邓庆媛;叶益聪;钟颖;盛苗苗;黄凤鸣;蒋澄宇;张抒扬;
DENG Qing-yuan;YE Yi-cong;ZHONG Ying;SHENG Miao-miao;HUANG Feng-ming;JIANG Cheng-yu;ZHANG Shu-yang;Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;State Key Laboratory of Medical Molecular Biology,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院心内科
• 2:中国医学科学院北京协和医学院基础医学研究所医学分子生物学国家重点实验室

摘要(Abstract)：

目的探讨血浆血管紧张素Ⅱ水平对行择期经皮冠状动脉介入治疗患者院内预后的预测作用。方法连续纳入2012年7月至2013年7月在北京协和医院心内科住院行择期经皮冠状动脉介入治疗的患者645例,测定其血浆血管紧张素Ⅱ水平并记录其发生院内主要心血管不良事件情况。院内主要心血管不良事件定义:全因死亡、非致死性心肌梗死、新发非致死性卒中(缺血性及出血性)、非计划再次血管重建。分析血管紧张素Ⅱ水平与院内心血管不良事件的相关性。结果 645例患者中共有68例(10.54%)发生院内心血管不良事件,发生院内心血管不良事件者血浆血管紧张素Ⅱ水平显著高于未发生院内心血管不良事件者[41.42(28.73,57.07)ng/L比35.66(22.84,48.22)ng/L,P=0.009]。多因素Logistic回归分析显示血管紧张素Ⅱ为院内心血管不良事件的独立危险因素(比值比1.018,95%CI:1.004¹.032,P=0.012)。结论血浆血管张素Ⅱ水平与择期经皮冠状动脉介入治疗患者的院内不良预后相关,具有重要的预测价值。
Objective To investigate the effect of angiotensin Ⅱ in predicting the in-hospital prognosis of patients who received elective percutaneous coronary intervention. Methods From July 2012 to July 2013,645 consecutive patients receiving elective percutaneous coronary intervention in Department of Cardiology in Peking Union Medical College Hospital were selected. Plasma level of angiotensin Ⅱ was measured in these patients,and in-hospital adverse cardiac events( including all-cause death,nonfatal myocardial infarction,new nonfatal ischemic stroke,new nonfatal hemorrhagic stroke,and unplanned vessel revascularization) were recorded. The re-lationship between angiotensin Ⅱ level and incidence of in-hospital adverse cardiac events was analyzed.Results Among the 645 patients,68( 10. 54%) developed in-hospital adverse cardiac events. Plasma level of angiotensin Ⅱ was significantly higher in the patients who had in-hospital adverse cardiac events compared with those who did not [41. 42( 28. 73,57. 07) ng / L vs. 35. 66( 22. 84,48. 22) ng / L,P = 0. 009]. Multivariate logistic regression analysis showed that plasma level of angiotensin Ⅱ was an independent risk factor of in-hospital adverse cardiac events( OR 1. 018,95% CI: 1. 004 1.032,P=0.012)。结论血浆血管张素Ⅱ水平与择期经皮冠状动脉介入治疗患者的院内不良预后相关,具有重要的预测价值。
Objective To investigate the effect of angiotensin Ⅱ in predicting the in-hospital prognosis of patients who received elective percutaneous coronary intervention. Methods From July 2012 to July 2013,645 consecutive patients receiving elective percutaneous coronary intervention in Department of Cardiology in Peking Union Medical College Hospital were selected. Plasma level of angiotensin Ⅱ was measured in these patients,and in-hospital adverse cardiac events( including all-cause death,nonfatal myocardial infarction,new nonfatal ischemic stroke,new nonfatal hemorrhagic stroke,and unplanned vessel revascularization) were recorded. The re-lationship between angiotensin Ⅱ level and incidence of in-hospital adverse cardiac events was analyzed.Results Among the 645 patients,68( 10. 54%) developed in-hospital adverse cardiac events. Plasma level of angiotensin Ⅱ was significantly higher in the patients who had in-hospital adverse cardiac events compared with those who did not [41. 42( 28. 73,57. 07) ng / L vs. 35. 66( 22. 84,48. 22) ng / L,P = 0. 009]. Multivariate logistic regression analysis showed that plasma level of angiotensin Ⅱ was an independent risk factor of in-hospital adverse cardiac events( OR 1. 018,95% CI: 1. 004 1. 032,P = 0. 012). Conclusion Plasma level of angiotensin Ⅱ may be correlated with poor in-hospital prognosis of patients who received elective percutaneous coronary intervention,hence it may have important predictive value.

关键词(KeyWords)： 血管紧张素Ⅱ;经皮冠状动脉介入治疗;预后
angiotensin Ⅱ;percutaneous coronary intervention;prognosis

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 邓庆媛;叶益聪;钟颖;盛苗苗;黄凤鸣;蒋澄宇;张抒扬;
DENG Qing-yuan;YE Yi-cong;ZHONG Ying;SHENG Miao-miao;HUANG Feng-ming;JIANG Cheng-yu;ZHANG Shu-yang;Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;State Key Laboratory of Medical Molecular Biology,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1]Rautureau Y,Paradis P,Schiffrin EL.Cross-talk between aldosterone and angiotensin signaling in vascular smooth muscle cells[J].Steroids,2011,76:834-839.
• [2]Neri SGG,Boddi M,Modesti PA,et al.Cardiac angiotensinⅡparticipates in coronary microvessel inflammation of unstable angina and strengthens the immunomediated component[J].Circ Res,2004,94:1630-1637.
• [3]张汉平,张卫泽,樊红艳,等.急性冠脉综合征患者血浆肾素-血管紧张素-醛固酮系统活性测定意义[J].西北国防医学杂志,2010,31:192-194.
• [4]熊力,罗斌华,王南丽,等.肾素-血管紧张素-醛固酮系统与急性心肌梗死短期预后关系的研究[J].中国循证心血管医学杂志,2014,6:92-94.
• [5]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39:579-616.
• [6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6:447-497.
• [7]翁心植,邱鹤庚.世界卫生组织(WHO)关于吸烟情况调查方法标准化的建议(节译)[J].心肺血管病杂志,1984,3:21-26.
• [8]Kannel WB,Feinleib M,Mc Namara PM,et al.An investiga-tion of coronary heart disease in families.The Framingham offspring study[J].Am J Epidemiol,1979,110:281-290.
• [9]Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction[J].J Am Coll Cardiol,2012,60:1581-1598.
• [10]Husain K,Hernandez W,Ansari RA,et al.Inflammation,oxidative stress and renin angiotensin system in atherosclerosis[J].World J Biol Chem,2015,6:209-217.
• [11]Leask A.Getting to the heart of the matter:new insights into cardiac fibrosis[J].Circ Res,2015,116:1269-1276.
• [12]Mc Alpine HM,Morton JJ,Leckie B,et al.Neuroendocrine activation after acute myocardial infarction[J].Br Heart J,1988,60:117-124.
• [13]Yusuf S,Sleight P,Pogue J,et al.Effects of an angiotensinconverting-enzyme inhibitor,ramipril,on cardiovascular events in high-risk patients.The Heart Outcomes Prevention Evaluation Study Investigators[J].N Engl J Med,2000,342:145-153.
• [14]Bertrand ME.Provision of cardiovascular protection by ACE inhibitors:a review of recent trials[J].Curr Med Res Opin,2004,20:1559-1569.
• [15]Aleti S,Bansal D,Agrawal M,et al.Effect of chronic angiotensin converting enzyme inhibitor therapy on myocardial injury in patients undergoing percutaneous coronary interventions[J].J Invasive Cardiol,2011,23:72-75.
• [16]Singh SM,Goodman SG,Yan RT,et al.Relation between previous angiotensin-converting enzyme inhibitor use and inhospital outcomes in acute coronary syndromes[J].Am J Cardiol,2012,109:332-336.