2019年11月30日池州市人民医院纳入的冠心病患者基本资料[n(%)]

Table 1. Basic data of CHD patients enrolled in Chizhou People's Hospital from April 1, 2018 to November 30, 2019 [n(%)]

项目	非衰弱(n=197)	衰弱(n=76)	t/χ²值	P值
年龄(x±s, 岁)	72.22±5.28	73.75±5.53	2.118	0.035
BMI(x±s, kg/m²)	24.22±3.38	23.86±4.08	-0.743	0.458
男性	120(60.91)	42(55.26)	0.726	0.394
吸烟	58(29.44)	25(32.89)	0.309	0.578
PCI	117(59.39)	43(56.58)	0.179	0.672
高血压	120(60.91)	41(53.95)	1.100	0.294
心力衰竭	50(25.38)	26(34.21)	2.129	0.145
心房颤动	65(32.99)	27(35.53)	0.157	0.692
糖尿病	52(26.40)	22(28.95)	0.181	0.671
高脂血症	58(29.44)	21(27.63)	0.087	0.768
慢性肾脏疾病	45(22.84)	18(23.68)	0.022	0.882
贫血	31(15.74)	28(36.84)	14.421	< 0.001
脑血管病	50(25.38)	21(27.63)	0.144	0.704
慢性阻塞性肺疾病	58(29.44)	28(36.84)	1.392	0.238

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表 2 两组老年冠心病患者生化检查指标比较(x±s)

Table 2. Comparison of biochemical parameters in two groups of elderly patients with coronary heart disease (x±s)

项目	非衰弱(n=197)	衰弱组(n=76)	t/χ²值	P值
氮末端脑钠肽前体(lg pg/ml)	3.18±0.48	3.26±0.53	1.198	0.232
白蛋白(g/L)	40.21±3.59	37.75±3.65	-5.051	< 0.001
前白蛋白(mg/L)	231.65±44.48	218.56±58.63	-1.986	0.048
谷丙转氨酶(U/L)	32.75±21.48	33.15±22.06	0.137	0.891
谷草转氨酶(U/L)	35.66±28.76	36.27±29.53	0.156	0.876
TC(mmol/L)	4.12±1.03	3.99±0.96	-0.952	0.342
TG(mmol/L)	1.43±0.57	1.37±0.62	-0.761	0.448
LDL-C(mmol/L)	1.08±0.28	1.06±0.30	-0.519	0.605
HDL-C(mmol/L)	2.35±0.68	2.31±0.57	-0.455	0.650
FPG(mmol/L)	6.21±3.75	6.26±3.68	0.099	0.921
血肌酐(μmol/L)	81.25±28.78	84.47±31.25	0.809	0.419
血尿酸(μmol/L)	358.25±125.56	346.37±127.39	-0.698	0.486

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表 3 患者全因死亡及心源性再住院发生率比较[n(%)]

Table 3. Comparison of the incidence of all-cause death and cardiogenic readmission [n(%)]

分组	衰弱	非衰弱	RR(95% CI)值	χ²值	P值
死亡
总人群	15(19.74)	14(7.11)	2.77(1.41~7.04)	9.215	0.002
PCI组	10(23.30)	9(7.70)	3.02(1.32~6.93)	7.278	0.007
非PCI组	5(15.15)	5(6.25)	2.42(0.75~7.82)	2.295	0.130
全因死亡/心源性再住院
总人群	39(51.32)	37(18.78)	2.73(1.90~3.93)	28.896	< 0.001
PCI组	25(58.14)	23(19.66)	2.96(1.89~4.62)	22.173	< 0.001
非PCI组	14(42.42)	14(17.50)	2.42(1.41~8.54)	7.787	0.005

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