急性ST段抬高型心肌梗死经心脏磁共振诊断新发心包积液的临床特点及危险因素分析  

Clinical characteristics and risk factors of acute ST-segment elevation myocardial infarction and new-onset pericardial effusion diagnosed by cardiac magnetic resonance with acute ST-segment dlevation myocardial infarction

作　　者：张乃今 孙兆青[2] 于彤彤 孙英贤[1] ZHANG Nai-jin;SUN Zhao-qing;YU Tong-tong;SUN Ying-xian(Department of Cardiology,the First 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,辽宁沈阳110001 [2]中国医科大学附属盛京医院心血管内科,辽宁沈阳110004

出　　处：《中国实用内科杂志》2021年第8期705-709,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2017YFC1307600)。

摘　　要：目的探讨急性ST段抬高型心肌梗死患者通过心脏磁共振(CMR)检查诊断新发心包积液的临床特点和危险因素。方法连续入选107例于2016年11月至2018年11月就诊于中国医科大学附属盛京医院,诊断为急性ST段抬高型心肌梗死且成功接受急诊直接经皮冠状动脉介入术(PCI)治疗的患者。107例入选患者依据有无新发心包积液分为两组:心包积液组(PE组,n=30)和无心包积液组(无PE组,n=77),研究心包积液组的临床特点,并通过二元logistic回归分析新发心包积液的危险因素。结果新发心包积液的患病率达28.0%,心脏磁共振的检出率显著高于心脏彩超(28.0%对2.8%,P=0.005),且无一例漏诊。与无心包积液组相比,心包积液组入院心率更快、梗死危险区域更大。二元Logistic回归分析进一步证实,更大的梗死危险区域是急性ST段抬高型心肌梗死患者急性期新发心包积液的独立危险因素(OR 1.044,95%CI 1.003~1.087;P=0.034)。结论新发心包积液在急性ST段抬高型心肌梗死且成功接受急诊直接PCI治疗的患者普遍存在,相比于心脏彩超CMR可以非常精确地检测出心包积液。更大的梗死危险区域是急性ST段抬高型心肌梗死患者急性期新发心包积液的独立危险因素。早期行CMR检查,可以有助于及早确定高危人群,有利于改善预后。Objective To investigate the prevalence,clinical features and risk factors of new-onset pericardial effusion in patients with acute ST-segment elevation myocardial infarction.Methods A total of 107 patients who were diagnosed with acute ST-segment elevation myocardial infarction and successfully received emergency direct PCI treatment in Shengjing Hospital of China Medical University from November 2016 to November 2018.The 107 patients were divided into two groups based on the presence of new-onset pericardial effusion:pericardial effusion group(PE group,n=30)and no-pericardial effusion group(no-PE group,n=77).The clinical characteristics of new-onset pericardial effusion were investigated,and the risk factors were analyzed by binary Logistic regression.Results The prevalence of new-onset pericardial effusion was28.0%,and the detection rate of cardiac magnetic resonance was significantly higher than that of echocardiography(28.0%vs.2.8%,P=0.005),and there was no missed diagnosis.Compared with no-PE group,PE group had faster admission heart rates and larger infarction risk area.The binary logistic regression analysis further confirmed that the greater infarction risk area was an independent risk factor for new-onset pericardial effusion in patients with acute ST-segment elevation myocardial infarction(OR 1.044,95%CI 1.003-1.087;P=0.034).Conclusions New-onset pericardial effusion is common in patients with acute ST-segment elevation myocardial infarction who have successfully received emergency direct PCI.CMR can detect pericardial effusion more accurately than echocardiography.The greater infarction risk area is an independent risk factor for new-onset pericardial effusion in patients with acute ST-segment elevation myocardial infarction.Early CMR examination can help us identify high-risk groups and improve the prognosis.

关 键 词：急性ST段抬高型心肌梗死 心包积液 心脏磁共振 危险因素 

分 类 号：R541.61[医药卫生—心血管疾病]