摘要
目的探讨急性心肌梗死(AMI)接受经皮冠状动脉介入治疗(PCI)患者术前收缩压/舒张压与主要不良心脑血管事件(MACCE)之间的关系。方法选取2015年1月至2016年1月期间收治的AMI行PCI治疗的住院患者582例,根据收缩压与舒张压水平分别单独排序,采用5分位数将收缩压与舒张压各分成5组:收缩压组1[(94.4±5.6),≤104 mm Hg],收缩压组2[(107.7±3.6),105~111 mm Hg],收缩压组3[(115.6±3.5),112~121 mm Hg],收缩压组4[(138.5±3.0),122~144 mm Hg],收缩压组5[(144.8±4.3),≥145 mm Hg]。舒张压组1[(56.5±3.5),≤61 mm Hg],舒张压组2[(64.8±1.8),62~66 mm Hg],舒张压组3[(68.7±1.9),67~73 mm Hg],舒张压组4[(75.2±2.2),74~79 mm Hg],舒张压组5[(84.6±4.7),80~90 mm Hg]。比较各组患者的临床特点;采用多因素Cox风险模型预测MACCE发生的影响因素。结果收缩压组1及舒张压组1患者体质量指数(BMI)、入院时心率低于其余4组患者(均P<0.05),收缩压组5及舒张压组5患者高血压比例高于其余4组患者(P<0.05)。收缩压组1及舒张压组1患者高密度脂蛋白胆固醇(HDL-C)高于其余4组患者(P<0.05)。收缩压组1与舒张压组1患者的血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)使用比例低于其余4组患者(P<0.05)。多因素Cox风险回归分析显示,AMI患者在PCI术前时收缩压≤104 mm Hg(HR 2.052)、收缩压≥145 mm Hg(HR 2.205)、舒张压≤61 mm Hg(HR 1.359)、舒张压≥80 mm Hg(HR 1.490)、年龄(HR 3.325)、Killip分级(3/4)(HR 11.687)是MACCE发生的独立危险因素。ACEI/ARB的使用(HR 0.204)是AMI患者MACCE发生的独立保护因素。收缩压/舒张压与MACCE发生之间呈现U形关系。结论 PCI术前AMI患者收缩压≤104或≥145 mm Hg,舒张压≤61或≥80 mm Hg可能是PCI术后MACCE发生的独立危险因素;收缩压/舒张压与MACCE发生之间均呈现U形关系。
Objective To investigate the relationship between systolic/diastolic blood pressure before percutaneous coronary intervention(PCI) and major adverse cardio-cerebrovascular events(MACCE) in patients with acute myocardial infarction(AMI). Methods Five hundred and eighty two patients with AMI treated by PCI from January 2015 to January 2016 were selected. According to the level of systolic and diastolic blood pressure, they were sorted separately and divided into five groups by 5-quartile: systolic blood pressure group-1 [(94.4±5.6), range ≤104 mm Hg], systolic blood pressure group-2 [(107.7±3.6), range 105-111 mm Hg], systolic blood pressure group-3 [(115.6±3.5), range 112-121 mm Hg], systolic blood pressure group-4 [(138.5±3.0), range 122-144 mm Hg] and systolic blood pressure group-5 [(144.8±4.3), range ≥145 mm Hg];diastolic pressure group-1 [(56.5±3.5), range≤61 mm Hg], diastolic pressure group-2 [(64.8±1.8), range 62-66 mm Hg], diastolic pressure group-3 [(68.7±1.9), range 67-73 mm Hg], diastolic pressure group-4 [(75.2±2.2), range 74-79 mm Hg] and diastolic pressure group-5 [(84.6±4.7), range 80-90 mm Hg]. The clinical characteristics of each group were compared. Multivariate Cox risk model was used to predict the independent factors of MACCE. Results Body mass index and heart rate at admission in systolic blood pressure group-1 and diastolic blood pressure group-1 were lower than those in the other four groups(P<0.05). The proportion of hypertension in systolic blood pressure group-5 and diastolic blood pressure group-5 were higher than that in the other four groups(P<0.05). High density lipoprotein cholesterol(HDL-C) levels in systolic blood pressure group-1 and diastolic blood pressure group-1 were higher than those in the other four groups(P<0.05). The proportion of angiotensin converting enzyme inhibitors(ACEI) or angiotensin receptor blockers(ARB) used in systolic and diastolic blood pressure group-1 were lower than that in the other four groups(P<0.05). Multivariate Cox risk regression showed that systolic blood pressure ≤104 mm Hg(HR 2.052), systolic blood pressure ≥145 mm Hg(HR 2.205), diastolic blood pressure ≤61 mm Hg(HR 1.359), diastolic blood pressure ≥80 mm Hg(HR 1.490), age(HR 3.325) and Killip classification(3/4)(HR 11.687) were independent risk factors for the occurrence of MACCE. The use of ACEI or ARB(HR 0.204) was an independent protective factor for the occurrence of MACCE in patients with AMI. The relationship between systolic/diastolic blood pressure and occurrence of MACCE was "U" shaped. Conclusion Systolic blood pressure(≤104 or ≥145 mm Hg), diastolic blood pressure(≤61 or ≥80 mm Hg) before PCI in patients with AMI may be independent risk factors for MACCE after PCI. The relationship between systolic/diastolic blood pressure and occurrence of MACCE is "U" shaped.
作者
钦佩
周志安
边树伟
金明磊
董铁柱
QIN Pei;ZHOU Zhi-an;BIAN Shu-wei;JIN Ming-lei;DONG Tie-zhu(Department of Geriatrics,Chengde Central Hospital,Chengde Hebei 067000 , China)
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2019年第6期536-542,共7页
Chinese Journal of Hypertension
关键词
血压
经皮冠状动脉介入
急性心肌梗死
主要不良心脑血管事件
blood pressure
percutaneous coronary intervention
acute myocardial infarction
major adverse cardio-cerebrovascular events
