影响急性心肌梗死近期预后的因素
《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]
- 期数:
- 2013年第6期
- 页码:
- 657-660
- 栏目:
- 临床研究
- 出版日期:
- 2013-11-25
文章信息/Info
- Title:
- Factors influencing the shortterm prognosis of patients with acute myocardial infarction
- Author(s):
- PAN Hui chao1; LIU Jian ping1; ZHANG Li hua2; JIN Yan3
- (1.Department of Geriatrics, 3.Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China; 2.Department of Cardiology, Tong Ren Hospital, Changning Branch, Shanghai 200050, China)
- 分类号:
- R541.4
- DOI:
- -
- 文献标识码:
- A
- 摘要:
- 目的:观察与分析影响急性心肌梗死(AMI)患者近期预后的因素。方法:回顾性分析2010年1月~2012年1月我院心内科因初发急性心肌梗死接受治疗的患者108例，收集血糖、血脂、肾功能、肌酸激酶(CK)、脑钠尿肽（BNP）、左室射血分数（LVEF）、入院Grace评分和冠脉造影结果进行分析。结果:事件组患者血清三酰甘油、尿素氮、尿酸平均水平均高于非事件组（P<0.05，P<0.01）。高三酰甘油、高空腹血糖发生率高于非事件组（P<0.05）；事件组各时间点BNP高于非事件组（P<0.01），入院第2天两组BNP均明显升高（P<001），非事件组CK显著升高（P<0.01）；入院1周时非事件组BNP明显回落（P<0.05），事件组CK值降幅明显低于非事件组（P<0.01）。事件组LVEF<55%患者比例及入院Grace评分高危患者比例高于非事件组（P<0.01），多支病变罹患率亦高于非事件组（P<0.01）。多因素非条件logistic回归分析(α= 0.1) 结果显示Grace分级、LVEF 、入院即刻与入院1周BNP、入院第2天CK为AMI近期预后的独立预测因子。结论:BNP、CK动态变化、入院Grace评分、LVEF 是AMI近期预后的独立预测因子。
- Abstract:
- AIM:To study the factors influencing the shortterm prognosis in patients with acute myocardial infarction (AMI) and to assess its predictive value with coronary angiographic findings. METHODS: A retrospective analysis of 108 AMI patients in the critical care unit (CCU) from January 2010 to January 2012 in our hospital was conducted for glucose, lipids, renal function, fibrinogen, creatine kinase, Btype natriuretic peptide and coronary angiographic findings. RESULTS: Average level of serum triglycerides, fasting glucose, average serum urea nitrogen level and average serum uric acid level in event group were higher than those in nonevent group. The mean BNP levels of each time point in event group were all higher than those in nonevent group. The percentage of patients with multivessel lesions in event group was higher than in nonevent group. CONCLUSION: The risk of adverse cardiac events in AMI patients increases with increasing triglycerides. Fasting glucose on admission is one of the high risk factors for cardiac events. Elevated level of serum uric acid and urea nitrogen are shortterm adverse prognostic risk factors for AMI. BNP is a risk for death and cardiovascular events in patients with AMI. Multivessel lesions suggest a high incidence of cardiac events and patients with infarctionrelated artery in LAD have a poorer prognosis than patients with infarctionrelated artery in RCA or LCX.
参考文献/References
[1]刘梅颜,胡大一.高尿酸血症与高甘油三酯血症对冠状动脉风险的联合评估价值[J].中国综合临床,2006,22(3):193-195.
[2]彭云珠,郭 涛.急性心肌梗死患者血脂改变及其对预后的影响分析[J].重庆医学,2012,41(16):1601-1603.
[3]陈晓勇,李结华.唐海沁.老年冠心病合并高血压及2型糖尿病患者核素心肌显像与血清学指标研究[J].中国老年学杂志,2009,29(20):2589-2591.
[4]郑 莺，刘建平.糖尿病致冠状动脉粥样硬化的机制[J].心脏杂志,2007,19(3):347-350.
[5]孙志宏，李 森.血清尿酸水平与冠心病相关性研究[J].中华实用诊断与治疗杂志,2010,24(9):873-874.
[6]徐 峰，焦 阳.血尿酸水平与急性心肌梗死预后的关系[J].苏州大学医学报,2012,32(4):559-560.
[7]丁海峰，马 兰.高血压病合并高尿酸血症与冠心病的关系[J].中国动脉硬化杂志,2011,19(4):339-342.
[8]闫荣香, 郭树江.血浆脑钠肽与急性心肌梗死临床及预后关系的研究[J].中华全科医学,2009,7(6):575-577.
[9]丁文惠,王晓阳,张宝娓,等.急性心肌梗死患者血浆脑钠尿肽动态演变的临床意义[J].中国动脉硬化杂志,2001,9(4):322-324.
[10]Antman WM,Braunwald E.Acute Myocardial infarction[M]// Braunwald E,Zipes D,Libby P.Heart Disease:A textbook of cardiovascular medicine.7th ed. Philadelphia:W.B.Saunders Company,2005.
[11]Sorajja P,Gersh BJ,Cox DA,et al.Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction[J].Eur Heart J,2007,28(14):1709-1716.
[12]Kandzari DE,Tcheng JE,Gersh BJ,et al.Relationship between infarct artery location,epicardial flow,and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction[J].Am Heart J,2006,151(6):1288-1295.
备注/Memo
- 备注/Memo:
- 收稿日期：2013-04-28通讯作者：刘建平，主任医师，主要从事冠心病介入治疗研究 Email：jpl@medmail.com.cn 作者简介：潘慧超，主治医师，硕士 Email：phc8866@live.cn
常用功能
统计/Statistics
- 摘要浏览/Viewed835
- 评论/Comments
