血清总胆红素对急性冠脉综合征经皮冠状动脉介入术预后的判断

摘要

目的 研究血清总胆红素(serum total bilirubin,STB)水平与急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术预后的关系.方法 入选2009年6月至2010年12月在郑州大学第一附属医院心内科成功行PCI术患者1273例,记录患者入院后24 h内空腹STB水平及其他临床资料.于2012年8月至11月进行电话或门诊随访,记录终点事件的发生情况.一级终点事件为全因死亡,二级终点事件包括心肌梗死,再次PCI或冠状动脉搭桥术,因心绞痛、心衰、脑卒中再入院.依据STB水平分为四组:低于正常水平组(G1:STB＜ 3.4 μmol/L)、正常水平低值组(G2:3.4 μmol/L≤STB≤10.3 μmoL/L)、正常水平高值组(G3:10.3 μmol/L＜STB≤17.1μmol/L)、高于正常水平组(G4:STB＞17.1μmol/L).应用单因素分析和多因素Logistic回归分析探索PCI术预后的相关因素,Kaplan-Meier生存曲线比较不同STB水平患者生存率的差异.P＜0.05为差异具有统计学意义.结果 (1)成功随访1152例(随访率90.5％),随访时间为(30.4±5.0)个月.187例发生终点事件(16.2％),死亡45例(3.9％)；(2) G1、G2、G3、G4组总终点事件的发生率逐渐降低(28.8％,17.1％,11.2％,8.5％,x2=22.159,P＜0.01),但4组一级终点事件发生率的差异无统计学意义(6.6％,4.3％,3.0％,2.8％,x2=2.366,P=0.500).(3)多因素Logistic逐步回归分析显示,G3和G4组患者终点事件的发生率较G1组分别减少56.4％(OR=0.436,95％CI:0.237～0.804,P=0.008)和63.6％(OR=0.364,95％CI:0.190～0.695,P=0.002).(4) Kaplan-Meier生存曲线分析显示:4组患者无终点事件的累积生存率差异具有统计学意义(P＜0.01).结论 STB与ACS患者PCI术后终点事件的发生呈负相关,但与PCI术后的病死率无明显关系.%Objective To investigate the predictive value of serum total bilirubin (STB) level in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 1273 consecutive patients treated with PCI in cardiology department,First Affiliated Hospital of Zhengzhou University from June 2009 to December 2010 were enrolled in this study.Patient' s fasting STB concentrations within 24 h after admission and other relevant clinical data were recorded.The patients were followed-up by telephone or in the Out-patient Department from August to November 2012.All end events were recorded.The primary end events were death resulted from various causes.The secondary end events were acute myocardial infarction,repeated PCI or coronary artary bapass grafting,readmission for angina pectoris,heart failure or stroke.The patients were divided into four groups according to the levels of STB:the subnormal low STB group (G1:STB ＜3.4 μmol/L),the low limit of normal STB group (G2:3.4 μmol/L≤STB≤10.3 μ mol/L),the upper limit of normal STB group (G3:10.3 μmol/L ＜ STB ≤ 17.1 μ mol/L) and the high level above normal STB group (G4:STB ＞ 17.1 μmol/L).Application of univariate and multivariate logistic regression analyses to explore factors associated with the prognosis.The survival rate was estimated using Kaplan-Meier survival curve.P ＜ 0.05 was considered as statistically significant difference.Results (1) 1152 patients (90.5 ％) were successfully followed-up.Mean follow-up time were (30.4-±5.0) months,and 187 patients experienced end events (16.2％),and 45 patients died (3.9％).(2) The incidence of total end events in the four groups decreased with increase in STB (28.8％,17.1％,11.2％,8.5％,x2 =22.159,P＜0.01).There were no differences in incidence of primary end events between 4 groups (6.6％,4.3％,3.0％,2.8％,x2 =2.366,P=0.500).(3) Multivariate logistic regression analysis showed that the incidences of total end events in G3 and G4 group were decreased to 56.4％ (OR=0.436,95％CI:0.237-0.804,P=0.008) and to 63.6％ (OR=0.364,95％ CI:0.190-0.695,P =0.002) respectively.(4) Kaplan-Meier survival curve analysis showed that there were significent differences in cumulative survival rates without end events between 4 groups (P ＜ 0.01).Conclusions STB concentration is associated negatively with the end events in patients with ACS after PCI.But it is not associated with mortality.