管慧 戴国华 高武霖 孙聪 侯晓铭 任丽丽 刘璋

摘要 目的：評价中医药干预急性心肌梗死并发心力衰竭患者终点事件发生的真实疗效。方法：采用回顾性队列研究设计。调查患者住院期间的一般资料、中药注射剂使用情况和终点事件发生情况，随访出院后口服中成药、中药汤剂的使用情况和终点事件发生情况。暴露定义为使用中药注射剂≥7 d，或使用口服中成药或中药汤剂≥28 d。使用多元Logistic回归分别分析住院和随访期间终点事件发生的相关因素。结果：共纳入急性心肌梗死并发心力衰竭患者159例，其中院内死亡51例，完成随访92例。住院期间暴露组与非暴露组比较，心源性死亡（28.16%对比39.29%，P<0.05）发生率明显降低。随访期间暴露组与非暴露组比较，心源性死亡（18.75%对比28.57%，P<0.05）、急性心力衰竭（14.06%对比21.43%，P<0.05）和心血管再住院（28.13%对比42.86%，P<0.05）发生率均明显降低。结论：真实世界条件下中医药治疗能够减少急性心肌梗死并发心力衰竭患者住院期间心源性死亡和随访期间心源性死亡、急性心力衰竭和心血管再入院的发生。

关键词 中医药;急性心肌梗死;心力衰竭;终点事件;队列研究;多元Logistic回归;真实世界研究

A Cohort Study on the Effects of Traditional Chinese Medicine on End-point Event in Patients with Acute Myocardial Infarction with Heart Failure

GUAN Hui1，DAI Guohua2，GAO Wulin1，SUN Cong1，HOU Xiaoming1，REN Lili1，LIU Zhang1

（1 The First Clinical Medical College of Shandong University of Traditional Chinese Medicine，Ji′nan 250014，China; 2 Affiliated Hospital of Shandong University of Traditional Chinese Medicine，Ji′nan 250011，China）

Abstract Objective：To evaluate the effects of traditional Chinese medicine （TCM） on end-point events in patients with acute myocardial infarction complicated with heart failure.Methods：Retrospective cohort study design was adopted.The general information of patients during hospitalization，the use of traditional Chinese medicine （TCM） injections and the occurrence of end-point events were investigated.Exposure was defined as the use of Chinese patent medicine injections for≥7 days，or the use of oral Chinese patent medicines or traditional Chinese medicine decoctions for≥28 days.Multivariate Logistic regression was used to analyze the relevant factors of the end-point events during hospitalization and follow-up.Results：A total of 159 AMI patients combined with HF were enrolled.Among them，51 cases passed away in the hospital，and 92 cases completed follow-up.Compared with the non-exposed group during hospitalization，the incidence of cardiogenic death （28.16% vs.39.29%，P<0.05） was significantly reduced.Comparing the exposure group with the non-exposure group during the follow-up period，cardiogenic death （18.75% vs.28.57%，P<0.05），acute heart failure （14.06% vs.21.43%，P<0.05），and cardiovascular rehospitalization （28.13% vs.42.86） %，P<0.05） the incidence rate was significantly reduced.Conclusion：Under real-world conditions，TCM can reduce the occurrence of cardiac death during hospitalization of patients with acute myocardial infarction complicated by heart failure and during follow-up，acute heart failure and cardiovascular re-admission.

Keywords Traditional Chinese medicine; Acute myocardial infarction; Heart failure; End-point event; Cohort study; Multiple Logistic Regression; Real world research

中圖分类号：R256.22文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.23.024

急性心肌梗死是由于冠状动脉急性、持续性地缺血缺氧导致心肌坏死，是心血管疾病中常见的急危重症。随着介入治疗的不断进步，通过尽早再灌注治疗，保护心脏功能，急性心肌梗死的死亡率大大下降。但急性心肌梗死极易并发心力衰竭，致残、致死、再入院率均较高，极大地威胁着人类的健康，且医疗花费巨大，给家庭、社会带来沉重的负担[1]。……