非ST段抬高心肌梗死早期危险分层的临床研究

Clinical Study on Early Risk Stratification in Non-ST-segment Elevation Acute Myocardial Infarction

目的分析急性非ST段抬高心肌梗死(NSTEMI)患者早期危险分层的影响因子。方法对102例急性NSTEMI患者分别检测QT离散度(QTd)、心肌钙蛋白I(cTNI)、C反应蛋白(CRP)及心电图有无ST段下降≥1 mm。依照冠状血管造影术(CAG)结果把102例患者分为3组:单支病变组、双支病变组和三支病变组。结果各组在年龄上虽然未显示统计学上的差异,但男性明显多于女性(P<0.001)。在冠脉多支病变组糖尿病患者占30%以上,与单支病变组比较差异有统计学意义(P<0.01)。单支病变组QTd、cTNI、CRP及有ST段下降与其他2组差异有统计学意义(QTd,P<0.01;cTNI,P<0.05;CRP,P<0.01;ST段下降,P<0.05)。多因素逻辑回归分析结果显示,高龄、糖尿病病史、QTd、cTNI、CRP及有ST段下降是NSTEMI患者早期危险分层的预测因子(OR值分别为1.401、1.632、2.041、2.322、2.102、1.310)。存在4个因子异常的患者住院期间不良事件(再发心肌梗死、再发心绞痛、充血性心力衰竭)发生率明显高于存在1个因子者(P<0.01或P<0.05);心源性休克和死亡率差异无统计学意义。结论在急性NSTEMI患者存在高龄、糖尿病病史、QTd、cTNI、CRP及ST段下降≥1 mm等因素可作为NSTEMI患者早期危险分层的独立预测因子,提示冠脉多支病变,心肌缺血广泛和严重。危险级别越高,住院期间不良心血管事件的发生率越高,预后不良。

Objective To investigate the influential factors of early risk stratification in non-ST-segment elevation acute myocardial infarction(NSTEMI).Methods QT dispersion(QTd),cardiac troponin I(cTNI),C-reactive protein(CRP),presence of ST-segment depression were measured and coronary angiography(CAG) undertaken in 102 patients with NSTEMI.According to the results of CAG(single-vessel,two-vessel and triple-vessel changes in CAG),the 102 patients were divided into three groups(groups 1,2 and 3).Results Although there was no significant difference in the basic characters among the three groups,the percentage of male was higher than that of the female(P<0.001).Patients in group 1 had lower QTd,cTNI,CRP and fewer presence of ST-segment depression than the others.The percentage of diabetes mellitus in the group 2 and group 3 was higher than that in group 1(P<0.05).Multivariable logistic regression analysis suggested that aging、history of diabetes、elevated QTd、cTNI and CRP、presence of ST-segment depression were predictors of early risk stratification(OR:1.401,1.632,2.041,2.322,2.102 and 1.310 respectively).Reinfarction,recurrent angina and congestive heart failure were more frequently seen in patients with 4 factors than those with one factor only(P<0.05);but there were no significant difference in the occurrence of cardiogenic shock and mortality.Conclusion Aging,History of diabetes,elevated QTd,cTNI and CRP,presence of ST-segment depression are independent predictors of early risk stratification in NSTEMI,which are associated with severe ischemia and multivessel coronary artery disease and indicate a poor prognosis.