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目的:探讨老年冠心病患者的临床特点及冠状动脉(冠脉)病变程度与肾功能水平的相关性。方法:按时间顺序纳入2015-05-01-2016-04-30因“胸痛”行冠脉造影检查的老年患者为研究对象,入组冠心病患者357例,其中AMI组93例、UA组164例、SA组100例,另取50例同期冠脉造影阴性者为对照组。详细记录其临床特征及相关生化指标,运用Gensini积分方法计算冠脉病变程度。结果:AMI组logGS高于UA及SA组(1.74±0.28、1.48±0.42、1.34±0.51,P<0.001),且伴有偏高的血肌酐水平(95.3±31.1、83.6±22.8、86.4±22.2、76.1±15.9,P<0.001)。单因素分析提示logGS与低肾小球滤过率、糖耐量异常、吸烟均有关(P<0.01),多因素分析亦证实logGS与低肾小球滤过率相关性具有统计学意义(P<0.01),Logistic分析提示Gensini积分与老年冠心病患者的急性冠脉综合征发生率显著相关(OR=1.007,95%CI:1.001-1.013,P=0.023)。结论:65岁以上冠心病患者中,心肌梗死患者冠脉狭窄程度最重,且伴有轻度肾功能的损害。logGS与肾功能下降有关,且Gensini积分每增加1分,急性冠脉综合征发生率也随之增加1.007倍。
Objective: To investigate the clinical features of elderly patients with coronary heart disease and the degree of coronary artery (coronary artery) disease and renal function. Methods: The chronological order was included in 2015-05-01-2016-04-30 In the elderly patients undergoing chest pain coronary angiography, 357 coronary heart disease patients were enrolled, including 93 AMI patients, UA 164 cases, SA group 100 cases, the other 50 cases of coronary angiography were negative control group. Detailed records of its clinical features and related biochemical indicators, the use of Gensini integral method to calculate the degree of coronary lesions. Results: The log GS in AMI group was significantly higher than that in UA group and SA group (1.74 ± 0.28,1.48 ± 0.42,1.34 ± 0.51, P <0.001), and was associated with high serum creatinine (95.3 ± 31.1,83.6 ± 22.8,86.4 ± 22.2 , 76.1 ± 15.9, P <0.001). Univariate analysis showed that logGS was associated with low glomerular filtration rate, impaired glucose tolerance and smoking (P <0.01). Multivariate analysis also showed that the correlation between logGS and glomerular filtration rate was statistically significant (P < 0.01). Logistic analysis showed that the Gensini score was significantly associated with the incidence of acute coronary syndrome in elderly patients with coronary heart disease (OR = 1.007, 95% CI: 1.001-1.013, P = 0.023). Conclusion: Among patients with coronary heart disease over 65 years old, the degree of coronary artery stenosis is the most serious in patients with myocardial infarction, with mild renal impairment. LogGS and renal function decline, and Gensini points for each additional 1 point, the incidence of acute coronary syndrome also increased 1.007 times.