ST段抬高型心肌梗死后室壁瘤形成相关因素的回顾性分析  

Retrospective Analysis on Risk Factors Correlated to Formation of Ventricular Aneurysm in Patients with ST-segment Elevation Myocardial Infarction

作　　者：来灿灿 陈浩 钟培圻 陈嘉怡 谢建彬 江秋琴 曹小织 罗助荣 LAI Cancan;CHEN Hao;ZHONG Peiqi;CHEN Jiayi;XIE Jianbin;JIANG Qiuqin;CAO Xiaozhi;LUO Zhurong(Department of Cardiology,Fuzhou General Hospital/Teaching Hospital of Bengbu Medical College/900 Hospital of the Joint Logistics Team,Fuzhou 350001,China)

机构地区：[1]蚌埠医学院福总教学医院(联勤保障部队第九〇〇医院)心内科,福州350001

出　　处：《医学综述》2020年第10期2042-2046,共5页Medical Recapitulate

基　　金：福建省自然科学基金重点项目(2016Y5004)。

摘　　要：目的探讨ST段抬高型心肌梗死(STEMI)患者左心室室壁瘤(LVA)形成的相关因素。方法选择2007年1月至2017年12月就诊于联勤保障部队第九〇〇医院的STEMI患者960例,对患者的性别、年龄、体质指数、高血压、糖尿病、是否吸烟、高脂血症、既往心绞痛史、平均发病至超声检查时间、直接经皮冠状动脉介入治疗(PPCI)、前壁心肌梗死、术前心肌梗死溶栓治疗(TIMI)分级、罪犯血管、Killip分级、总胆固醇(TC)、术后2 h ST段回落率、高敏C反应蛋白(hs-CRP)、脑钠肽(BNP)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、β受体阻滞剂等因素与LVA形成的相关性进行研究。结果960例STEMI患者中LVA 99例,non-LVA 861例。LVA组患者既往心绞痛史、TC、术后2 h ST段回落率(≥50%)、β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ拮抗剂均低于non-LVA组(P<0.05)。LVA组患者PPCI、前壁心肌梗死、术前TIMI分级(0~1级)、罪犯血管冠状动脉左前降支/左主干(LAD/LM)、左心室射血分数<55%、术后hs-CRP>8 mg/L、术后BNP>100 ng/L、附壁血栓形成均高于non-LVA组(P<0.05)。LVA组患者CK峰值和CK-MB峰值高于non-LVA组(P<0.05)。经多因素回归分析,既往心绞痛史、罪犯血管LAD/LM、术后2 h ST段回落率(≥50%)、术后hs-CRP>8 mg/L、术后CK-MB峰值是LVA形成的影响因素(P<0.05)。结论既往心绞痛史、罪犯血管LAD/LM、术后2 h ST段回落率(≥50%)、术后hs-CRP>8 mg/L是STEMI后LVA发生的影响因素。Objective To explore the related factors of left ventricular aneurysm(LVA)formation in patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 960 STEMI patients admitted to 900 Hospital of the Joint Logistics Team from Jan.2007 to Dec.2017 were included in the study.The correlation of patient characteristics,including age,gender,body mass index,hypertension,diabetes,smoking,hyperlipidemia,previous angina pectoris history,average onset to ultrasound examination time,primary percutaneous coronary intervention(PPCI),anterior wall myocardial infarction,preoperative thrombolysis in myocardial infarction(TIMI)grading,culprit vessel,Killip grade,total cholesterol(TC),ST segment regression rate 2 h after operation,high-sensitivity C-reactive protein(hs-CRP),brain natriuretic peptide(BNP),creatine kinase(CK),creatine kinase-myocardial band(CK-MB),and receptorβblockers with the formation of LVA was studied.Results Of 960 STEMI patients,LVA group were 99 cases,non-LVA group were 861 cases.The previous history of angina pectoris,TC,ST resolution≥50%at postoperative 2 h,β-blockers,and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor of the LVA group were all lower than those in the non-LVA group(P<0.05).The PPCI,anterior wall myocardial infarction,preoperative TIMI grade(0-1),culprit vessel left anterior descending/left main artery(LAD/LM),mural thrombosis,left ventricular ejection fraction<55%,postoperative hs-CRP>8 mg/L,postoperative BNP>100 ng/L,and mural thrombosis were all higher than those in the non-LVA group(P<0.05).The peak of CK and CKMB in the LVA group were higher than those in the non-LVA group(P<0.05).Through multiple factors regression analysis,culprit vessel LAD/LM,ST segment reduction rate(≥50%)2 hours after operation,postoperative hs-CRP>8 mg/L,peak value of CK-MB after operation were the influencing factors of LVA formation(P<0.05).Conclusion Previous history of angina pectoris,cuprit LAD/LM,2 h ST segment reduction rate(≥50%)and hs-CRP>8 mg/L are in

关 键 词：ST段抬高型心肌梗死 室壁瘤 冠状动脉左前降支或左主干 高敏C反应蛋白 

分 类 号：R541.1[医药卫生—心血管疾病]