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  

Early serum aldosterone levels are association with heart failure in patients with ST-elevation myocardial infarction

作　　者：龚兴荣[1] 何奔[1] 周磊[1] 张清[1] 葛恒[1] 何清[1] 姜萌[1] 厉锦华[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200001

出　　处：《心脏杂志》2009年第3期393-396,共4页Chinese Heart Journal

基　　金：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(PW2006D-3)

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<100μg/L组,100μg/L≤Aldo≤200μg/L组,Aldo>200μg/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 3.37 95%CI 1.19-9.60,P<0.05),3个月心衰发生率(r=0.48,OR2.98 95%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。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 aldostcrone 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- Ⅳ grade ） 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, hypercholester- olemia, diabetes, hypertension and smoking, the serum aldosterone level was a strong predictor of 30-day （r=0.54, OR3.37 95%CI 1.19 to9.60, P〈0.05）and3-month （r=0.48,0R2.98 95%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 aldoste- rone level is a strong predictor of 30-day and 3-month incidence of heart failure.

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. 

分 类 号：R541.4[医药卫生—心血管疾病]