经皮冠状动脉介入治疗对老年急性心肌梗死患者肝功能的影响  

Influence of PCI on the Liver Function of Elderly Patients With Acute Myocardial Infarction

作　　者：刘阳[1] 贾玲[1] 李栋博[1] 

机构地区：[1]郑州大学第一附属医院老年心血管科,河南省郑州市450052

出　　处：《中国全科医学》2015年第23期2762-2765,共4页Chinese General Practice

摘　　要：目的探讨经皮冠状动脉介入(PCI)治疗对老年急性心肌梗死(AMI)患者肝功能的影响。方法选取2012年7月—2014年4月在郑州大学第一附属医院住院治疗的老年AMI患者187例为研究对象,根据患者是否行PCI分为PCI组(103例)和非PCI组(84例)。PCI组患者入院后当日即行急诊PCI,非PCI组仅给予溶栓、抗凝等各种对症支持治疗措施。记录患者性别、年龄及心功能Killip分级,分别于入院时及入院后1 d常规检测肝功能指标,对于入院后1 d肝功能异常者继续于入院后3、6、9、12、15 d监测肝功能的变化。结果 PCI组与非PCI组入院后1 d肝功能异常者分别有26例(25.2%)、39例(46.4%),差异有统计学意义(χ2=9.157,P<0.05)。两组入院后1 d肝功能异常者谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)及直接胆红素(DBi L)升高水平比较,差异无统计学意义(P>0.05);PCI组入院后1 d肝功能异常者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)升高水平低于非PCI组,总胆红素(TBi L)升高水平高于非PCI组,差异有统计学意义(P<0.05)。PCI组和非PCI组肝功能异常患者ALT、AST分别于入院第6、9天达到峰值,后逐渐下降,其平均水平于入院15 d后仍未达到参考值。多因素Logistic回归分析显示,性别〔OR=0.293,95%CI(0.125,0.683),P=0.005〕、年龄〔OR=1.271,95%CI(1.169,1.382),P<0.001〕及是否接受PCI术〔OR=0.211,95%CI(0.089,0.499),P<0.001〕是老年AMI患者入院后1 d肝功能的影响因素。结论 PCI治疗是老年AMI患者肝功能的保护性因素,早期行PCI术可改善肝功能的损伤程度。Objective To evaluate the influence of PCI on the liver function of elderly patients with acute myocardial infarction （ AMI） .Methods 187 elderly patients admitted to the First Affiliated Hospital of Zhengzhou University from July 2012 to April 2014 were included.Patients were divided into PCI group （n=103） and non-PCI group （n=84）.On the day of admission, PCI group was administrated with emergent PCI and non -PCI group was only given symptomatic and supportive treatments, such as thrombolysis and anticoagulant therapy .Gender, age and Killip grading were recorded.At admission and on day 1 after admission , conventional examination of liver function was conducted , and the patients who had abnormal liver function indexes were continually monitored on day 3, 6, 9, 12, 15 after admission in elderly patients with AMI .Results The number of patients who had abnormal liver function indexes on day 1 after admission was 26 （25.2%） in PCI group and 39 （46.4%） in non-PCI group, with significant difference between them （χ2 =9.157, P〈0.05）.On day 1 after admission, the two groups were not significantly different （ P 〉0.05 ） in the elevated levels of GGT , ALP and DBiL in patients with abnormal liver function indexes; on day 1 after admission, PCI group was lower （P〈0.05） in elevated levels of ALT and AST and higher （ P 〈0.05 ） in the elevated level of TBiL in patients with abnormal liver function indexes than non -PCI group.Patients with abnormal liver function indexes in PCI group and non -PCI group had their ALT and AST reach peak on day＆amp;nbsp;6 and day 9 respectively and decline gradually after that .On day 15, the average value of ALT and AST still hadn′t reached the reference values.The multivariate Logistic regression analysis showed that gender 〔OR=0.293, 95%CI （0.125, 0.683）, P=0.005〕, age 〔OR =1.271, 95%CI （1.169, 1.382）, P 〈0.001〕, whether receiving PCI 〔OR =0.211, 95%CI （0.089, 0.499）, P〈0.001〕 were influencing factors for the liver f

关 键 词：血管成形术  经腔  经皮冠状动脉 心肌梗死 肝功能 老年人 

分 类 号：R654.3[医药卫生—外科学]