2017 年第 8 期 第 12 卷

血清阴离子间隙与冠状动脉狭窄严重程度及全因死亡率的相关性

Relevance among serum anion gap, severity of coronary stenosis and all-cause mortality in coronary heart disease

作者：杨士伟周玉杰赵迎新刘宇扬周志明贾德安胡宾申华高霏马茜韩红亚王志坚

英文作者：Yang Shiwei Zhou Yujie Zhao Yingxin Liu Yuyang Zhou Zhiming Jia Dean Hu Bin Shen Hua Gao Fei Ma Qian Han Hongya Wang Zhijian

单位：100029首都医科大学附属北京安贞医院心内十二病房北京市心肺血管疾病研究所

英文单位：The 12th Ward Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：冠状动脉疾病；阴离子间隙；冠状动脉狭窄；全因死亡

英文关键词：Coronaryheartdisease；Aniongap；Coronaryarterystenosis；All-causedeath

• 摘要：

• 目的 探讨冠状动脉粥样硬化性心脏病（冠心病）患者血清阴离子间隙（AG）水平与冠状动脉狭窄严重程度及全因死亡率的关系。方法  共入选2004年4月至2010年10月在5家临床中心就诊的18 115例冠心病患者。计算所有患者血清AG水平，根据冠状动脉狭窄支数和SYNTAX评分判断冠状动脉狭窄严重程度，分析血清AG水平与患者冠状动脉狭窄严重程度及术后30 d全因死亡率的关系。结果  共有4 510例（24.9%）患者血清AG水平超过16 mmol/L。根据血清AG水平四分位数将患者分为Q1组（AG＜11.40 mmol/L，4 537例）、Q2组（11.40 mmol/L≤AG＜13.52 mmol/L，4 558例）、Q3组（≥13.52 mmol/L≤AG＜15.92 mmol/L，4 508例）和Q4组（≥15.92 mmol/L，4 512例）。单因素及多因素分析均显示，血清AG水平与冠状动脉狭窄严重程度无相关性（均P＞0.05）。血清AG水平是术后30 d全因死亡率的独立预测因子，与Q1组比较，Q3、Q4组全因死亡风险明显增加（均P＜0.05）。结论  高血清AG水平与冠心病患者的全因死亡风险增加显著相关，且独立于冠状动脉狭窄严重程度。

• Objective  To explore the relevance among serum anion gap(AG), severity of coronary stenosis and all-cause mortality in patients with coronary heart disease(CHD). Methods  Totally 18 115 patients with CHD were enrolled at 5 hospitals from April 2004 to October 2010. The serum level of AG was calculated in all patients; the severity of coronary stenosis was defined according to numbers of stenosis vessels and the SYNTAX score. Relations among serum AG, severity of coronary stenosis and postoperative 30 d all-cause mortality were analyzed. Results  There were 4 510 patients(24.9%) had serum AG＞16 mmol/L. The patients were divided into Q1 group(AG＜11.40 mmol/L, n=4 537), Q2 group(11.40 mmol/L≤AG＜13.52 mmol/L, n=4 558), Q3 group(13.52 mmol/L≤AG＜15.92 mmol/L, n=4 508) and Q4 group(AG≥15.92 mmol/L, n=4 512) according to the quartile values of AG. No correlation was observed between serum AG and severity of coronary stenosis（P＞0.05）. Serum AG was an independent predictor of postoperative 30 d all-cause mortality; the all-cause mortality risk in Q3 and Q4 group significantly increased compared to that in Q1 group（P＜0.05）. Conclusion  Elevated level of serum AG is associated with the risk of all-cause mortality but not the severity of coronary stenosis in patients with CHD.