中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
12期
1266-1270
,共5页
张智云%冯玉宝%苏平%李永玲%王海军%李长青%郭小燕%郝东亚
張智雲%馮玉寶%囌平%李永玲%王海軍%李長青%郭小燕%郝東亞
장지운%풍옥보%소평%리영령%왕해군%리장청%곽소연%학동아
饮酒%急性心肌梗死%危险因素%男性
飲酒%急性心肌梗死%危險因素%男性
음주%급성심기경사%위험인소%남성
Alcohol drinking%Acute myocardial infarction%Risk factors%Male
目的 探讨不同饮酒量与初次急性心肌梗死(AMI)男性患者的危险因素、生化指标、冠状动脉病变严重程度、心功能及6个月再发心血管事件的关系.方法 连续入选明确诊断为初次AMI的男性患者186例,根据饮酒量不同分为不饮酒组、适量饮酒组、大量饮酒组.对比分析其各项临床资料并随访6个月时心血管事件发生情况.结果 不饮酒组及适量饮酒组的平均年龄明显高于大量饮酒组[(60.30±11.87)、(62.52 ±10.05)岁与(54.77±11.37)岁,P均＜0.05];与不饮酒组比较,大量饮酒组吸烟率(97.10％与78.38％).、血清天冬氨酸氨基转移酶[58.24(13.48) mmol/L与45.36(11.32)mmol/L]、丙氨酸氨基转移酶[56.34(12.98) mmol/L与36.25(9.62) mmol/L]及血尿酸水平[(326.77±67.72) μmol/L与(293.68 ±52.29) μmol/L]显著升高,左心室射血分数[(49.51±9.62)％与(54.35±8.61)％]、左心室短轴缩短率[(28.09±4.89)％与(30.86±5.08)％]及E/A值(0.83 ±0.31与1.01±0.43)明显降低(P均＜0.05);大量饮酒组较适量组高密度脂蛋白胆固醇明显降低[(0.94±0.23)mmol/L与(1.12±0.39) mmoL/L],甘油三酯明显升高[2.18(0.65) mmol/L与1.46(0.46) mmol/L],差异均有统计学意义(P均＜0.05);适量饮酒组较不饮酒组高密度脂蛋白胆固醇明显升高[(1.12±0.39)mmol/L与(0.95 ±0.30) mmol/L],差异有统计学意义(P＜0.05);大量饮酒组心血管事件发生率明显高于其他两组[25.72％ (18/70)与13.51％ (10/74)与9.50％(4/42)],差异均有统计学意义(P均＜0.05);Logistic回归分析提示吸烟(OR=3.648,95％ CI:1.025～12.968,P=0.046)、糖尿病(OR=7.068,95％ CI:1.049 ～ 15.284,P=0.013)是新发心血管事件的独立预测因素.结论 大量饮酒患者AMI发病年龄较轻、血脂异常发生率较高、心脏的收缩及舒张功能较差;吸烟和糖尿病与6个月再发心血管事件呈正相关;通过改善血脂异常,适量饮酒可能对AMI的发病有一定保护作用.
目的 探討不同飲酒量與初次急性心肌梗死(AMI)男性患者的危險因素、生化指標、冠狀動脈病變嚴重程度、心功能及6箇月再髮心血管事件的關繫.方法 連續入選明確診斷為初次AMI的男性患者186例,根據飲酒量不同分為不飲酒組、適量飲酒組、大量飲酒組.對比分析其各項臨床資料併隨訪6箇月時心血管事件髮生情況.結果 不飲酒組及適量飲酒組的平均年齡明顯高于大量飲酒組[(60.30±11.87)、(62.52 ±10.05)歲與(54.77±11.37)歲,P均＜0.05];與不飲酒組比較,大量飲酒組吸煙率(97.10％與78.38％).、血清天鼕氨痠氨基轉移酶[58.24(13.48) mmol/L與45.36(11.32)mmol/L]、丙氨痠氨基轉移酶[56.34(12.98) mmol/L與36.25(9.62) mmol/L]及血尿痠水平[(326.77±67.72) μmol/L與(293.68 ±52.29) μmol/L]顯著升高,左心室射血分數[(49.51±9.62)％與(54.35±8.61)％]、左心室短軸縮短率[(28.09±4.89)％與(30.86±5.08)％]及E/A值(0.83 ±0.31與1.01±0.43)明顯降低(P均＜0.05);大量飲酒組較適量組高密度脂蛋白膽固醇明顯降低[(0.94±0.23)mmol/L與(1.12±0.39) mmoL/L],甘油三酯明顯升高[2.18(0.65) mmol/L與1.46(0.46) mmol/L],差異均有統計學意義(P均＜0.05);適量飲酒組較不飲酒組高密度脂蛋白膽固醇明顯升高[(1.12±0.39)mmol/L與(0.95 ±0.30) mmol/L],差異有統計學意義(P＜0.05);大量飲酒組心血管事件髮生率明顯高于其他兩組[25.72％ (18/70)與13.51％ (10/74)與9.50％(4/42)],差異均有統計學意義(P均＜0.05);Logistic迴歸分析提示吸煙(OR=3.648,95％ CI:1.025～12.968,P=0.046)、糖尿病(OR=7.068,95％ CI:1.049 ～ 15.284,P=0.013)是新髮心血管事件的獨立預測因素.結論 大量飲酒患者AMI髮病年齡較輕、血脂異常髮生率較高、心髒的收縮及舒張功能較差;吸煙和糖尿病與6箇月再髮心血管事件呈正相關;通過改善血脂異常,適量飲酒可能對AMI的髮病有一定保護作用.
목적 탐토불동음주량여초차급성심기경사(AMI)남성환자적위험인소、생화지표、관상동맥병변엄중정도、심공능급6개월재발심혈관사건적관계.방법 련속입선명학진단위초차AMI적남성환자186례,근거음주량불동분위불음주조、괄량음주조、대량음주조.대비분석기각항림상자료병수방6개월시심혈관사건발생정황.결과 불음주조급괄량음주조적평균년령명현고우대량음주조[(60.30±11.87)、(62.52 ±10.05)세여(54.77±11.37)세,P균＜0.05];여불음주조비교,대량음주조흡연솔(97.10％여78.38％).、혈청천동안산안기전이매[58.24(13.48) mmol/L여45.36(11.32)mmol/L]、병안산안기전이매[56.34(12.98) mmol/L여36.25(9.62) mmol/L]급혈뇨산수평[(326.77±67.72) μmol/L여(293.68 ±52.29) μmol/L]현저승고,좌심실사혈분수[(49.51±9.62)％여(54.35±8.61)％]、좌심실단축축단솔[(28.09±4.89)％여(30.86±5.08)％]급E/A치(0.83 ±0.31여1.01±0.43)명현강저(P균＜0.05);대량음주조교괄량조고밀도지단백담고순명현강저[(0.94±0.23)mmol/L여(1.12±0.39) mmoL/L],감유삼지명현승고[2.18(0.65) mmol/L여1.46(0.46) mmol/L],차이균유통계학의의(P균＜0.05);괄량음주조교불음주조고밀도지단백담고순명현승고[(1.12±0.39)mmol/L여(0.95 ±0.30) mmol/L],차이유통계학의의(P＜0.05);대량음주조심혈관사건발생솔명현고우기타량조[25.72％ (18/70)여13.51％ (10/74)여9.50％(4/42)],차이균유통계학의의(P균＜0.05);Logistic회귀분석제시흡연(OR=3.648,95％ CI:1.025～12.968,P=0.046)、당뇨병(OR=7.068,95％ CI:1.049 ～ 15.284,P=0.013)시신발심혈관사건적독립예측인소.결론 대량음주환자AMI발병년령교경、혈지이상발생솔교고、심장적수축급서장공능교차;흡연화당뇨병여6개월재발심혈관사건정정상관;통과개선혈지이상,괄량음주가능대AMI적발병유일정보호작용.
Objective To investigate the relationship of alcohol consumption with risk factors,biochemical indexes,severity of coronary stenosis,cardiac function and recurrent cardiovascular events after a fellow up of 6 months in male patients with initial Acute Myocardial Infarction(AMI).Methods One hundred and eighty-six male patients were selected as our subjects who were initially diagnosed as AMI.Thepatients were divided into non alcohol group,moderate drinking group and heavy drinking group.They were conducted 6 month follow up.The clinical data and the occurrence of recurrent cardiovascular events were recorded.Results Average age of non-drinker group and moderate drinking group were (60.30 ± 11.87) year and (62.52 ± ± 10.05) year,older than that of heavy drinking group ((54.77 ± 11.37) year; P ＜ 0.05)).Percentage of smoking in heavy drinking group was 97.10％,higher than that in non-drinker group (78.38％) (P ＜ 0.05).Meanwhile,the levels of serum aspartate aminotransferase,alanine aminotransferase,urea in heavy drinking group were 58.24 (13.48) mmol/L,56.34 (12.98) mmol/L,(326.77 ± 67.72) μmol/L respectively,higher than that in non-alcohol group(45.36(11.32) mmol/L,36.25(9.62) mmol/L,(293.68 ±52.29) μmol/L;P ＜ 0.05).However,the left ventricular ejection factor,fractional shortening,E/A were (49.51 ± 9.62) ％,(28.09 ± 4.89)％,(0.83 ± 0.31) in heavy drinking group,lower than that in non alcohol group((54.35 ± ± 8.61) ％,(30.86 ± 5.08) ％,1.01 ± 0.43 ; P ＜ 0.05).High-density lipoproteincholesterol levels were significantly lower while triglyceride levels were much higher in heavy drinking group than moderate drinking group ((0.94±0.23 mmol/Lvs.(1.12 ±0.39) mmol/L;2.18(0.65) mmol/L vs.1.46(0.46) mmol/L;P ＜0.05).Serum levels of high-density lipoproteincholesterol in moderate drinking group was (1.12 ± 0.39) mmol/L,significantly higher than that in non-alcohol group ((0.95 ±0.30) mmol/L,P ＜0.05).The highest percentage of recurrent cardiovascular events in the heavy drinking groups was 25.72％ (18/70),higher than other two groups (13.51％ (10/74),9.5％ (4/42) ; P ＜ 0.05).Logistic regression analysis indicated that smoking (OR =3.648,95 ％ CI:1.025-12.968,P =0.046),diabetes (OR =7.068,95 ％ CI:1.049-15.284,P =0.013) were both independent predictors of the recurrent cardiovascular events.Conclusion Patients with heavy drinking show younger ages with initial AMI,higher incidences of dyslipidemia,and poorer cardiac systolic/diastolic function.Recurrent cardiovascular events in a 6 month follow up were positively correlated with smoking and diabetes.Moderate drinking might be helpful to improve the disorders of lipid metabolism in AMI patients.
