ST段抬高型心肌梗死患者发生心功能不全的相关因素研究

摘要

Objective To explore the characteristics and risk factors of heart failure in patients with ST - elevation my-ocardial infarction ( STEMI ).Methods In the three - year retrospective cohort study 371 patients ( 303 males and 68 females ) with STEMI treated with primary percutaneous coronary intervention ( PCI ) were recruited in Beijing Anzhen Hospital, from Jan.2007 to Jan.2010, with the average age of ( 56.1 ±11.7 ) years.STEMI patients were, according to the heart function of Killip grade at the time of admission, divided into severe heart failure ( HF ) group ( Killip Ⅲ-Ⅳ grades ) and the group with mild or no HF ( Killip Ⅰ-Ⅱ grades ).The parameters of age, gender, history of angina, previous MI, history of hypertension, history of diabetes mellitus, history of smoking, location of MI, number of Culprit vessels, time between onset of symptoms and admission, triglycerides, cholesterol, high density lipoprotein, low density lipoprotein, glycated hemoglobin, fibrinogen, D -dimer, blood urea, creatinine, serum potassium, uric acid, blood glucose, leukocyte, neutrophil percentage, and hemoglobin were analyzed and compared between the two groups with simple correlation analysis and Logistic regression analysis.Results History of diabetes mellitus, and parameters of urea and creatinine were significantly different between the two groups ( P ＜ 0.10 ).Logistic regression analysis showed creatinine and history of diabetes mellitus were major risk factors of severe HF in patients with STEMI ( P ＜ 0.05 ), with the highest contribution of creatinine.Conclusion Elevated creatinine level and history of diabetes mellitus are important risk factors of severe HF in patients with STEMI.%目的 探讨ST段抬高型心肌梗死(STEMI)患者发生心功能不全的特点及其相关因素,以期提高STEMI患者的存活率.方法 本研究是一个历时三年的回顾性队列研究.选取2007年1月-2010年1月连续收入的STEMI并行直接经皮冠状动脉介入术(PCI)的患者371例,其中男303例,女68例,平均年龄(56.1±11.7)岁.根据入院时心功能Killip分级,将STEMI患者分为轻度或无心功能不全组(Killip I～Ⅱ级)和重度心功能不全组(Killip Ⅲ～Ⅳ级).对两组患者的年龄、性别、既往心绞痛史、既往心梗史、高血压史、糖尿病史、吸烟史、心梗位置、单多支病变、罪犯血管、心梗时间距采血时间、三酰甘油、胆固醇、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白、纤维蛋白原、D-二聚体、尿素、肌酐、血钾、尿酸、血糖、白细胞、中性粒细胞百分比和血红蛋白等参数进行单因素分析和Logistic回归分析.结果 两组患者的糖尿病史、尿素和肌酐等参数间差异有统计学意义(P＜0.10);最后进入回归方程的只有肌酐和糖尿病史(P＜0.05),贡献最大的是肌酐.结论 肌酐水平高和糖尿病史是STEMI患者发生心功能不全的重要危险因素.