急性前壁心肌梗死合并室壁瘤及其相关危险因素分析

发布时间：2018-04-26 03:05

本文选题：急性前壁心肌梗死 + 室壁瘤　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的分析急性前壁心肌梗死患者出现室壁瘤并发症的临床资料及危险因素,以早期识别高危患者,为AMI患者早期评估LVA形成的危险因素提供补充依据。方法病例对照研究。收集宁夏医科大学总医院自2010年1月至2016年10月收住心内科的急性前壁心肌梗死且有冠状动脉造影资料患者共2602例,其中并发室壁瘤形成106例,符合纳入标准85例为病例组。随机选取同一时间段入院,按年龄、性别匹配无室壁瘤形成的急性前壁心肌梗死170例为对照组。总结并分析室壁瘤形成相关因素。采用条件Logistic回归分析急性前壁心肌梗死并发室壁瘤形成的独立危险因素。结果本研究共纳入85例急性前壁心肌梗死并发室壁瘤患者,其中男性57例(33.3%),女性28例(33.3%),平均年龄(62.45±11.89)岁;170例急性前壁心肌梗死患者中,男性114例(66.7%),女性56例(66.7%),平均年龄(62.44±11.86)岁。(1)两组患者年龄、性别、民族、高血压、糖尿病、高脂血症、陈旧性心肌梗死、PCI史、冠心病家族史、吸烟史、脑卒中方面均无统计学差异(P0.05),临床基线资料基本一致。(2)LVA组患者入院时收缩压升高、窦性心动过速、恶性心律失常及STEMI的发生率均高于非LVA组,而LVA组梗死前心绞痛发生率低于非LVA组(均P0.05)。(3)LVA组NT-proBNP、WBC、PLT、UREA、UA水平均较非LVA组高(均P0.05)。(4)LVA组LVEF、FS水平均低于非LVA组(均P0.05),而LVA组LVEDD、LVESD均高于非LVA组(P0.001),LVA组左心室血栓发生率较非LVA组高(P0.001)。(5)LVA组心功能KillipIII级、KillipIV级发生率均高于非LVA组(均P0.05)。(6)LVA组行急诊PCI及侧支循环建立的发生率均低于非LVA组(均P0.05);而LVA组单支血管病变、病变血管完全或次全闭塞的发生率均高于非LVA组(均P0.05)。(7)入院时收缩压升高、KillipIII/IV级、STEMI、单支血管病变、病变血管完全或次全闭塞是LVA事件的独立危险因素,其OR值分别是:5.113、13.008、12.076、6.025、7.296(均P0.05)。而梗死前心绞痛、急诊PCI、侧支循环建立是LVA事件的保护性因素,OR值分别是:0.196、0.071、0.151(均P0.05)。结论STEMI患者中室壁瘤发生率较高。NT-proBNP不仅是心肌坏死和反应心功能状态的标志物,而且对于LVA的形成具有一定的提示作用。入院时收缩压升高、KillipIII/IV级、STEMI、单支血管病变、梗塞血管完全或次全闭塞是急性前壁心肌梗死后LVA事件的独立危险因素。
[Abstract]:Objective to analyze the clinical data and risk factors of ventricular aneurysm complications in patients with acute anterior wall myocardial infarction (AMI) so as to identify high-risk patients early and provide additional evidence for early evaluation of risk factors of LVA formation in patients with AMI. Methods A case-control study was conducted. From January 2010 to October 2016, 2602 patients with acute anterior myocardial infarction (AMI) and coronary angiography (CAG) were collected from the General Hospital of Ningxia Medical University. 170 patients with acute anterior myocardial infarction without ventricular aneurysm were randomly selected as control group. The factors related to the formation of ventricular aneurysms were summarized and analyzed. Conditional Logistic regression analysis was used to analyze the independent risk factors of ventricular aneurysm formation in acute anterior myocardial infarction. Results A total of 85 patients with acute anterior wall myocardial infarction complicated with ventricular aneurysm were included in this study. Among them, 57 cases were male and 28 cases were female, with an average age of 62.45 卤11.89 years old and 170 cases with acute anterior wall myocardial infarction. The age, sex, nationality, hypertension, diabetes mellitus, hyperlipidemia, old myocardial infarction history, coronary heart disease family history, smoking history of the two groups were 62.44 卤11.86 years old (mean age 62.44 卤11.86) years (n = 114), 66.7% (n = 56), 66.7% (n = 56), and (1) age, sex, nationality, hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease (CHD), family history and smoking history. There was no significant difference in stroke between two groups (P 0.05). The clinical baseline data were basically the same. The systolic blood pressure, sinus tachycardia, malignant arrhythmia and STEMI were higher in the STEMI group than in the non-LVA group, and the incidence of sinus tachycardia, malignant arrhythmia and STEMI were higher than those in the non LVA group. The incidence of pre-infarction angina pectoris in LVA group was lower than that in non-LVA group (all P0.05).(3)LVA group was higher than that in non-LVA group (P0.05).(4)LVA group was lower than non-LVA group (P 0.05), and LVA group was higher than non-LVA group (P 0.001). LVESD was higher than that in non-LVA group.) the incidence of left ventricular thrombosis in P0.05).(3)LVA group was higher than that in non-LVA group (P 0.05). The incidence of left ventricular thrombosis in LVA group was higher than that in non-LVA group (P 0.001). The incidence of left ventricular thrombosis in LVA group was higher than that in non-LVA group. The incidence of KillipIII grade Killip IV of cardiac function in the group of high P0.001 + 5 LVA was higher than that in the group without LVA (the incidence of emergency PCI and collateral circulation establishment in both P0.05).(6)LVA group was lower than that in the non-LVA group (all P 0.05), and the incidence of single vessel disease in LVA group was higher than that in the control group (P < 0.05). The incidence of complete or subtotal occlusion of the diseased vessels was higher than that of the non LVA group (P0. 05, P < 0. 05, P < 0. 05). The risk factors of LVA events were single vessel lesion and total or subtotal occlusion of the diseased vessels. The OR values were respectively 5. 11313. 0013. 0012. 6. 0257.296 (all P 0. 05). The OR of preinfarction angina pectoris, emergency PCI and collateral circulation were 0. 196 0. 071 卤0. 151 (P < 0. 05), respectively. Conclusion the incidence of ventricular aneurysm in patients with STEMI is relatively high. NT-proBNP is not only a marker of myocardial necrosis and reactive cardiac function, but also a clue to the formation of LVA. Elevated systolic blood pressure (systolic blood pressure) at admission was an independent risk factor for LVA events after acute anterior myocardial infarction (AMI) with single vessel disease and complete or subtotal occlusion of infarcted vessels.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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