2022 年第 6 期 第 17 卷

代谢综合征对行冠状动脉血运重建高龄患者全因死亡率的影响

Imapct of metabolic syndrome on all-cause mortality in octogenarians undergoing coronary revascularization

作者：胡宾成万钧贾硕杨士伟贾德安马晓腾刘宇扬史冬梅周玉杰

英文作者：Hu Bin Cheng Wanjun Jia Shuo Yang Shiwei Jia Dean Ma Xiaoteng Liu Yuyang Shi Dongmei Zhou Yujie

单位：首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室首都医科大学冠心病临床诊疗与研究中心，北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Heart Disease Clinical Center for Coronary Atherosclerotic Heart Disease Capital Medical University Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；代谢综合征；血运重建

英文关键词：Coronaryatheroscleroticheartdisease;Metabolicsyndrome;Revascularization

• 摘要：

• 目的 评估代谢综合征（MS）对行冠状动脉血运重建高龄患者全因死亡率的影响。方法 回顾性分析2016年2月至2018年10月于首都医科大学附属北京安贞医院行冠状动脉血运重建的566例≥80岁高龄冠心病（冠状动脉粥样硬化性心脏病）患者的临床资料，根据是否患有MS分为MS组和非MS组。对所有患者进行随访，记录患者的基线资料及随访期间全因死亡发生情况。分析患者全因死亡的危险因素。结果 MS组共纳入257例患者，其中225例（87.5%）住院期间行经皮冠状动脉介入（PCI）治疗、32例（12.5%）患者行冠状动脉旁路移植术（CABG）；非MS组共纳入309例患者，其中240例（77.7%）行PCI治疗、69例（22.3%）患者行CABG。MS组体重指数≥25.0 kg/m2、糖尿病、高血压病、血脂异常、既往心肌梗死、慢性肾脏病、既往PCI、左心室射血分数＜50%及口服降糖药物比例均高于非MS组，差异均有统计学意义（均P＜0.05）。随访期间，MS组42例（16.3%）患者、非MS组24例（7.8%）患者死亡。Kaplan-Meier生存曲线分析结果显示,MS组患者的全因死亡率高于非MS组(Log-rank P=0.003)。调整混杂因素后，MS仍是行冠状动脉血运重建的高龄冠心病患者全因死亡的独立危险因素（风险比=1.715，95%置信区间：1.027～2.862,P=0.039）。结论 MS可增加行冠状动脉血运重建高龄患者的全因死亡率。

• Objective To assess the impact of metabolic syndrome (MS) on all-cause mortality in octogenarians undergoing coronary revascularization. Methods From February 2016 to October 2018, clinical data of 566 octogenarians (≥80 years) with coronary atherosclerotic heart disease who underwent coronary revascularization in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. According to MS, patients were divided into MS group and non-MS group. All patients were followed-up, and the baseline data and all-cause death during the period were recorded. The risk factor of all-cause death of patients were anzlyzed. Results   The MS group including 257 patients, 225(87.5%) of them were treated with percutaneous coronary intervention (PCI) and 32(12.5%) were treated with coronary artery bypass grafting (CABG); the non-MS group including 309 patients, 240(77.7%) of them were treated with PCI and 69(22.3%) were treated with CABG. Proportions of body mass index≥25.0 kg/m2, diabetes mellitus, hypertension, dyslipidemia, previous myocardial infarction, chronic kidney disease, previous PCI, left ventricular ejection fraction <50%, and using oral hypoglycemic drugs in the MS group were higher than those in the non-MS group (all P<0.05). During the follow-up, 42 patients (16.3%) dead in the MS group and 24 patients (7.8%) dead in the non-MS group. Kaplan-Meier survival curve analysis showed that all-cause mortality in the MS group was higher than that in the non-MS group (Log-rank P=0.003). After adjustment for confounding factors, MS was still an independent risk factor for all-cause death in octogenarians with coronary atherosclerotic heart disease undergoing coronary revascularization (hazard ratio=1.715, 95% confidence interval: 1.027-2.862, P=0.039). Conclusion  MS increases all-cause mortality in octogenarians with coronary atherosclerotic heart disease undergoing coronary revascularization.