急性冠脉综合征患者GRACE评分与心功能及冠脉病变的关系研究

目的:探讨全球急性冠状动脉疾病登记(GRACE)风险评分与急性冠脉综合征(ACS)患者心功能及冠脉病变的关系。方法:回顾性分析2015年4月至2017年6月我院收治的276例ACS患者的临床资料,根据GRACE评分结果进行分组,GRACE评分140分者作为高危组(93例),GRACE评分109~140分者作为中危组(96例),GRACE评分109分者作为低危组(87例),比较三组的一般资料、生化指标、心功能指标、冠脉病变严重程度,采用Spearman相关系数分析GRACE评分与心功能指标和冠脉病变严重程度的相关性。结果:高危组和中危组男性所占比例、年龄、高血压比例、载脂蛋白-B(Apo-B)、空腹血糖(FBG)、纤维蛋白原(FIB)、胱抑素-C(Cys-C)、同型半胱胺酸(Hcy)、左心房前后径(LAAP)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、多支血管病变所占比例以及重度狭窄和完全闭塞所占比例高于低危组,且高危组高于中危组,差异均有统计学意义(P0.05);高危组和中危组三酰甘油(TG)、载脂蛋白-A(Apo-A)、左心室射血分数(LVEF)低于低危组,且高危组低于中危组,差异均有统计学意义(P0.05)。Spearman相关系数分析显示,GRACE评分与LAAP、LVESD、LVEDD、冠脉病变血管支数、狭窄程度呈正相关关系(P0.05),GRACE评分与LVEF水平呈负相关关系(P0.05)。结论:GRACE评分越高,ACS患者的心功能越差,冠脉病变越严重,GRACE评分可以反映ACS患者的心功能水平和冠脉病变的严重程度。

Relationship Between GRACE Score and Cardiac Function and Coronary Lesion in Patients with Acute Coronary Syndrome

ABSTRACT Objective: To investigate the relationship between the global acute coronary disease registration (GRACE) risk score and cardiac function and coronary artery lesions in patients with acute coronary syndrome (ACS). Methods: The clinical data of 276 pa- tients with ACS, who were treated in 148th Central Hospital of PLA from April 2015 to June 2017, were analyzed retrospectively and di- vided into high risk group (n=93, GRACE score over 140 points), middle risk group (n=96, GRACE score between 109~140 points) and low risk group (n=87, GRACE score less than 109 points) according to the GRACE score. The general data, biochemical indexes, cardiac function indexes and severity of coronary lesions were compared among the three groups. The spearman correlation coefficient was used to analyze the correlation between GRACE score and cardiac function index and severity of coronary lesions. Results: The proportion of men, age, hypertension, ratio of apolipoprotein -B (Apo-B), fasting blood glucose (FBG), fibrinogen (FIB), Cystatin -C (Cys-C), homocys- teine (Hcy), left atrial diameter (LAAP), end systolic diameter left ventricular (LVESD), left ventricular end diastolic diameter (LVEDD), multi vessel disease and the proportion of severe stenosis and complete occlusion of the proportion in the high risk group and the middle risk group were higher than those in the low risk group, and the high risk group was higher than the middle risk group,the differences were statistically significant (P<0.05). The levels of TG, Apo-A and LVEF in the high risk group and the middle risk group were lower than those in the low risk group, the differences were statistically significant (P<0.05). Spearman correlation coefficient analysis showed that there was a positive correlation between GRACE score and LAAP, LVESD, LVEDD, the number of coronary lesions and the degree of stenosis (P<0.05) and there was a negatively correlation between the GRACE score and the level of LVEF (P<0.05). Conclusion: The higher the GRACE score, the worse the heart function in ACS patients and the severity of coronary disease. The GRACE score can re- flect the cardiac function level and the severity of coronary artery disease in ACS patients.