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  • 李海玲,侯攀,郭显,唐文栋,柳俊梅*,赵仙先,李攀*.急性冠状动脉综合征患者替格瑞洛相关呼吸困难的危险因素分析[J].第二军医大学学报,2020,41(1):11-17    [点击复制]
  • LI Hai-ling,HOU Pan,GUO Xian,TANG Wen-dong,LIU Jun-mei*,ZHAO Xian-xian,LI Pan*.Risk factors of ticagrelor-associated dyspnea in patients with acute coronary syndrome[J].Acad J Sec Mil Med Univ,2020,41(1):11-17   [点击复制]
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急性冠状动脉综合征患者替格瑞洛相关呼吸困难的危险因素分析
李海玲,侯攀,郭显,唐文栋,柳俊梅*,赵仙先,李攀*
0
(海军军医大学(第二军医大学)长海医院心血管内科, 上海 200433
*通信作者)
摘要:
目的 探讨经皮冠状动脉介入(PCI)治疗的急性冠状动脉综合征(ACS)患者服用替格瑞洛后呼吸困难的发生率、临床特点及相关危险因素。方法 前瞻性纳入2018年12月至2019年6月我院283例PCI治疗后服用阿司匹林联合替格瑞洛治疗的ACS患者,排除既往肺部基础疾病和心功能不全(NYHA心功能分级Ⅲ级及以上或需药物干预治疗)的患者。采用Borg评分量表评估替格瑞洛相关呼吸困难的发生情况及严重程度,采用心肌梗死溶栓治疗出血分级评估患者出血情况,分析替格瑞洛相关呼吸困难的危险因素。绘制ROC曲线计算左心室射血分数(LVEF)对替格瑞洛相关呼吸困难发生的诊断效能。结果 替格瑞洛相关呼吸困难的发生率为16.3%(46/283),其中服药1周内发生呼吸困难者占60.9%(28/46)。替格瑞洛相关呼吸困难主要表现为轻度呼吸困难(56.5%,26/46),中度、重度呼吸困难分别占28.3%(13/46)和15.2%(7/46)。因药物不良反应停用替格瑞洛治疗的患者占8.5%(24/283),其中因为不能耐受呼吸困难而停药者占62.5%(15/24)。呼吸困难组患者出血事件、男性患者比例、吸烟史、左心房容积均高于非呼吸困难组(P均<0.05),而LVEF低于非呼吸困难组(P<0.01)。多因素logistic回归分析结果显示出血事件、低LVEF、男性、吸烟史是替格瑞洛相关呼吸困难发生的独立危险因素(P均<0.05);其中发生出血事件的患者呼吸困难的风险是未发生出血事件患者的2.925倍(OR=2.925,95% CI:1.386~6.175,P=0.005)。ROC曲线分析结果显示LVEF的诊断界值为61%,即LVEF ≤ 61%的ACS患者更容易发生替格瑞洛相关呼吸困难。结论 呼吸困难在服用替格瑞洛的中国ACS人群中较常见,其程度多为轻度且大部分在服药后1周内出现。出血事件、低LVEF、吸烟史和男性是ACS患者发生替格瑞洛相关呼吸困难的危险因素。
关键词:  替格瑞洛  呼吸困难  急性冠状动脉综合征  出血  发生率  危险因素
DOI:10.16781/j.0258-879x.2020.01.0011
投稿时间:2019-08-29修订日期:2019-11-21
基金项目:国家"十三五"重点研发计划(2016YFC1301300,2016YFC1301303),上海市卫生和计划生育委员会优秀青年人才项目(2017YQ029).
Risk factors of ticagrelor-associated dyspnea in patients with acute coronary syndrome
LI Hai-ling,HOU Pan,GUO Xian,TANG Wen-dong,LIU Jun-mei*,ZHAO Xian-xian,LI Pan*
(Department of Cardiovascular Medicine, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors)
Abstract:
Objective To investigate the incidence, clinical characteristics and related risk factors of dyspnea in acute coronary syndrome (ACS) patients taking ticagrelor after percutaneous coronary intervention (PCI). Methods This prospective study included 283 ACS patients under the treatment of ticagrelor after PCI from Dec. 2018 to Jun. 2019. Patients with lung diseases, cardiac insufficiency grade Ⅲ or above (New York Heart Association[NYHA] heart function classification), or with medicine intervention were excluded from the study. Dyspnea was assessed by Borg scale. The hemorrhage was evaluated by thrombolysis in myocardial infarction (TIMI) bleeding classification. Risk factors of ticagrelor-related dyspnea were analyzed by one-way ANOVA and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve was drawn to calculate left ventricular ejection fraction (LVEF) in the diagnosis of ticagrelor-related dyspnea. Results The incidence of ticagrelor-related dyspnea was 16.3% (46/283), and 60.9% (28/46) of the patients developed dyspnea within 1 week after taking ticagrelor. Mild dyspnea manifested in 56.5% (26/46) patients, moderate dyspnea in 28.3% (13/46) patients and severe dyspnea in 15.2% (7/46) patients. Discontinuation of ticagrelor due to adverse drug reactions accounted for 8.5% (24/283), and 62.5% (15/24) of them terminated ticagrelor because of intolerable dyspnea. The bleeding events, proportion of male patients, smoking history, and left atrial volume (LA) of the dyspnea group were significantly higher than those of the non-dyspnea group (all P<0.05). LVEF of the dyspnea group was significantly lower than that of the non-dyspnea group (P<0.01). Multivariate logistic regression analysis showed that bleeding events, low LVEF, male and smoking were independent risk factors for ticagrelor-related dyspnea (P<0.05). The risk of dyspnea in patients with bleeding events was 2.925 times higher than that in patients without bleeding events (odds ratio[OR]=2.925, 95% confidence interval[CI]:1.386-6.175, P=0.005). ROC curve analysis showed that the cut-off of LVEF for diagnosis of ticagrelor-related dyspnea was 61%. Conclusion Ticagrelor-related dyspnea is very common in Chinese ACS patients. Mild dyspnea presents within 1 week after taking the drug in most patients. Bleeding events, low LVEF, smoking, and male are risk factors for ticagrelor-related dyspnea.
Key words:  ticagrelor  dyspnea  acute coronary syndrome  bleeding  incidence  risk factors