李妙男, 包炳蔚, 姚卓亚, 钱少环, 史晓俊, 闵生萍, 高大胜, 王洪巨. 女性急性冠脉综合征病人临床特征、GRACE危险分层、TIMI危险评分及预后的关系研究[J]. 蚌埠医学院学报, 2021, 46(5): 574-578. DOI: 10.13898/j.cnki.issn.1000-2200.2021.05.004
    引用本文: 李妙男, 包炳蔚, 姚卓亚, 钱少环, 史晓俊, 闵生萍, 高大胜, 王洪巨. 女性急性冠脉综合征病人临床特征、GRACE危险分层、TIMI危险评分及预后的关系研究[J]. 蚌埠医学院学报, 2021, 46(5): 574-578. DOI: 10.13898/j.cnki.issn.1000-2200.2021.05.004
    LI Miao-nan, BAO Bing-wei, YAO Zhuo-ya, QIAN Shao-huan, SHI Xiao-jun, MIN Sheng-ping, GAO Da-sheng, WANG Hong-ju. Study on the relationship between the clinical characteristics, GRACE risk stratification score, TIMI risk and prognosis in female patients with acute coronary syndrome[J]. Journal of Bengbu Medical College, 2021, 46(5): 574-578. DOI: 10.13898/j.cnki.issn.1000-2200.2021.05.004
    Citation: LI Miao-nan, BAO Bing-wei, YAO Zhuo-ya, QIAN Shao-huan, SHI Xiao-jun, MIN Sheng-ping, GAO Da-sheng, WANG Hong-ju. Study on the relationship between the clinical characteristics, GRACE risk stratification score, TIMI risk and prognosis in female patients with acute coronary syndrome[J]. Journal of Bengbu Medical College, 2021, 46(5): 574-578. DOI: 10.13898/j.cnki.issn.1000-2200.2021.05.004

    女性急性冠脉综合征病人临床特征、GRACE危险分层、TIMI危险评分及预后的关系研究

    Study on the relationship between the clinical characteristics, GRACE risk stratification score, TIMI risk and prognosis in female patients with acute coronary syndrome

    • 摘要:
      目的分析女性急性冠脉综合征(ACS)病人临床特征、全球急性冠状动脉事件注册评分(GRACE危险分层)、心肌梗死溶栓治疗临床试验危险评分(TIMI危险评分)和临床预后的关系。
      方法连续纳入2018年10月至2019年7月行冠状动脉造影检查确诊的ACS病人601例。收集所有病人的一般临床资料、实验室检查结果、影像学资料和介入治疗资料。根据性别分为女性组和男性组;根据GRACE危险分层,将2组病人分为高危组、中危组和低危组;根据TIMI危险评分将2组病人分为高危组、中危组和低危组。所有病人计算血管病变支数和Gensini评分。对出院后ACS组病人通过电话或门诊随访平均12个月,通过设计调查表统计Maces事件的发生,根据Maces事件将2组病人分为Maces组和非Maces组。
      结果601例病人中,女236例(39.3%),男365例(60.7%),年龄(64.8±10.3)岁。基线资料显示,女性病人年龄、不稳定型心绞痛比例、合并糖尿病比例、总胆固醇、低密度脂蛋白胆固醇水平均高于男性病人(P < 0.05~P < 0.01);急性心肌梗死比例、早发冠心病比例、吸烟、血肌酐、尿酸均低于男性病人(P < 0.05~P < 0.01);围手术期用药、合并高血压、脑梗死、房颤比例差异均无统计学意义(P>0.05)。GRACE危险分层显示,2组病人低危、中危和高危组比例差异无统计学意义(P>0.05);TIMI危险分层显示,女性病人与男性病人间差异有统计学意义(P < 0.05)。冠状动脉造影结果显示,2组病人在血管病变支数和Gensini评分上差异无统计学意义(P>0.05)。统计2组Maces事件显示,2组病人发生Maces事件比例差异无统计学意义(P>0.05),二元logistic回归显示,年龄和血糖是女性病人发生Maces事件的独立危险因素(P < 0.01),而吸烟、低密度脂蛋白胆固醇是男性病人发生Maces事件的独立危险因素(P < 0.01和P < 0.05)。
      结论女性ACS病人发病较男性偏晚,但更容易合并血糖、血脂的异常,且发病后的血管病变程度、临床危险分层和预后同男性病人无明显差别,应重视女性病人的筛查和防治。

       

      Abstract:
      ObjectiveTo analyze the relationship between the clinical characteristics, global registration of acute coronary event score(GRACE risk score), thrombolysis in myocardial infarction risk score(TIMI risk score) and clinical prognosis in female patients with acute coronary syndrome(ACS).
      MethodsSix hundred and one ACS patients diagnosed using coronary angiography from October 2018 to July 2019 were selected.The general clinical data, laboratory examination results, imaging data and interventional therapy data of all patients were collected.According to the gender, the patients were divided into the female group and male group.According to the GRACE risk score, the patients were divided into the high-risk, medium-risk and low-risk groups.According to the TIMI risk score, the patients were divided into the high-risk, medium-risk and low-risk groups.The number of vascular lesions and Gensini score in all patients were calculated.All ACS patients were followed up by telephone or outpatient for an average of 12 months after discharge.A questionnaire was designed to calculate the occurrence of Maces events.According to the Maces events, the patients were divided into the Maces group and non-Maces group.
      ResultsAmong the 601 patients, there were 236 females(39.3%) and 365 males(60.7%) with an age of(64.8±10.3) years.The results of baseline data showed that the age, proportion of unstable angina pectoris, proportion of combined diabetes, total cholesterol and low density lipoprotein cholesterol levels in female patients were higher than those in male patients(P < 0.05 to P < 0.01).The proportion of acute myocardial infarction and early coronary heart disease, smoking, serum creatinine and uric acid in female patients were lower than those in male patients(P < 0.05 to P < 0.01).There was no statistical significance in the proportion of perioperative medication, hypertension, cerebral infarction and atrial fibrillation between female and male patients(P>0.05).The results of Grace risk score showed that there was no statistical significance in the proportion of low-risk, medium-risk and high-risk groups between two groups(P>0.05).The results of TIMI risk score showed that the proportion of female patients in the low-risk group was lower than that of male patients(P < 0.05).The results of coronary angiography showed that there was no statistical significance in the number of vascular lesions and Gensini score between two groups(P>0.05).The results of Maces events showed that there was no statistical significance in the proportion of Maces events between two groups(P>0.05).The results of binary logistic regression analysis showed that the age and blood glucose were the independent risk factors of Maces in female patients(P < 0.01), while the smoking and low density lipoprotein cholesterol were the independent risk factors of Maces in male patients(P < 0.01 and P < 0.05).
      ConclusionsThe onset of ACS in female patients is later than that in male patients, but they are more likely to be associated with abnormal blood glucose and lipid, and the degree of vascular disease, clinical risk stratification and prognosis after onset are not significantly different from those in male patients.Therefore, the attention should be paid to the screening, prevention and treatment of female patients.

       

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