急性心肌梗死患者急诊冠状动脉介入治疗后左心室重构原因分析  

The Analysis of Left Ventricular Remodeling After Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

作　　者：史卫国[1] 王津文 周波[1] 牟晓雯[2] 周春[2] 

机构地区：[1]青岛市第八人民医院心内科,山东省青岛市266100 [2]青岛市第八人民医院特检科,山东省青岛市266100

出　　处：《中国动脉硬化杂志》2011年第12期1020-1023,共4页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨急性心肌梗死患者接受急诊冠状动脉介入治疗术后左心室重构的形成原因。方法根据急诊冠状动脉介入治疗术后1年左心室舒张末期容积指数是否较基线值增加20%将233例首次急性心肌梗死患者分为非左心室重构组(n=181)和左心室重构组(n=52)。采用Logistic逐步回归法分析急诊冠状动脉介入治疗术后发生左心室重构的危险因素。结果 233例患者中52例于冠状动脉介入治疗术后1年内发生左心室重构,发生率为22.3%。与非左心室重构组比较,左心室重构组年龄、发病到球囊扩张时间、肌酸激酶同工酶活性增高(P<0.05或P<0.01),前壁梗死、多支血管病变、糖尿病、ST段回落不良比例增加(P<0.05或P<0.01)。左心室重构组冠状动脉介入治疗术前及术后7天血浆脑钠尿肽水平高于非左心室重构组(P<0.05或P<0.01)。冠状动脉介入治疗术后脑钠尿肽水平升高、肌酸激酶同工酶活性、ST段回落不良、糖尿病与左心室重构独立相关。结论冠状动脉介入治疗术后脑钠尿肽水平、肌酸激酶同工酶活性、ST段回落不良、糖尿病是急性心肌梗死患者冠状动脉介入治疗术后发生左心室重构的预测因子。Aim To investigate the reason of left ventricular（LV） remodeling after successful percutaneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）. Methods Based on the results that whether or not the LV end-diastolic volume index（EDVI） increased 20% from baseline value one year after PCI,233 patients were divided into LV remodeling group（52 cases） and control group（181 cases）.The logistic regression analysis was performed to identify independent predictors of LV remodeling after PCI. Results Among all the 233 patients,22.3% had LV remodeling within 1 year after PCI.Compared with the control group,age,creatine kinase-MB（CK-MB） activity,pain to balloon time and the incidences of anterior wall infarction,multivessel disease,prevalence of diabetes and incomplete ST-segment resolution（STR） were higher（P0.05 or P0.01）,and plasma brain natriuretic peptide（BNP） was higher in LV remodeling group before and 7 days after PCI（P0.05 or P0.01） in LV remodeling group.LV remodeling was found to be independently related to CK-MB activity,prevalence of diabetes,incomplete STR,and increasing of BNP at 7 days after PCI. Conclusions CK-MB activity,prevalence of diabetes,incomplete STR,BNP at 7 days after PCI were independent risk factors for LV remodeling in patients with AMI.

关 键 词：左心室重构 冠状动脉介入治疗 急性心肌梗死 

分 类 号：R5[医药卫生—内科学]