代谢综合征与急性心肌梗死患者PCI术后并发心力衰竭的关系分析  

Relationship between metabolic syndrome and heart failure in patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：张雪亚[1] 郭迎春[2] Zhang Xueya;Guo Yingchun(Henan Provincial Chest Hospital,Chest Hospital of Zhengzhou University,Zhengzhou 450003,China;不详)

机构地区：[1]河南省胸科医院郑州大学附属胸科医院心血管内科,郑州450003 [2]河南省胸科医院郑州大学附属胸科医院麻醉科,郑州450003

出　　处：《中国循证心血管医学杂志》2023年第10期1224-1228,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨分析代谢综合征(MS)与急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后并发心力衰竭(HF)的关系。方法回顾性分析2018年3月至2022年3月于河南省胸科医院心血管内科行PCI术治疗的271例AMI患者的临床资料,并根据是否合并MS分为MS组(n=124)与非MS组(n=147)。统计271例AMI患者PCI术后1年HF并发情况,并比较MS组与非MS组一般资料,采用Kaplan-Meier生存曲线分析MS和非MS的AMI患者PCI术后并发HF的发生率,并采用Cox回归分析AMI患者PCI术后并发HF的影响因素。结果MS组中女性、年龄≥65岁、高血压史、糖尿病史、高血脂症史占比、体质指数(BMI)、腰围、入院时的收缩压、舒张压、心率、空腹血糖、空腹三酰甘油(TG)水平均高于非MS组患者(P<0.05),入院空腹高密度脂蛋白胆固醇(HDL-C)水平低于非MS组患者(P<0.05);AMI患者PCI术后随访1年期内并发HF的发生率为25.09%(68/271),MS组AMI患者在PCI术后1年并发HF的发生率明显高于非MS组患者(P<0.05)。并发HF的患者的年龄≥65岁、糖尿病史、高血压史、Gensini等级Ⅲ/Ⅳ级、梗死后心律失常、多支血管病变占比和术前肌钙蛋白T(cTnT)水平、肌酸激酶同工酶(CK-MB)水平、超敏C反应蛋白(hs-CRP)水平均高于未并发HF者(P<0.05);Cox多因素回归分析显示年龄≥65岁、高血压史、Gensini等级Ⅲ/Ⅳ级、梗死后心率失常、MS、多支血管病变、术前CK-MB水平升高、术前hs-CRP水平升高均是影响AMI患者PCI术后并发HF的危险因素(P<0.05)。结论AMI患者中合并MS者在PCI术后随访1年期内并发HF的发生率高于未合并MS者,MS与年龄≥65岁、高血压史、Gensini等级Ⅲ/Ⅳ级、心肌梗死后心律失常、多支血管病变、术前CK-MB、hs-CRP水平升高均是AMI患者PCI术后并发HF的危险因素,需对具有以上危险因素的AMI患者加强监测和实施个体化干预。Objective To analyze the relationship between metabolic syndrome(MS)and heart failure(HF)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods The clinical materials of AMI patients(n=271)undergone PCI were retrospectively analyzed in Department of Cardiovascular Medicine in Chest Hospital of Henan Province from Mar.2018 to Mar.2022.The patients were divided,according to whether having complicated MS or not,into MS group(n=124)and non-MS group(n=147).The complication of HF was counted in all AMI patients after PCI.The general materials were compared between MS group and non-MS group.The incidence rate of HF was analyzed by using Kaplan-Meier survival curve in MS group and non-MS group.The influence factors of complicated HF were analyzed by using Cox regression analysis.Results The percentages of female cases,and cases with age≥65,hypertension history,diabetes history and hyperlipidemia history,body mass index(BMI),waistline,and levels of systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),fasting plasma glucose(FPG)and fasting triglyceride(TG)at admission time were higher(P<0.05),and fasting high-density lipoprotein-cholesterol(HDL-C)at admission time was lower in MS group than those in non-MS group(P<0.05).The incidence rate of HF was 25.09%(68/271)in AMI patients after PCI within 1 y,and incidence rate of HF was higher in MS group than that in non-MS group after PCI for 1 y(P<0.05).The percentages of cases with age≥65,diabetes history,hypertension history,Ⅲ/Ⅳgrades of Gensini grading,post-infarction arrhythmia and multi-vessel lesions,and preoperative levels of cardiac troponin T(cTnT),creatine kinase-MB isoenzyme(CK-MB)and high sensitivity C-reactive protein(hs-CRP)all were higher in patients with complicated HF than those in patients without complicated HF(P<0.05).The results of multi-factor Cox regression analysis showed that age≥65,hypertension history,Ⅲ/Ⅳgrades of Gensini grading,post-infarction arrhythmia,MS,multi-vessel

关 键 词：代谢综合征 急性心肌梗死 经皮冠状动脉介入治疗 心力衰竭 

分 类 号：R544.22[医药卫生—心血管疾病]