慢性阻塞性肺病急性加重期合并急性心肌梗死的临床观察

Clinical observation of chronic obstructive pulmonary disease with acute myocardial infarction

目的:探讨慢性阻塞性肺病(COPD)急性加重期合并急性心肌梗死(AMI)的临床特点、诊断及预后。方法:比较COPD急性加重期合并AMI患者(A组,43例)及单纯冠心病AMI患者(B组,158例)在临床表现、心律失常、AMI类型、肌酸激酶-MB(CK-MB)及肌钙蛋白T峰值等方面的异同,显示前者的临床特点,并随访6个月,比较两组的预后(再AMI率、再住院率、病死率)。结果:A组胸痛发生率明显低于B组(25.6%vs60.1%,P<0.01),A组肺水肿和心源性休克发生率明显高于B组(48.8%vs20.2%,P<0.01和20.9%vs8.8%,P<0.05);A组房性心律失常(包括房颤)和右束支传导阻滞发生率高于B组(65.1%vs18.9%,P<0.01和25.6%vs10.7%,P<0.05);与B组相比,A组非ST段抬高型AMI(NSTEMI)发生率相对较高(30.2%vs17.1%),但差别无统计学意义(P>0.05);两组CK-MB和肌钙蛋白T峰值差异无统计学意义;两组再AMI率差异无统计学意义,A组再住院率及病死率高于B组(23.2%vs10.1%,P<0.05和16.2%vs6.3%,P<0.05)。结论:COPD合并AMI患者胸痛发生较少,较易出现肺水肿和心源性休克;再住院率和病死率较高,预后较差。追踪心电图及心肌酶谱动态变化有助诊断。

Objective： To explore the clinical characteristics, diagnosis and prognosis of chronic obstructive pulmonary disease （COPD） complicated by acute myocardial infarction （AMI）. Methods： A total of 201 AMI patients were divided according to their history of COPD into Group A （ with COPD, n = 43） and B （without COPD, n = 158）. Comparative analyses were made of such clinical data as symptoms, kinds of arrhythmia, the rates of ST- and non ST-segment elevation myocardial infarction （STEMI and NSTEMI） , peak levels of creatine kinase-MB （CK-MB） and cardiac troponin-T （cTn-T）. All the patients were followed up for 6 months. The rates of re-yocardial infarction and re-admission and mortality were compared. Results ： The incidence of chest pain was significantly lower, while that of pulmonary edema and cardiogenic shock statistically higher in Group A than in B （25.6% vs 60.1% , P 〈 0.01 ;48.8% vs 20.2%, P 〈0.01; 20.9% vs 8.8%, P 〈0.05）. The rate of NSTEMI was slightly higher in the former than in the latter （30.2% vs 17.1%, P 〉0.05）. No statistical differences were observed either in the peak levels of CK-MB and cTn-T or in the incidence of re-myocardial infarction between the two groups. The percentage of re-admission and mortality were significantly higher in Group A （23.2% and 16.2% ） than in B （ 10.1% and 6.3% ） （ P 〈 0.05 ）. Conclusion ： COPD patients with AMI have a low incidence of chest pain, high incidences of pulmonary edema and cardiogenic shock, a high rate of re-admission, poor prognosis and high mortality. ECG tracing and myocardial zymogram may help to make a definite diagnosis.