CAJ | 학술논문

目的分析老年急性心肌梗死(AMI)伴消化道出血患者的临床特点及预后.方法 325例确诊为AMI的老年患者分为对照组(304例)、AMI后消化道出血组(14例)和消化道出血后AMI组(7例),分析老年AMI伴消化道出血患者的临床特点和1年心血管死亡和因再发心绞痛、非致死性AMI、心力衰竭和脑卒中而住院的复合终点结果.结果 (1)AMI后消化道出血组的估测肾小球滤过率(eGFR)低于对照组,分别为(61.9±27.3)ml·min-·1.73 m-2与(77.3±27.9)ml·min-1·1.73 m2,差异有统计学意义(P＜0.05),多因素回归分析结果显示,eGFR降低对老年AMI患者发生消化道出血的相对危险为0.980(95％CI为0.960～0.999,P＜0.05)；(2)消化道出血后AMI组抗血小板、抗凝治疗的比例和AMI后消化道出血组阿司匹林使用的比例均低于对照组(P均＜0.05),消化道出血后AMI组的血红蛋白低于AMI后消化道出血组,分别为(74±14)g/L与(111±25)g/L,差异有统计学意义(P＜0.01),接受输血治疗的比例高于AMI后消化道出血组,分别为85.7％(6例)与28.6％(4例),差异有统计学意义(P＜0.05)；消化道出血后AMI组介入或溶栓治疗的比例显著低于对照组差异有统计学意义(P＜0.01)；(3)AMI后消化道出血组的1年心血管死亡和因再发心绞痛、非致死性AMI、心力衰竭和脑卒中而住院的复合终点高于对照组,分别为42.9％(6/14)与17.8％(54/304),差异有统计学意义(P＜0.05).结论 eGFR降低是老年AMI患者发生消化道出血重要的预测因素.老年AMI患者伴发消化道出血常使抗血小板、抗凝和冠状动脉再通治疗困难,且多预后不良.
목적 분석노년급성심기경사(AMI)반소화도출혈환자적림상특점급예후.방법 325례학진위AMI적노년환자분위대조조(304례)、AMI후소화도출혈조(14례)화소화도출혈후AMI조(7례),분석노년AMI반소화도출혈환자적림상특점화1년심혈관사망화인재발심교통、비치사성AMI、심력쇠갈화뇌졸중이주원적복합종점결과.결과 (1)AMI후소화도출혈조적고측신소구려과솔(eGFR)저우대조조,분별위(61.9±27.3)ml·min-·1.73 m-2여(77.3±27.9)ml·min-1·1.73 m2,차이유통계학의의(P＜0.05),다인소회귀분석결과현시,eGFR강저대노년AMI환자발생소화도출혈적상대위험위0.980(95％CI위0.960～0.999,P＜0.05)；(2)소화도출혈후AMI조항혈소판、항응치료적비례화AMI후소화도출혈조아사필림사용적비례균저우대조조(P균＜0.05),소화도출혈후AMI조적혈홍단백저우AMI후소화도출혈조,분별위(74±14)g/L여(111±25)g/L,차이유통계학의의(P＜0.01),접수수혈치료적비례고우AMI후소화도출혈조,분별위85.7％(6례)여28.6％(4례),차이유통계학의의(P＜0.05)；소화도출혈후AMI조개입혹용전치료적비례현저저우대조조차이유통계학의의(P＜0.01)；(3)AMI후소화도출혈조적1년심혈관사망화인재발심교통、비치사성AMI、심력쇠갈화뇌졸중이주원적복합종점고우대조조,분별위42.9％(6/14)여17.8％(54/304),차이유통계학의의(P＜0.05).결론 eGFR강저시노년AMI환자발생소화도출혈중요적예측인소.노년AMI환자반발소화도출혈상사항혈소판、항응화관상동맥재통치료곤난,차다예후불량.
Objective To investigate the clinical characteristics and prognosis of acute myocardial infarction(AMI) patients with gastrointestinal bleeding (GIB) in the elderly.Methods Total 325 elderly patients with AMI were divided into AMI control group (n=304,patients without gastrointestinal bleeding around the period of AMI),GIB-post-AMI (n=14,patients developing gastrointestinal bleeding after AMI) group and AMI-post-GIB (n=7,patients with gastrointestinal bleeding subsequently suffered an AMI) group.The clinical characteristics and combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal AMI,heart failure and stroke were analysed.Results (1) Estimated glomerular filtration rate (eGFR) became lower in the patients with GIB-post-MI (61.9+27.3) ml · min-1 · 1.73 m2 compared with AMI control patients (77.3+27.9) ml · min-1 · 1.73 m2,P＜0.05.Multivariate regression analysis revealed that the relative risk from a decreased eGFR for developing gastrointestinal bleeding after AMI in elderly patients was 0.980 (95％CI:0.960-0.999,P＜0.05).(2) There were significantly less patients adopting anti-platelet and anti-coagulant medications in AMI-post-GIB group and less patients applying aspirin in GIB-post-AMI group as compared with AMI control group,respectively (P＜0.05).AMIpost-GIB patients had significantly lower hemoglobin (74 + 14) g/L than GIB-post-AMI patients (111±25) g/L,P＜0.01.More MI-post-GIB patients (6 cases,85.7％) versus GIB-post-AMI patients (4 cases,28.6％)underwent blood transfusion( P＜0.05).There were significantly less patients adopting PCI and thrombolytic therapy in AMI-post-GIB group as compared to AMI control patients (P＜0.01).(3) The combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-lethal MI,heart failure and stroke in GIB-post-MI group were significantly higher than in AMI control group[42.9％ (6/14) vs.17.8％ (54/304),P＜0.05].Conclusions Reduced eGFR is an important predictor for elderly AMI patients developing gastrointestinal bleeding which makes it difficult to take anti-platelet and anti-coagulant medication and to receive revascularization treatment,usually with worse prognosis.