急性心肌梗死患者血钙水平与心功能及出院后90d内非计划性再住院的关系  

Relationship between serum calcium level and cardiac function and unplanned rehospitalization in 90 days after discharge in patients with acute myocardial infarction

作　　者：户富栋 陈熙 申泱泱[1] 付新[1] 胡彩娜 姜正明[1] HU Fudong;CHEN Xi;SHEN Yangyang;FU Xin;HU Caina;JIANG Zhengming(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院心内科,河南郑州450052

出　　处：《新乡医学院学报》2020年第5期456-461,共6页Journal of Xinxiang Medical University

基　　金：河南省重点研发与推广项目(编号:182102310476);郑州大学第一附属医院院内青年创新基金项目(编号:YNQN2017109)。

摘　　要：目的探讨急性心肌梗死(AMI)患者入院血钙水平与其心脏功能的关系及对其出院后90 d内非计划性再住院情况的影响。方法选择2017年1月至2018年12月郑州大学第一附属医院收治的298例>18岁的疑似冠状动脉性心脏病(CAD)患者为观察对象,患者均有心肌缺血症状或缺血性心电图表现。根据冠状动脉造影检查结果分为AMI组(n=129)、CAD组(n=102)和对照组(冠状动脉未见狭窄性病变且血流正常)(n=67),并根据血钙水平将AMI患者分为低钙血症组(血钙<2.20 mmol·L^-1,n=64)和正常血钙组(血钙2.20~2.75 mmol·L^-1,n=65)。记录患者性别、年龄、高血压病、2型糖尿病、高脂血症、吸烟者比例等病史资料及心电图、X线胸片检查结果,观察患者入院第2天血清N末端B型利钠肽原(NT-proBNP)、血钙、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、空腹血糖、心肌酶、肌钙蛋白水平;采用彩色多普勒超声诊断仪检测患者的左心室射血分数(LVEF)和心腔大小;分析血钙水平对AMI患者出院后90 d内非计划性再住院率的影响。结果3组患者的年龄、性别、高血压病患病率、2型糖尿病患病率、吸烟者比例、TC、LDL-C、收缩压、舒张压、空腹血糖、LVEF、NT-proBNP和血钙水平比较差异均有统计学意义(P<0.05),3组患者的高脂血症史和TG水平比较差异无统计学意义(P>0.05)。与对照组比较,CAD组患者的年龄、高血压病患病率、2型糖尿病患病率、TC、LDL-C、空腹血糖和NT-proBNP水平显著增加,血钙和LVEF水平显著下降(P<0.05);与对照组比较,AMI组患者的年龄、男性比例、吸烟者比例及高血压患病率、2型糖尿病患病率、TC、LDL-C、空腹血糖和NT-proBNP水平显著增高,而女性患者比例、血钙和LVEF水平显著下降(P<0.05)。与CAD组比较,AMI组患者LDL-C、空腹血糖和NT-proBNP水平显著增高,血钙、LVEF、收缩压和舒张压水平显著下降(P<0.05)。血钙�Objective To investigate the relationship between the blood calcium level and cardiac function in patients with acute myocardial infarction(AMI)and its effect on their unplanned rehospitalization in 90 days after discharge.Methods A total of 298 suspected coronary artery disease(CAD)patients(>18 years old)in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018 were selected as study subjects.All patients had myocardial ischemia symptoms or the manifestations of ischemic electrocardiogram(ECG).According to the results of coronary angiography,the patients were divided into AMI group(n=129),CAD group(n=102)and control group(without coronary stenotic changes and the coronary blood flow was normal)(n=67),and the patients with AMI were further divided into hypocalcemia group(serum calcium<2.20 mmol·L^-1,n=64)and normal serum calcium group(serum calcium 2.20-2.75 mmol·L^-1,n=65)according to the serum calcium levels after admission.The data of medical history such as sex,age,hypertension,type 2 diabetes mellitus(T2DM),hyperlipemia,smoking rate and other medical history data as well as the results of electrocardiogram and X-ray examination were recorded.The levels of serum N-terminal pro-B-type natriuretic peptide(NT-proBNP),calcium,total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),triacylglycerol(TG),fasting blood glucose,cardiac enzymes and troponin were tested and observed especially on the second day after admission.The left ventricular ejection fractions(LVEF)and the sizes of cardiac chambers were examined by color doppler ultrasonic diagnosis apparatus,and the effect of hypocalcemia on unplanned rehospitalization in 90 days after discharge was analyzed in patients with AMI.Results There was statistically significant difference in the age,sex,hypertension prevalence rate,T2DM prevalence rate,smoking rate,TC,LDL-C,systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),LVEF,NT-proBNP and serum calcium levels among the three groups(P<0.0

关 键 词：血钙 急性心肌梗死 心功能 再住院 

分 类 号：R541.4[医药卫生—心血管疾病]