血清醛固酮水平对左室收缩功能正常的急性心肌梗死患者院内不良事件的预测价值  

Investigation of predictive value of serum aldosterone levels in in-hospital adverse cardiac events in acute myocardial infarction patients with normal left ventricular systolic function

作　　者：苗明利 徐峰[1] Miao Mingli;Xu Feng(Department of Cardiovascular Medicine,First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院心血管内科

出　　处：《中国心血管杂志》2019年第6期522-526,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨血清醛固酮水平对左室收缩功能正常的急性心肌梗死患者院内不良心血管事件的预测价值。方法纳入2017年5~12月于中国医科大学附属第一医院行经皮冠状动脉介入治疗的左心室射血分数≥50%的急性心肌梗死患者121例。所有患者均于入院次日清晨采集仰卧位静脉血,采用放射免疫法测定血清醛固酮水平(本研究醛固酮参考值范围60~170μg/L)。根据血清醛固酮水平分为两组:正常组(醛固酮<170μg/L)86例和升高组(醛固酮≥170μg/L)35例。记录患者院内室性心律失常、再发缺血事件、出现心力衰竭等不良事件的情况,比较两组差异。通过logistic回归分析血清醛固酮水平升高是否可以预测急性心肌梗死患者的院内不良事件。结果与正常组比较,血清醛固酮升高组患者的院内室性心律失常(68.6%比27.9%,χ^2=17.18,P<0.01)、再发缺血事件(40.0%比16.3%,χ^2=7.87,P<0.01)、出现心力衰竭(31.4%比14.0%,χ^2=4.93,P=0.03)、院内不良事件总发生率(77.1%比41.9%,χ^2=12.41,P<0.01)均明显增加。Logistic回归分析显示,血清醛固酮水平升高是早期左室收缩功能正常的急性心肌梗死患者发生院内不良事件的独立预测因子(OR=1.030,95%CI:1.013~1.048,P<0.01)。结论血清醛固酮水平升高是左室收缩功能正常的急性心肌梗死患者院内不良事件的预测因子。Objective To investigate the predictive value of plasma aldosterone of in-hospital adverse cardiac events in patients with acute myocardial infarction(AMI)with normal cardiac systolic function.Methods A total of 121 AMI patients whose left ventricular ejection fraction(LVEF)≥50%and underwent percutaneous coronary intervention(PCI)in Cardiovascular Department of First Affiliated Hospital of China Medical University from May 2017 to December 2017 were enrolled.Aldosterone level was tested in the morning of second day after admission.The aldosterone level was measured by radioimmunoassay(the reference range was 60-170μg/L).According to serum aldosterone level,86 patients were divided into the normal group(aldosterone<170μg/L)and 35 patients in the elevated group(aldosterone≥170μg/L).Adverse events(AE),such as in-hospital ventricular arrhythmia,recurrent ischemic events and heart failure were recorded in each group.In-hospital AE were compared between the two groups.Multivariate logistic regression was used to determine the predictive value of aldosterone in AMI patients.Results Compared with the normal group,in-hospital ventricular arrhythmia(68.6%vs.27.9%,χ^2=17.18,P<0.01),recurrent ischemic events(40.0%vs.16.3%,χ^2=7.87,P<0.01),new or worsening heart failure(31.4%vs.14.0%,χ^2=4.93,P=0.03),and general in-hospital AE(77.1%vs.41.9%,χ^2=12.41,P<0.01)were significantly higher in elevated serum aldosterone group.Multivariate logistic regression analysis showed that aldosterone level(OR=1.030,95%CI:1.013-1.048,P<0.01)were independent risk factor for in-hospital AE in AMI patients with early normal left ventricular systolic function.Conclusions The aldosterone level may be an predictor for in-hospital AE in AMI patients with normal left ventricular systolic function.

关 键 词：急性心肌梗死 醛固酮 心室功能 左 不良心血管事件 

分 类 号：R54[医药卫生—心血管疾病]