入院时C反应蛋白与首次急性心肌梗死后新发心房颤动的相关性  

Relationship between C-reactive protein at admission and new-onset atrial fibrillation after initial acute myocardial infarction

作　　者：罗晓颖[1] 张健盛[1] 张风如[1] 葛晓虹[1] 沈卫峰[1] 戚文航[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心内科,200025

出　　处：《上海医学》2009年第8期690-693,共4页Shanghai Medical Journal

摘　　要：目的探讨首次急性心肌梗死患者入院时的C反应蛋白(CRP)与新发心房颤动的关系。方法测定136例首次急性心肌梗死患者入院时的CRP,持续监测入院7d内有无心房颤动发作,同时分析临床资料、心脏超声和冠状动脉造影检查的资料。结果新发心房颤动的发生率是22.8%,根据是否发生心房颤动分成心房颤动组和非心房颤动组。单变量分析发现,心房颤动组的年龄、超敏CRP(hs-CRP)和合并高血压、前壁心肌梗死、左前降支和三支血管病变的构成比分别为(69.0±10.5)岁、(26.7±19.6)mg/L、71.0%、67.7%、71.0%和22.6%,均显著高于非心房颤动组的(60.2±12.3)岁、(13.1±12.7)mg/L、50.5%、47.6%、46.7%和8.6%(P值均<0.05);左心房内径为(36.8±5.2)mm,显著大于非心房颤动组的(34.5±3.6)mm(P<0.05);左心室射血分数为0.477±0.107,显著低于非心房颤动组的0.538±0.124(P<0.05)。多变量分析显示,年龄(OR=1.05,95%CI为1.00～1.13)和CRP水平(OR=1.28,95%CI为1.00～1.61)是新发心房颤动的独立预测因素(P值均<0.05)。结论入院时的CRP水平是首次急性心肌梗死患者新发心房颤动的独立危险因素,提示炎性反应参与急性心肌梗死后新发心房颤动的发生。Objective To investigate the association between C-reactive protein （CRP） and new-onset atrial fibrillation （AF） in patients with initial acute myocardial infarction （AMI）. Methods CRP was measured in 136 patients with initial AMI at admission. All patients were monitored continuously for new-onset AF for 7 days since admission. Clinical manifestations, echocardiographic data and angiographic data were also evaluated in all patients. Results AF occurred in 23% of patients. All patients were divided into a group with new-onset AF and a group without new-onset AF. Univariate analysis showed that patients with new-onset AF had a significantly older age （[69.0±10.51 years） and higher CRP level （[26.7±19.6]mg/L）, percentage of high blood pressure （71.0%）, anterior AMI （67.7%）, left-anterior-descending-artery lesion （71.0%） and 3-vessel lesion （22.6%） compared with patients without new-onset AF [ 60.2±12.3 ] years, [13.1±12.7] mg/L, 50.5 %, 47.6 %, 46.7 %, and 8.6 %, respectively; all P〈0.05）. Left atrial diameter was （36.8±5.2） mm in patients with new-onset AF, which was significantly larger than that in patients without new-onset AF （[34.5±3.6] mm, P〈0.05）. Left ventricular ejection fraction was 0. 477±0. 107 in patients with new-onset AF, which was significantly lower than patients without new-onset AF （0. 538 ±0. 124, P〈 0.05）. In multivariate analysis, only age （ OR = 1.05, 95% CI, 1.00-1.13,）and CRP levels （OR= 1.28, 95% CI= 1.00-1.61, P〈 0. 05 ） were independent predictors of new-onset AF. Conclusion CRP level at admission is an independent risk factor for new-onset AF in patients with initial AMI, which suggests that CRP might be involved in the initiation process of AF in patients with AMI.

关 键 词：C反应蛋白 急性心肌梗死 心房颤动 

分 类 号：R542.22[医药卫生—心血管疾病] R541.75[医药卫生—内科学]