| 王宁,杨旭,戴国华,马婷,张成博.心肌梗死患者随访期间终点事件发生情况的亚组分析：回顾性队列研究[J].,2023,43(7):808-816 |
| 心肌梗死患者随访期间终点事件发生情况的亚组分析：回顾性队列研究 |
| A Subgroup Analysis of the Occurrence of End-point Events During the Follow-up Period of Patients with Myocardial Infarction：A Retrospective Cohort Study |
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| DOI：10. 7661/j. cjim. 20230127.067 |
| 中文关键词: 心肌梗死 终点事件 亚组分析 Logistic回归分析 中医药 临床疗效评价 |
| 英文关键词:myocardial infarction endpoint events subgroup analysis Logistic regression analysis Chinese medicine clinical efficacy evaluation |
| 基金项目:国家自然科学基金资助项目（No.81774047）;山东省中医药科技发展计划项目（No.2019-0039） |
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| 中文摘要: |
| 目的 探讨中医药干预心肌梗死不同亚组患者的真实世界疗效。方法 采用回顾性队列研究设计，根据患者随访期间是否使用中医药及使用时间分为暴露组和非暴露组。暴露组包括高强度暴露组（出院后应用中医药治疗时间≥6个月者）、中强度暴露组（3个月≤出院后应用中医药治疗时间<6个月者）和低强度暴露组（1个月≤出院后应用中医药治疗时间<3个月者）。非暴露组为出院后应用中医药治疗时间<1个月，或未服用中药者。共收集心肌梗死合并高血压患者高暴露组246例、中暴露组150例、低暴露组69例、非暴露组166例;心肌梗死合并2型糖尿病患者高暴露组165例、中暴露组118例、低暴露组124例、非暴露组157例;心肌梗死合并血脂异常患者高暴露组160例、中暴露组81例、低暴露组96例、非暴露组105例。随访患者出院后的中药使用情况和终点事件发生情况。运用多元Logistic回归分析随访期间中医药干预与心肌梗死不同亚组患者终点事件发生的相关性。结果 随访期间中成药应用前3位的依次为复方丹参滴丸、麝香保心丸和速效救心丸。中药汤剂应用前3位的依次为生脉散、桃红四物汤、瓜蒌薤白半夏汤。多元Logistic回归分析结果显示，中医药干预、降脂治疗是心肌梗死合并高血压患者心源性死亡终点事件的正相关因素（P<0.05）;中医药干预是心肌梗死合并高血压患者再梗死和脑卒中复合终点事件的正相关因素（P<0.05）;中医药干预、降脂治疗是心肌梗死合并高血压患者急性心力衰竭终点事件的正相关因素（P<0.05）。中医药干预是心肌梗死合并2型糖尿病患者心源性死亡终点事件的正相关因素（P<0.05）;中医药干预是心肌梗死合并2型糖尿病患者再梗死和脑卒中复合终点事件的正相关因素（P<0.05）;中医药干预、降脂治疗是心肌梗死合并2型糖尿病患者急性心力衰竭终点事件的正相关因素（P<0.05）;中医药干预是心肌梗死合并2型糖尿病患者心血管再入院终点事件的正相关因素（P<0.05）。中医药干预、抗栓治疗是心肌梗死合并血脂异常患者心源性死亡终点事件的正相关因素（P<0.05）;中医药干预、抗栓治疗是心肌梗死合并血脂异常患者再梗死和脑卒中复合终点事件的正相关因素（P<0.05）。结论 随访期间，持续的中医药干预对减少心肌梗死患者出院后心源性死亡、预防急性心力衰竭等终点事件的发生及维持心功能等方面具有显著意义，验证了中医药对心肌梗死合并不同疾病的可观疗效。 |
| 英文摘要: |
| Objective To explore the real world effect of Chinese medicine（CM） on different subgroups of patients with myocardial infarction.Methods A retrospective cohort study design was adopted，and patients were assigned to exposed group and non-exposed group according to whether they used CM during the follow-up period and the use time.The exposure group includes the high-intensity exposure group（who have been treated with CM for≥6 months after discharge），the medium-intensity exposure group（who have been treated with CM for less than 6 months after discharge）and the low-intensity exposure group（who have been treated with CM for less than 3 months after discharge）.The non-exposed group was treated with CM for less than 1 month after discharge，or did not take CM.There were 246 cases in the high exposure group，150 cases in the middle exposure group，69 cases in the low exposure group，and 166 cases in the non-exposed group of patients with myocardial infarction and hypertension.There were 165 cases in the high exposure group，118 cases in the medium exposure group，124 cases in the low exposure group，and 157 cases in the non exposure group of patients with myocardial infarction and diabetes.There were 160 cases in the high exposure group，81 cases in the middle exposure group，96 cases in the low exposure group，and 105 cases in the non-exposed group of patients with myocardial infarction and dyslipidemia.Follow up the use of CM and the occurrence of endpoint events.Multivariate Logistic regression was used to analyze the correlation between the intervention of CM and the occurrence of endpoint events in different subgroups of patients with myocardial infarction during the follow-up period.Results During the follow-up period，the top 3 Chinese patent drugs were Compound Danshen Dropping Pills，Musk Heart Protecting Pills and Quick Effect Heart Saving Pills.The top 3 Chinese herbal decoction applications are Shengmai Powder，Taohong Siwu Decoction，Gualou Xiebai Banxia Decoction.The results of multiple Logistic regression analysis showed that CM intervention and lipid-lowering therapy were positive correlation factors of cardiac death endpoint in patients with myocardial infarction and hypertension（P<0.05）.CM intervention was positive correlation factor of the composite endpoint of reinfarction and stroke in patients with myocardial infarction and hypertension（P<0.05）.CM intervention and lipid-lowering therapy were positive correlation factors of acute heart failure endpoint events in patients with myocardial infarction and hypertension（P<0.05）.CM intervention was positive correlation factor of cardiac death endpoint event in patients with myocardial infarction and diabetes（P<0.05）.CM intervention was positive correlation factor of the composite endpoint of reinfarction and stroke in patients with myocardial infarction and diabetes（P<0.05）.CM intervention and lipid-lowering therapy were positive correlation factors of the endpoint event of acute heart failure in patients with myocardial infarction and diabetes（P<0.05）.CM intervention was positive correlation factor of cardiovascular readmission endpoint in patients with myocardial infarction and diabetes（P<0.05）.CM intervention and antithrombotic therapy were positive correlation factors of cardiac death endpoint in patients with myocardial infarction and dyslipidemia（P<0.05）.CM intervention and antithrombotic therapy were positive correlation factors of the composite endpoint of reinfarction and stroke in patients with myocardial infarction and dyslipidemia（P<0.05）.Conclusion During the follow-up period，continuous intervention of CM has significant significance in reducing cardiogenic death of patients with myocardial infarction after discharge，preventing the occurrence of terminal events such as acute heart failure，and maintaining cardiac function，which verifies the considerable effect of CM on myocardial infarction complicated with different disease. |
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