急性ST段抬高心肌梗死患者合并心力衰竭的危险因素分析  

Risk factors for heart failure in patients with acute ST-segment elevation myocardia1 infarction

作　　者：史云桃[1] 蒋廷波[2] 

机构地区：[1]南京高淳县人民医院心内科,211300 [2]苏州大学附属第一医院心内科

出　　处：《中华老年心脑血管病杂志》2014年第2期151-154,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 通过回顾性分析影响急性ST段抬高心肌梗死（STEMI）患者入院时心功能的相关因素,为临床医师预测STEMI患者心力衰竭（心衰）发生提供临床依据.方法 收集205例因STEMI入院患者的临床特征及冠状动脉造影结果,分为心衰组86例,非心衰组119例.应用单因素logistic回归分析可能与心衰相关的因素;多因素logistic逐步回归分析STEMI患者发生心衰的危险因素.结果 与非心衰组比较,心衰组年龄偏大,心绞痛、高血压、糖尿病、空腹血糖、高敏C反应蛋白、病变支数、局部室壁运动障碍均明显升高（P＜0.05）.收缩压、舒张压、血红蛋白、肌酐清除率明显下降（P＜0.05）.单因素logistic回归分析显示,心绞痛、糖尿病、高血压、收缩压、舒张压、血红蛋白、白蛋白、肌酐清除率、局部室壁运动障碍与STEMI患者心功能相关.多因素logistic回归分析显示,糖尿病、舒张压是STEMI患者合并心衰的危险因素（OR=2.757,95％CI：1.330～5.714,P=0.006;OR=1.042,95％CI：1.017～1.067,P=0.001）.结论 STEMI发生心衰比例较高,且受多种因素影响.其中糖尿病、舒张压可能是STEMI患者发生心竭的危险因素.Objective To study the risk factors for heart failure （HF） in patients with acute ST-segment elevation myocardia1 infarction （STEMI）.Methods Two hundred and five acute STEMI patients were divided into HF group （n=86） and non-HF group （n=119） according to their clinical manifestations and coronary angiographic fidings.Risk factors for HF in acute STEMI patients were analyzed by univariate logistic regression analysis and multivariable logistic regression anaslysis,respectively.Results The age was older,and the incidence of angina pectoris,hepertensin and diabetes,the serum fasting blood glucose and hs-CRP,the number of double and multiple vessel lesions and abnormal regional wall movement were significantly higher whereas the SBP,DBP,serum hemoglobin level and creatine clearance rate were significantly lower in HF group than in non-HF group （P＜0.05）.Univariate logistic regression analysis showed that angina pectoris,diabetes,hypertension,SBP,DBP,serum hemoglobin and albumin level,creatine clearance rate,abnormal regional wall movement were related with the heart function of acute STEMI patients.Multivariate logistic regression anaslysis displayed that diabetes and DBP were the independent risk factors for HF in acute STEMI patients.Conclusion The incidence of HF is rather high in acute STEMI patients due to various factors with diabetes and DBP as its independent risk factors.

关 键 词：心肌梗死 心力衰竭 冠状血管造影术 C反应蛋白质 肌钙蛋白I 高血压 糖尿病 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病] R541.6[医药卫生—内科学]