从回顾性队列研究构建急性心肌梗死远期预后因素的Cox比例风险回归模型

作者	单位
农一兵	北京中医药大学附属东直门医院
林谦	北京中医药大学附属东方医院
段文慧	中国中医研究院西苑医院
杨宏丽	北京中医药大学附属东直门医院

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中文摘要:

目的研究包括中药汤剂在内的多种可能因素对急性心肌梗死 (acutemyocardialinfarction ,AMI)远期预后的影响。方法连续收集 1996年 1月— 2 0 0 2年 4月间渡过急性期的AMI患者 (共 16 2例 )的病历资料 ,随访观察患者发生死亡和重大心脑血管事件的预后情况 ,用Cox比例风险回归模型分析可能因素对预后的影响。结果年龄每增加 10岁 ,心功能纽约分级升高 1级 ,死亡的相对危险度分别上升到1 983和 3 16 9,应用中药汤剂和血管紧张素转换酶抑制剂 (angiotensinconvertingenzymeinhibitor ,ACEI)则分别降低到 0 177和 0 16 1;以包括死亡在内的重大心脑血管事件为终点 ,年龄每增加 10岁 ,心功能纽约分级升高 1级 ,终点事件的相对危险度分别上升到 2 0 2 1和 1 86 3,有前壁梗死、心律失常和糖尿病史则分别上升到 2 90 3、2 5 88、4 0 39,而使用中药汤剂和ACEI制剂能使之下降到 0 0 93和 0 14 1。结论年龄、心衰、前壁梗死、心律失常、糖尿病史是AMI远期预后的危险因素 ,而早期应用中药汤剂和ACEI制剂是保护因素

英文摘要:

Objective To study the effects of the potential factors, including Chinese herbal decoction, on the long term prognosis of acute myocardial infarction (AMI). Methods Previous clinical data of 162 patients with AMI were collected, who were followed up to observe the important events for prognosis, as death and cardio cerebral episode, and the Cox proportional hazards regression model was used to assess the relative factors. Results The degree of cardiac function (by New York grading) increased 1 grade when age increased for 10 years, and the relative hazardous degree (RHD) raised to 1 983 and 3 169. After treatment with Chinese herbal decoction and angiotensin converting enzyme inhibitor (ACEI), the RHD could be reduced to 0 177 and 0 161 respectively. Taking the important cardio cerebral events, including death, as the endpoint, when age increased for 10 years, the cardiac function would increase for 1 grade and RHD of endpoint events increased to 2 021 and 1 863, if patients had history of anterior infarction, arrhythmia and diabetes mellitus, it increased to 2 903, 2 588 and 4 039 respectively. Chinese decoction and ACEI treatment could reduce it to 0 093 and 0 141 respectively. Conclusion Age, heart failure, anterior infarction, arrhythmia and diabetes mellitus are the hazardous factors of the long term prognosis of AMI, Chinese herbal decoction and ACEI are the protective factors.

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