急性ST段抬高型心肌梗死院内发生室壁瘤的危险因素分析  

Risk Factors for the Development of Ventricular Aneurysm in the Hospital for Acute ST-segment Elevation Myocardial Infarction

作　　者：徐雨晴 徐陈承 李勋[1] XU Yuqing;XU Chencheng;LI Xun(Department of Cardiology,The First Affiliated Hospital of Soochow University,Suzhou Jiangsu 215000,China)

机构地区：[1]苏州大学附属第一医院心血管内科,江苏苏州215000

出　　处：《中国卫生标准管理》2022年第15期98-103,共6页China Health Standard Management

摘　　要：目的 探讨急性ST段抬高型心肌梗死患者(ST-segment elevation myocardial infarction,STEMI)首次住院期间发生室壁瘤的危险因素。方法 收集2018年1月—2020年10月住院的STEMI患者共757例,根据是否发生室壁瘤分为两组,其中,室壁瘤组共90例,无室壁瘤组共667例;回顾性收集两组患者的临床资料,并对可能导致室壁瘤发生的危险因素进行单因素分析,选择有意义的指标进行多因素Logistic回归分析,并对有价值的指标绘制ROC曲线。结果 (1)本研究中STEMI后发生室壁瘤的机率为11.89%。(2)单因素分析发现,室壁瘤组患者的年龄、心率、左房内径、左室收缩末期内径、N末端脑钠肽前体、D二聚体、纤维蛋白原、纤维蛋白降解产物、中性粒细胞百分比、高密度脂蛋白、总胆红素和血肌酐显著高于无室壁瘤组;女性、胸痛时间≥12 h、前壁心肌梗死、高血压病史、糖尿病病史、Killip分级> 1、罪犯血管为前降支比例显著低于无室壁瘤组,而在吸烟史、罪犯血管为右冠及回旋支比例、左室射血分数(left ventricular ejection fraction,LVEF)、淋巴细胞计数、甘油三酯、前白蛋白、白蛋白和肾小球滤过率显著低于无室壁瘤组。(3)将单因素分析中有统计学意义的指标纳入多因素Logistic回归分析后示,年龄[OR=1.036(1.013~1.060)]、前壁心肌梗死[OR=10.068(2.348~43.166)]和LVEF [OR=0.902(0.862~0.943)]为室壁瘤的影响因素(P <0.05)。(4)将多因素Logistic回归分析中的连续变量LVEF、年龄及LVEF联合年龄进行ROC曲线绘制,得到三者的曲线下面积分别为0.797、0.671和0.811。结论 高龄、LVEF降低和前壁心肌梗死为STEMI患者发生室壁瘤的危险因素,LVEF联合年龄对室壁瘤发生的预测价值更高。Objective To explore the risk factors for development of ventricular aneurysm during the first hospitalization of patients with acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 757 patients with STEMI during January 2018 to October 2020 were divided into two groups based on diagnosis of ventricular aneurysm, including 90 with ventricular aneurysm and 667 without;retrospectively collected clinical data from both groups and univariate analysis of risk factors that may lead to ventricular aneurysm, selected meaningful indicators for multivariate Logistic regression analysis and drew ROC curves for valuable indicators. Results(1)The chance of ventricular aneurysm after STEMI in this study was 11.89%.(2) The univariate analysis found that the patients in the ventricular aneurysm group had significantly higher age, heart rate, left atrial diameter, left ventricular end-systolic diameter, N-terminal pro-B-type natriuretic peptide, D dimer,fibrinogen, fibrin degradation products, percentage neutrophils,high density lipoprotein, total bilirubin and blood creatinine;and the proportion of women, chest pain time ≥ 12 hours, anterior wall myocardial infarction, hypertension, diabetes, Killip grade > 1, the proportion of criminal vessels as left anterior descending branch was significantly were lower in the aneurysm-free group. However, in the proportion of smoking, the proportion of criminal vessels as right coronary artery and left circumflex branch, left ventricular ejection fraction(LVEF), lymphocyte count, triglycerides, prealbumin, albumin, and glomerular filtration rate were significantly lower than in the aneurysm-free group.(3) The statistically significant indicators in the univariate analysis were included in the multivariate Logistic regression analysis, age [OR=1.036(1.013-1.060)], anterior wall infarction [OR=10.068(2.348-43.166)] and LVEF [OR=0.902(0.862-0.943)]were found as the influencing factors of ventricular aneurysm(P < 0.05).(4) The continuous variables LVEF, age and LVEF in m

关 键 词：急性ST段抬型高心肌梗死 室壁瘤 危险因素 年龄 左心室射血分数 前壁心肌梗死 

分 类 号：R541[医药卫生—心血管疾病]