初始血清阴离子间隙与急性ST段抬高型心肌梗死院内死亡的关系研究  

Relationship between initial serum anion gap and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction

作　　者：赵晓彬 牛书林 邱久纯[3] 余淑华 袁如玉[3] ZHAO Xiao-bin;NIU Shu-lin;QIU Jiu-chun;YU Shu-hua;YUAN Ru-yu(Department of hypertension,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China;Department of cardiovascular Medicine,General Hospital,Tianjin Medical University,Tianjin 300052,China;Department of cardiology,The Second Hospital,Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]郑州大学附属郑州中心医院高血压科,郑州450007 [2]天津医科大学总医院心血管内科,天津300052 [3]天津医科大学第二医院心脏科,天津300211

出　　处：《天津医科大学学报》2023年第2期109-112,共4页Journal of Tianjin Medical University

基　　金：天津市自然科学基金(19JCYBJC26800)。

摘　　要：目的:探讨急性ST段抬高型心肌梗死(STEMI)早期阴离子间隙(AG)与院内死亡率的关系。方法:回顾性研究459例STEMI患者,分为AG升高组(AG≥16 mmol/L,n=230)和AG正常组(AG<16 mmol/L,n=229),对N端脑利钠肽前体(NT-proBNP)、肌钙蛋白I(TnI)、估算的肾小球滤过率(eGFR)和射血分数(EF)等进行分析;以院内是否发生死亡为因变量,进行Logistic回归分析,比较AG与年龄、性别、eGFR和EF的相关性。结果:两组性别、高血压、糖尿病、血脂异常、吸烟、家族史等差异均无统计学意义(均P>0.05)。与AG正常组相比,AG升高组的NT-proBNP和TnI升高(均P<0.05),eGFR和EF降低(均P<0.05),院内心力衰竭和死亡的发生率显著升高(均P<0.05)。Logisitic回归分析发现AG升高是STEMI患者早期院内死亡的独立危险因素(OR=1.179,95%CI:1.034~1.345,P=0.014)。结论:AG升高可增加STEMI患者院内心力衰竭和死亡风险,是STEMI早期评估预后的独立危险因素。Objective:To investigate the relationship between early anion gap(AG)level and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:A retrospective study was conducted on 459 patients with STEMI.The patients were divided into two groups:elevated AG group(AG≥16 mmol/L,n=230)and normal group(AG<16 mmol/L,n=229).N-telencephalic natriuretic peptide precursor(NT-ProBNP),Troponin I(TnI),estimated glomerular filtration rate(eGFR)and ejection fraction(EF)were analyzed between two groups.With in-hospital death as the dependent variable,Logistic regression analysis was performed to compare the correlation between AG and age,sex,eGFR and EF.Results:There was no significant difference in gender,smoking status,family history and other factors between two groups,as well as incidence of hypertension,diabetes and dyslipidemia(all P>0.05).Compared with normal group,NT-proBNP and TnI in elevated AG group were significantly increased(all P<0.05),eGFR and EF were significantly decreased(all P<0.05),the incidence of heart failure and in-hosptial mortality was significantly increased(all P<0.05).Logisitic regression analysis showed that elevated AG was an independent risk factor for early in-hospital death in STEMI patients(OR=1.179,95%CI:1.034-1.345,P=0.014).Conclusion:Elevated AG increases the risk of in-hospital heart failure and death in STEMI patients,which is an independent risk factor for early prognosis assessment of STEMI.

关 键 词：急性ST段抬高型心肌梗死 阴离子间隙 心力衰竭 院内死亡率 

分 类 号：R541.4[医药卫生—心血管疾病]