我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

急性ST段抬高型心肌梗死PCI术前血清醛固酮水平对近期心力衰竭的预测价值

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第3期
页码:
393-395
栏目:
临床研究
出版日期:
2009-05-15

文章信息/Info

Title:
Early serum aldosterone levels are association with heart failure in patients with ST-elevation myocardial infarction
作者:
龚兴荣; 何奔; 周磊; 张清; 葛恒; 何清; 姜萌; 厉锦华
上海交通大学医学院附属仁济医院心内科，上海 200001
Author(s):
GONG Xing-rong;  HE Ben;  ZHOU Lei;  ZHANG Qing;  GE Heng;  HE Qing;  JIANG Meng;  LI Jin-hua
Department of Cardiology, Renji Hospital Affiliated to Medical College, Shanghai Jiaotong University, Shanghai 200001, China
关键词:
心肌梗死; 急性; ST段抬高型; 醛固酮; 心力衰竭; 经皮冠状动脉介入治疗。
Keywords:
ST-elevation myocardial infarction;  adlosterone;  heart failure;  percutaneous coronary intervention
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 探讨在急性ST段抬高型心肌梗死（STEMI）患者中发病初期的血清醛固酮（Aldo）水平是否可以预测近期内心力衰竭的发生。方法 2007年1月～10月连续收集117例STEMI患者,在发病12 h内行急诊冠状动脉介入治疗术(PCI),在术前股动脉穿刺后［发病至抽血时间(5.7±2.5)h］留取血清，采用放射免疫法测定Aldo水平。观察发病后30 d，3个月的心力衰竭的发生情况。结果 按Aldo水平分成3组:Aldo<100 μg/L组，100 μg/L≤Aldo≤200 μg/L组，Aldo>200 μg/L组，随Aldo水平升高，30 d(P<0.05)、3个月(P<0.01)心衰发生率增加。多变量Logistic回归分析中Aldo独立于年龄、性别、家族史、吸烟、高胆固醇血症、高血压、糖尿病等冠心病危险因素，预测30 d心衰发生率（r=0.54，OR 3.3795%CI 1.19-9.60,P<0.05 ），3个月心衰发生率（r=0.48，OR 2.9895%CI 1.31-6.80,P<0.01）。结论 随着急性心肌梗死早期Aldo的水平增高，心力衰竭事件发生呈明显递增趋势。多变量Logistic回归分析中Aldo为独立预测因素。
Abstract:
AIM To assess the value of symptom-onset serum aldosterone levels in predicting short-term heart failure in patients with STEMI. METHODS The study included 117 consecutive patients in our hospital from January, 2007 to October, 2007, who underwent PCI within 12 hours of the symptom onset. Blood samples were drawn through the femoral arterial sheath before cardiac catheterization with the patients in the supine position (5.7±2.5) hours. Serum aldosterone levels were measured with a commercially available radioimmunoassay kit. The 30-day and a 3-month follow-ups of heart failure （acute attack or NYHA Ⅲ-Ⅳgrade）were recorded. RESULTS According to the aldosterone levels, we devided the patients into 3 groups (Aldo<100 μg/L, 100 μg/L≤Aldo≤200 μg/L and Aldo>200 μg/L). The rates of heart failure increased with the increase of serum aldosterone. Logistic analysis showed that independent of other prognostic factors such as age, gender, family heredity, hypercholesterolemia, diabetes, hypertension and smoking, the serum aldosterone level was a strong predictor of 30-day（r=0.54， OR 3.3795%CI 1.19 to 9.60, P<0.05）and 3-month （r=0.48，OR 2.9895%CI 1.31 to 6.80, P<0.01） incidence of heart failure. CONCLUSION The serum aldosterone level is associated with the increase of the rates of heart failure. Independent of other prognostic factors, the serum aldosterone level is a strong predictor of 30-day and 3-month incidence of heart failure.

参考文献/References

[1］ Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators［J］. N Engl J Med， 1999， 341(10):709-717.

［2］ Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective Aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction［J］. N Engl J Med， 2003， 348(14):1309-1321.

［3］ Katayama T, Nakashima H, Furudono S, et al. Evaluation of neurohumoral activation (adrenomedullin, BNP, catecholamines, etc.) in patients with acute myocardial infarction［J］. Intern Med, 2004， 43(11):1015-1022.

［4］ Vantrimpont P, Rouleau JL, Ciampi A, et al. Two-year time course and significance of neurohumoral activation in the Survival and Ventricular Enlargement (SAVE) Study［J］. Eur Heart J, 1998， 19(10):1552-1563.

［5］ Rouleau JL, Packer M, Moye L, et al. Prognostic value of neurohumoral activation in patients with an acute myocardial infarction: effect of captopril［J］. J Am Coll Cardiol, 1994， 24(3):583-591.

［6］ Sigurdsson A, Held P, Swedberg K. Short- and long-term neurohormonal activation following acute myocardial infarction［J］. Am Heart J, 1993， 126(5):1068-1076.

［7］ Farquharson CA, Struthers AD. Aldosterone induces acute endothelial dysfunction in vivo in humans: evidence for an Aldosterone-induced vasculopathy［J］. Clin Sci (Lond), 2002， 103(4):425-431.

［8］ Jaffe IZ, Mendelsohn ME. Angiotensin II and Aldosterone regulate gene transcription via functional mineralocortocoid receptors in human coronary artery smooth muscle cells［J］. Circ Res, 2005， 96(6):643-650.

［9］ Fejes-Toth G, Naray-Fejes-Toth A. Early Aldosterone-regulated genes in cardiomyocytes: clues to cardiac remodeling?［J］. Endocrinology, 2007， 148(4):1502-1510.

［10］Hayashi M, Tsutamoto T, Wada A, et al. Relationship between transcardiac extraction of Aldosterone and left ventricular remodeling in patients with first acute myocardial infarction: extracting Aldosterone through the heart promotes ventricular remodeling after acute myocardial infarction［J］. J Am Coll Cardiol, 2001， 38(5):1375-1382.

［11］Hayashi M, Tsutamoto T, Wada A, et al. Immediate administration of mineralocorticoid receptor antagonist spironolactone prevents post-infarct left ventricular remodeling associated with suppression of a marker of myocardial collagen synthesis in patients with first anterior acute myocardial infarction［J］. Circulation, 2003， 107(20):2559-2565.

［12］Pitt B, White H, Nicolau J, et al. Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure［J］. J Am Coll Cardiol, 2005， 46(3):425-431.

备注/Memo

备注/Memo:
收稿日期：2008-3-24.基金项目：上海市科委登高重点课题项目资助(064119501);浦东新区重大协作课题项目资助(PW2006 D-3) 通讯作者：何奔,主任医师，主要从事冠心病的防治研究Email：heben@medmail.com.cn 作者简介：龚兴荣，住院医师，硕士生Email:gongxingrong@hotmail.com
更新日期/Last Update: 2009-05-18