2023 年第 12 期 第 18 卷

急性冠状动脉综合征患者发病及死亡影响因素研究

Study on the risk factors of morbidity and mortality in patients with acute coronary syndrome

作者：李艳艳1徐宝利2

英文作者：Li Yanyan1 Xu Baoli2

单位：1空军军医大学第一附属医院综合诊疗科，西安710032；2空军军医大学第一附属医院医务处，西安710032

英文单位：1Department of General Diagnosis and Treatment the First Affiliated Hospital of Air Force Medical University Xi′an 710032 China; 2Department of Medical Service the First Affiliated Hospital of Air Force Medical University Xi′an 710032 China

关键词：急性冠状动脉综合征；发病影响因素；死亡影响因素

英文关键词：Acutecoronarysyndrome;Influencingfactorsofmorbidity;Influencingfactorsofmortality

• 摘要：

• 目的  探讨急性冠状动脉综合征（ACS）患者发病及死亡的影响因素。方法  选择2020年1月至2022年12月空军军医大学第一附属医院综合诊疗科收治的180例冠心病（冠状动脉粥样硬化性心脏病）患者作为研究对象，按病情的不同分为急性组（66例，ACS患者）和非急性组（114例，非ACS患者）。比较2组患者的临床资料，采用多因素Logistic回归模型分析ACS患者发病及死亡的影响因素。结果  急性组年龄、三酰甘油水平及高血压病、糖尿病、高脂血症、吸烟史、饮酒史比例大于/高于非急性组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，年龄、高血压病、糖尿病、高脂血症、吸烟史、饮酒史、三酰甘油是ACS发病的危险因素（比值比=3.586、4.225、4.204、3.728、4.003、5.349、3.391，95%置信区间：1.498～5.674、1.987～6.463、1.979～6.429、1.669～5.787、1.897～6.109、2.846～7.852、1.388～5.394，均P＜0.05）。ACS患者中死亡组年龄、发病至就诊时间及心功能Killip分级≥Ⅲ级、高血压病、糖尿病、高脂血症、吸烟史、饮酒史、病变血管数目为三支、弥漫性病变患者比例大于/长于/高于存活组，侧支循环建立比例低于存活组（均P＜0.05）。多因素Logistic回归分析结果显示，年龄、发病至就诊时间、心功能Killip分级≥Ⅲ级、高血压病、糖尿病、高脂血症、吸烟史、饮酒史、三支病变、弥漫性病变是ACS患者死亡的危险因素，侧支循环建立是ACS患者死亡的保护因素（均P＜0.05）。结论  ACS患者发病、死亡的影响因素较多，有相关高危因素者需重视ACS的预防与治疗，尽早入院接受有效救治，控制病情发展进程，以减少ACS死亡人数。

• Objective To investigate the risk factors of morbidity and mortality in patients with acute coronary syndrome (ACS). Methods A total of 180 patients with coronary atherosclerotic heart disease admitted to the Department of General Diagnosis and Treatment, the First Affiliated Hospital of Air Force Medical University from January 2020 to December 2022 were selected as the research subjects. According to the different conditions, they were divided into acute group (66 cases, ACS patients) and non-acute group (114 cases, non-ACS patients). The clinical data of the two groups were compared, and the multivariate Logistic regression model was used to analyze the influencing factors of the morbidity and mortality of ACS patients. Results  The age, triglyceride level and the proportion of hypertension, diabetes, hyperlipidemia, smoking history, and drinking history in the acute group were greater/higher than those in the non-acute group (all P＜0.05). Multivariate Logistic regression analysis showed that age, hypertension, diabetes, hyperlipidemia, smoking history, drinking history, and triglyceride were risk factors of ACS (odds ratio=3.586, 4.225, 4.204, 3.728, 4.003, 5.349, 3.391, 95% confidence interval: 1.498-5.674, 1.987-6.463, 1.979-6.429, 1.669-5.787, 1.897-6.109, 2.846-7.852, 1.388-5.394, all P＜0.05). In ACS patients, age, time from onset to visit, the proportions of patients with Killip grade ≥ Ⅲ, hypertension, diabetes, hyperlipidemia, smoking history, drinking history, three-vessel disease, and diffuse lesions in death group were greater/longer/higher than those in survival group, and the proportion of collateral circulation establishment in death group was lower than that in survival group (all P＜0.05). Multivariate Logistic regression analysis showed that age, time from onset to visit, Killip grade ≥Ⅲ, hypertension, diabetes, hyperlipidemia, smoking history, drinking history, three-vessel disease, and diffuse lesions were risk factors for death of ACS patients, and collateral circulation was a protective factor for mortality in ACS patients (all P＜0.05). Conclusions  There are many influencing factors for the morbidity and mortality of ACS. Patients with related high-risk factors should pay attention to the prevention and treatment of ACS, be admitted to the hospital as soon as possible to receive effective treatment, and control the development process of the disease to reduce the number of ACS deaths.