非 ST 段抬高型心肌梗死患者再发心肌梗死的影响因素及预防策略研究

摘要

目的：探究非 ST 段抬高型心肌梗死（NSTEMI）患者再发心肌梗死的影响因素，并提出预防对策。方法选取阳江市阳东区人民医院2011年3月—2014年3月收治的 NSTEMI 患者196例，出院后均随访1年。结合专业知识，初步筛选 NSTEMI 患者再发心肌梗死的相关因素，并比较再发心肌梗死患者和未再发心肌梗死患者上述因素间的差异，并采用多因素 logistic 回归模型筛选 NSTEMI 患者再发心肌梗死的影响因素。结果196例患者随访期间失访36例，死亡7例，再发心肌梗死33例，未再发心肌梗死120例；再发心肌梗死患者年龄﹥70岁、合并糖尿病、合并高脂血症、合并高同型半胱氨酸血症及随访频率≤6次/年者所占比例均高于未再发心肌梗死患者（P ＜0.05）；再发心肌梗死和未再发心肌梗死患者男性、合并高血压、合并睡眠障碍、合并高尿酸血症者所占比例及吸烟率、饮酒率比较，差异无统计学意义（P ﹥0.05）。多因素 logistic 回归分析结果显示，合并糖尿病〔OR ＝4.01，95% CI（1.70，9.12）〕、合并高脂血症〔 OR ＝14.15，95% CI（2.29，98.36）〕、合并高同型半胱氨酸血症〔 OR ＝21.12，95% CI（3.42，130.32）〕是 NSTEMI 患者再发心肌梗死的危险因素，随访频率〔OR ＝0.24，95% CI（0.08，0.73）〕是 NSTEMI 患者再发心肌梗死的保护因素（P ＜0.05）。结论合并糖尿病、合并高脂血症、合并高同型半胱氨酸血症的 NSTEMI 患者易再发心肌梗死，随访频率增高可降低 NSTEMI 患者心肌梗死再发率，因此，临床上应加强对 NSTEMI 患者血糖、血脂及血清同型半胱氨酸水平的控制，并定期随访。%Objective To analyze the influencing factors of recurrent myocardial infarction in patients with non ST -segment elevation myocardial infarction(NSTEMI),to discuss the preventive strategies. Methods From March 2011 to March 2014,a total of 196 patients with NSTEMI were selected in the People′s Hospital of Yangdong District,Yangjiang,and all of them were followed up for 1 year after discharge. According to professional knowledge,related factors of recurrent myocardial infarction in patients with NSTEMI were preliminarily analyzed,then multivariate logistic regression model was used to analyze the influencing factors of recurrent myocardial infarction in patients with NSTEMI. Results During the fellow - up,36 cases withdrawn,7 cases died,33 cases occurred recurrent myocardial infarction( served as A group),other 120 cases did not occurred recurrent myocardial infarction(served as B group). The proportion of patients over 70 years old,complicated with diabetes,with hyperlipidaemia,with hyperhomocysteinemia,with follow - up frequency less than 6 times per year of A group was statistically significantly higher than that of B group,respectively(P < 0. 05),while no statistically significant differences of proportion of male,proportion of patients complicated with hypertension,with sleep disorders,with hyperuricemia smoking rate or drinking rate was found between the two groups( P ﹥ 0. 05 ). Multivariate logistic regression analysis showed that, complicated with diabetes〔OR = 4. 01,95% CI(1. 70,9. 12)〕,complicated with hyperlipidaemia〔 OR = 14. 15,95% CI (2. 29,98. 36)〕,complicated with hyperhomocysteinemia〔 OR = 21. 12,95% CI(3. 42,130. 32)〕 were risk factors of recurrent myocardial infarction in patients with NSTEMI,while fellow - up frequency〔OR = 0. 24,95% CI(0. 08,0. 73)〕was the protective factor of recurrent myocardial infarction in patients with NSTEMI(P < 0. 05). Conclusion NSTEMI patients complicated with diabetes,with hyperlipidaemia,with hyperhomocysteinemia have high risk of recurrent myocardial infarction, while high fellow - up frequency was the protective factor,so clinician should strengthen the control of blood glucose,blood lipid,serum homocysteine level and regular follow - up.