查尔森合并症指数对急性冠状动脉综合征患者预后的临床评价

摘要

目的：急性冠状动脉综合征（ acute coronary syndrome ， ACS）患者常伴有各种慢性合并症，严重影响预后。文中通过评估单个及权重分配后合并症的影响，探讨查尔森合并症指数（Charlson Comorbidity Index， CCI）评价急性冠状动脉综合征患者预后的预测辨别能力。方法回顾性分析2010年1月至2014年3月入住南京军区南京总医院1096例ACS患者的临床资料，查阅并记录入院时的一般资料、临床表现、合并症，并计算CCI分值及入院前后的治疗情况，以住院病死率作为判断预后的指标。结果①所有患者中男性占73％，年龄（64．2±12．9）岁；女性占27％，年龄（72．1±12．6）岁。46．8％的患者伴有合并症。 CCI评分系统纳入的疾病中，心肌梗死病史患者最多（18．0％），其次为糖尿病患者（14．7％），再者为中重度肾疾病（7．1％）、脑血管疾病（6．0％）、慢性肺部疾病（6．0％）。单因素分析表明ACS住院患者的临床各指标，包括冠状动脉病史、高血压病史、出现症状至入院所用时间、血流动力学、药物治疗和再灌注治疗等，CCI不同分值组组间比较的差异有统计学意义（P＜0．05）。②采用Logistic回归分析显示，CCI评分系统中，心脏衰竭（OR＝1．88，95％CI：1．57～2．25）、转移性肿瘤（OR＝2．25，95％CI：1．60～3．19）、肾疾病（OR＝1．84，95％CI：1．60～2．11）和糖尿病（OR＝1．35，95％CI：1．19～1．54）是预测ACS患者住院病死率较强的因素。③受试者工作特征曲线（ receiver operating characteristic ， ROC）分析表明，CCI分别合并年龄、年龄及性别的预测能力均优于单独CCI评分， ROC曲线下面积依次为0．761（95％CI：0．748～0．773）、0．756（95％CI：0．743～0．768）和0．670（95％CI：0．656～0．685）。结论心脏衰竭、糖尿病、肾疾病和转移性肿瘤严重影响ACS患者住院病死率，CCI合并年龄及性别可较好的判断ACS住院患者的预后。%Objective Acute coronary syndrome ( ACS) is frequently accompanied by chronic comorbidities , which may se-riously affect its prognosis .This study aims to investigate the value of the Charlson Comorbidity Index ( CCI) in predicting the outcome of ACS by assessing the impact of individual and post-weighted-assignment comorbid conditions of the disease . Methods We retro-spectively analyzed the clinical data on 1 096 cases of ACS treated in Jinling Hospital from January 2010 to March 2014 .We reviewed their general information , clinical presentations , complications , and previous treatments , calculated CCI , and used in-hospital mortali-ty as the index for judging the prognosis . Results Of the 1 096 patients, 73%were males (aged 64.2 ±12.9 years), 27% were females (aged 72.1 ±12.6 years), and 46.8% had comorbidities. Of the diseases included in the CCI system , previous myocardial infarction was the most frequent comorbidity (18.0%), followed by diabetes mellitus ( 14.7%), moderately to severe renal disease (7.1%), cerebrovascular disease (6.0%), and chronic lung dis-ease (6.0%).Single factor analysis revealed statistically significant differences between different CCI groups in such clinical indicators as history of coronary artery disease , history of hypertension , time between symptom onset and admission , hemodynamics , drugs adminis-tered (aspirin, P2Y12 blockers, ACEI/ARB or statins), and reperfusion therapy (P<0.05).Logistic regression analysis showed the strongest predictors of in-hospital mortality were heart failure (OR 1.88, 95%CI:1.57-2.25), metastatic tumor (OR 2.25, 95%CI:1.60-3.19), renal disease (OR 1.84, 95% CI:1.60-2.11), and diabetes mellitus (OR 1.35, 95% CI:1.19-1.19). Receiver operating characteristic curve analysis manifested that either CCI with age or CCI with age and gender was superior to CCI a -lone in predicting in-hospital mortality of ACS patients (AUC 0.761 [95%CI 0.748-0.773] and 0.756 [95%CI:0.743-0.768] vs 0.670 [95%CI:0.656-0.685]). Conclusion Heart failure, diabetes mellitus, renal disease, and metastatic tumors contrib-ute to the in-hospital mortality of ACS patients .CCI together with age and gender may help to assess the prognosis of the disease .