CAJ | 학술논문

目的分析急性ST段抬高型心肌梗死(STEMI)合并解剖性左心室室壁瘤(LVA)的危险因素,建立多重危险因素模型以定量评价各种因素对LVA的致病危险.方法 2010年6月至2013年12月河北省承德医学院附属医院心内科住院的冠心病患者3 523例,其中急性STEMI患者580例,占18.3％,符合纳入标准的急性STEMI患者518例均连续入选,分为LVA组106例(20.5％)和无LVA组412例(79.5％).收集所有患者的人口学特征与临床资料,建立STEMI合并LVA的多因素logistic回归模型.结果前壁STEMI、前降支闭塞、双支或三支病变、入院时收缩压升高、窦性心动过速及白细胞升高等均为STEMI患者发生解剖LVA的独立危险因素,其比值比(OR值)依次为18.21、21.56、4.22、7.16、1.98、1.57(均P＜0.05);而STEMI后12h内就诊、冠状动脉侧支循环建立、静脉药物溶栓治疗与急诊经皮冠状动脉介入治疗均为STEMI患者发生解剖性LVA的独立保护因素,OR值依次为0.60、0.53、0.23、0.12(均P＜0.05).结论前壁STEMI、前降支闭塞、双支或三支病变、入院时收缩压升高、窦性心动过速与白细胞升高等均为STEMI患者发生解剖LVA的独立危险因素,而STEMI后12h内就诊、冠状动脉侧支循环建立、静脉药物溶栓治疗与急诊PCI均为STEMI患者发生解剖性LVA的独立保护因素.心血管医生应及时评估危险因素,尽早干预可控制因素,降低STEMI患者LVA发生率,改善预后.
목적 분석급성ST단태고형심기경사(STEMI)합병해부성좌심실실벽류(LVA)적위험인소,건립다중위험인소모형이정량평개각충인소대LVA적치병위험.방법 2010년6월지2013년12월하북성승덕의학원부속의원심내과주원적관심병환자3 523례,기중급성STEMI환자580례,점18.3％,부합납입표준적급성STEMI환자518례균련속입선,분위LVA조106례(20.5％)화무LVA조412례(79.5％).수집소유환자적인구학특정여림상자료,건립STEMI합병LVA적다인소logistic회귀모형.결과 전벽STEMI、전강지폐새、쌍지혹삼지병변、입원시수축압승고、두성심동과속급백세포승고등균위STEMI환자발생해부LVA적독립위험인소,기비치비(OR치)의차위18.21、21.56、4.22、7.16、1.98、1.57(균P＜0.05);이STEMI후12h내취진、관상동맥측지순배건립、정맥약물용전치료여급진경피관상동맥개입치료균위STEMI환자발생해부성LVA적독립보호인소,OR치의차위0.60、0.53、0.23、0.12(균P＜0.05).결론 전벽STEMI、전강지폐새、쌍지혹삼지병변、입원시수축압승고、두성심동과속여백세포승고등균위STEMI환자발생해부LVA적독립위험인소,이STEMI후12h내취진、관상동맥측지순배건립、정맥약물용전치료여급진PCI균위STEMI환자발생해부성LVA적독립보호인소.심혈관의생응급시평고위험인소,진조간예가공제인소,강저STEMI환자LVA발생솔,개선예후.
Objective To set up the multiple risk factors model of patients with anatomical left ventricular aneurysm (LVA) post acute ST-elevation myocardial infarction (STEMI) and quantitatively assess the pathopoiesis of all the factors.Methods A total of 518 consecutive inpatients with acute STEMI hospitalized from June 2010 to December 2013 in our hospital were enrolled in this study,patients were divided into two groups:LVA group (n =106,20.5％) and non-LVA group (n =412,79.5％).All demographic and clinical data were collected by cardiologists.Finally,all of the risk factors for anatomical LVA in the acute STEMI patients were quantitatively analyzed by a binary logistic regression model.Results The muhiple risk factors logistic regression model was set up for the anatomical LVA in patients with acute STEMI.Anterior wall myocardial infarction,occlusion of the left anterior descending branch,two or three vessels stenosis,high systolic blood pressure,sinus tachycardia and white blood cell count over 10 000 per microliter were all independent risk factors of the LVA in acute STEMI,with the odds ratio (OR) 18.21,21.56,4.22,7.16,1.98 and 1.57,respectively(all P ＜ 0.05).However,first medical contact less than 12 hours(OR =0.60),collateral circulation of the coronary arteries (OR =0.53),primary percutanous coronary intervention(OR =0.23) and venous thrombolysis (OR =0.12) were all protecting factors of the LVA in acute STEMI patients (all P ＜ 0.05).Conclusion Anterior wall STEMI,occlusion of the left anterior descending branch,two or three vessels stenosis,high systolic blood pressure,sinus tachycardia and white blood cell count over 10 000 per microlitre are independent risk factors of the LVA in acute STEMI patients.However,first medical contact less than twelve hours,collateral circulation of the coronary arteries,together with the primary percutanous coronary intervention and venous thrombolysis are protective factors of the LVA in patients with acute STEMI.It is important for cardiologists to assess the risks of LVA and make emergent and suitable efforts to reduce the risk of developing LVA in STEMI patients.