«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《慢性病学杂志》[ISSN:1674-8166/CN:11-5900/R]

卷:

21

期数:

2020年06期

页码:

807-812

栏目:

论　著

出版日期:

2020-06-28

文章信息/Info

Title:

Analysis of related factors of heart failure during hospitalization in patients with ST-segment elevation myocardial infarction after direct percutaneous coronary intervention

作者:

孙梦涵; 王薇; 李勇; 时培苗; 宋涛

济宁医学院附属滕州市中心人民医院心内一科，山东 滕州 277500

Author(s):

SUNMeng-han; WANGWei; LIYong; SHIPei-miao; SONGTao

Departmentof Cardiology,Tengzhou CentralPeople’sHospitalAffiliated toJining MedicalCollege, Tengzhou, Shandong277500,China Correspondingauthor:SONGTao,E-mail:st990933@163.com

关键词:

ST段抬高型心肌梗死; 直接经皮冠状动脉介入治疗; 心力衰竭

Keywords:

ST-segment elevation myocardial infarction;  Percutaneous coronary intervention;  Heart failure

分类号:

R541.6

DOI:

-

摘要:

目的 探讨ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）后住院期间发生 心力衰竭的相关因素。方法 回顾性分析2018年1月至2019 年12月济宁医学院附属滕州市中心人民医院 298例首次诊断为STEMI并接受直接PCI治疗患者的临床与影像资料，根据心脏超声结果及患者术后症状、体 征将其分为心力衰竭组（n=48）和非心力衰竭组（n=250），分析各影响因素与心力衰竭发生的关系。结果 心 力衰竭组谷草转氨酶、谷丙转氨酶、肌酸激酶、肌酸激酶同工酶（CK-MB）、血尿酸（UA）、入院时心率均明 显高于非心力衰竭组（P<0.01）；入院时心功能分级、糖尿病病史两组差异有统计学意义（P<0.01）；心力衰竭 组心梗部位多为前壁、前间壁、高侧壁（P<0.01），非心力衰竭组梗死部位多为下壁、后壁、右室（P<0.01）； 心力衰竭组梗死相关动脉多为前降支（P<0.01），非心力衰竭组梗死相关动脉多为右冠状动脉（P<0.01）；心力 衰竭组术中发生慢血流及无复流的比例高于非心力衰竭组（P<0.05）。应用多因素Logistic回归分析，结果显示 前壁心肌梗死、前间壁心梗、糖尿病、CK-MB、UA是STEMI患者直接PCI术后住院期间发生心力衰竭的独立 预测因素（P<0.01或0.05）。对UA进行ROC分析，最大约登指数是307 μmol/L，其敏感度为83.3%、特异度 为55.2%。对CK-MB进行ROC分析，最大约登指数是148 U/L，其敏感度为79.2%、特异度为70.4%。结论 前壁心梗、前间壁心梗、糖尿病以及高水平的CK-MB、UA是STEMI患者直接PCI术后住院期间发生心力衰 竭的独立预测因素。

Abstract:

Objective To investigate the related factors of heart failure during hospitalization in patients with ST-segment elevation myocardial infarction（STEMI）after direct percutaneous coronary interven-tion（PCI）. Methods The clinical and imaging data of298 patients with STEMI diagnosed for the first time and treated with direct PCI from January 2018to December 2019in Tengzhou Central People’s Hospital Affiliated to Jining Medical College were analyzed retrospectively. According to the results of cardiac ultrasound and postoperative symptoms and signs, the patients were divided into heart failure group（n=48）and non-heart failure group（n=250）. The relationship between the influencing factors and the occurrence of heart failure was analyzed. Results Levels of aspartate aminotransferase（AST）, alanine aminotransferase（ALT）, creatine kinase（CK）, CK-MB, uric acid（UA）and heart rate at admission in heart failure group were significantly higher than those in non-heart failure group（P<0.01）. There were significant differences in cardiac function classification and diabetes histo-ry between the two groups at admission（P<0.01）. In the heart failure group, most of the myocardial infarction sites were anterior wall, anterior interwall and high lateral wall （P<0.01）. In the non-heart failure group, the infarction sites were mostly inferior wall, posterior wall and right ventricle （P< 0.01）. In the heart failure group, most of the infarct-related arteries were anterior descending branch （P<0.01）. In non-heart failure group, most of the infarct-related arteries were right coronary arteries （P<0.01）. The incidence of slow blood flow and no reflow in heart failure group was higher than that in the non-heart failure group（P<0.05）. Multivariate logistic regression analysis showed that an-terior wall myocardial infarction, anteroseptal myocardial infarction, diabetes mellitus, CK-MB and UA were independent predictors of heart failure in patients with STEMI during hospitalization after direct PCI（P<0.01 or 0.05）. ROC analysis of UA showed that the maximum Jordan index was 307 μmol/L, the sensitivity was 83.3% and the specificity was55.2%. ROC analysis of CK-MB showed that the maximum Jordan index was 148 U/L, the sensitivity was 79.2% and the specificity was 70.4%. Conclusion Anterior wall myocardial infarction, anteroseptal myocardial infarction, diabetes mellitus, and high levels of CK-MB and UA are independent predictors of heart failure during hospitalization af-ter direct PCI in patients with STEMI.

参考文献/References:

[1] 关秀萍,邓倾,朱丽敏,等.实时三维超声心动图评价不同部位心 肌梗死患者左心室收缩功能与同步性[J].临床超声医学杂志, 2010,12(10):657-660. [2] Borghi C, Cosentino ER, Rinaldi ER, et al. Uricaemia and ejection fraction in elderly heart failure outpatients [J]. Eur J Clin Invest,2014,44(6):573-578. [3] Liu ZB. Studying the change of serum uric acid and renal function in patients with chronic heart failure [J]. Ningxia Med J,2006,28(8):574-575. [4] Vaduganathan M, Greene SJ, Ambrosy AP,et al. Rela-tion of serum uric acid levels and outcomes among patients hospitalized for worsening heart failure with reduced ejec-tion fraction (from tIIe efficacy of vasopressin antagonism in heart failure outcome study with Tolvaptan trial) [J]. Am J Cardiol,2014,114(11):1713-1721. [5] Palazzuoli A, Ruocco G, Pellegrini M, et al. Prognostic significance of hyperuricemia in patients with acute heart failure [J]. Am J Cardiol, 2016,117(10):1616-1621. [6] Seferovie PM, Petrie MC, Filippatos GS, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Soci-ety of Cardiology [J]. Eur J Heart Fail, 2018,20(5):853-872 [7] Kim G, Jo K, Kim KJ,et al. Visceral adiposity is associ-ated with altered myocardial glucose uptake measured by (18)FDG-PET in 346 subjects with normal glucose toler-ance, prediabetes, and type 2 diabetes [J]. Cardiovasc Dia-betol,2015,14(1):1-10. [8] Fontes-Carvalho R, Sampaio F, Teixeira M,et al. Left ventricular diastolic dysfunction and E/E’ratio as the strongest echocardiographic predictors of reduced exercise capacity after acute myocardial infarction [J]. Clin Cardiol, 2015,38(4):222-229. [9] Bugger H, Abel ED. Molecular mechanisms of diabetic cardiomyopathy [J]. Diabetologia, 2014,57(4):660-671. [10] Selvin E, Lazo M, Chen Y,et al. Diabetes mellitus, pre-diabetes, and incidence of subclinical myocardial damage [J]. Circulation,2014,130(16):1374-1382. [11] Dei Cas A, Fonarow GC, Gheorghiade M,et al. Con-comitant diabetes mellitus and heart failure [J]. Curr Probl Cardiol,2015,40(1):7-43. [12] Wannamethee G, Shaper AG, Macfarlane PW,et al. Risk factors for sudden death in midde-aged British man [J]. Circulation, 1995,91(6):1749-1756. [13] Palahini P, Julius S. Review article: Association of tachy-cardia with morbidity and morality: pathophysiological con-siderations [J]. J Hum Hypertens, 2007,11(1):19-27. [14] Fox K, Ford I, Steg PG,et al. Heart rate as a prognos-tic risk factor in patients with coronary artery disease and 1eft—ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial [J]. Lan-cet, 2008,372(9641):817-821. [15] Stone GW, Webb J, Cox DA,et al. Distal microcircula-tory protection during percutaneous coronary intervention in acute ST- segment elevation myocardial infarction:a ran-domized controlled trial [J]. JAMA,2005,293:1063-1072.

备注/Memo

备注/Memo:

基金项目：济宁医学院教师科研扶持基金（JYFC2019FKJ099） 作者简介：孙梦涵，硕士研究生，主治医师，研究方向：心内科 通信作者：宋涛，E-mail：st990933@163.com

常用功能

更新日期/Last Update: 2020-06-28