急性心肌梗死患者低钙血症情况分析

Hypocalcaemia in patients with acute myocardial infarction

目的探讨急性心肌梗死患者低钙血症的发生及其与预后的关系。方法对2003年1月至2006年12月哈尔滨医科大学附属第一医院CCU病房收治的1274例急性心肌梗死患者进行回顾性分析，常规方法测定血浆钙离子浓度，依据最低值进行分组，A组Ca^2＋≥2．20mmol／L，B组Ca^2＋（2．00～2．19）mmol／L，C组Ca^2＋（1．90～1．99）mmol／L，D组Ca^2＋〈1．90mmol／L组，比较各组间病死率，并分析可能与之相关的因素。于入院后2～3d内行床旁超声心动图检查。结果A组Ca^2＋≥2．20mmol／L，共668例（52．4％）；B组（2．00～2．19）mmol／L，共476例（37．4％）；C组（1．90～1．99）mmol／L，共73例（5．7％）；D组Ca^2＋〈1．90mmol／L，共45例（3．5％）。A、B、C、D各组的死亡情况分别为17（2．5％）、37（7．8％）、15（20．5％）、8（17．8％），差异具有统计学意义（P〈0．001）；对急性心肌梗死后30d住院期间死亡危险因素进行Logistic回归分析，血钙浓度是否低于2．2mmol／L的伽值为0．501（P=0．044）。结论低钙血症的发生是急性心肌梗死后30d病死率的独立预测因子。

Objective To determine the prevalence and prognostic implication of hypocalcemia in the setring of acute myocardial infarction. Method The study consisted of 1274 consecutive patients presenting with acute myocardial infarction. Plasma calcium concentrations were obtained on the 1st day, 2nd day, 3rd day after admission. According to the plasma calcium concentrations, 1274 patients with AMI were designed into four groups： group A （Ca^2＋≥ 2.20 mmol/L）, group B （2.00- 2.19 mmoL/L）, group C （1.90- 1.99 mmol/L）, group D （Ca^2＋ 〈 1.9 mmol/L）. Echocardiographie examination was performed on day 2 or 3 of hospitalization. Results There were 606 patients （47.6%） having hypacalcemia, defined as a plasma calcium level 〈 2.2 mmol/L. Among them, there were 476 patients（37.4% ）in group B（2.00- 2.19 mmol/L）,73 patients（5.7% ） in group C （1.90- 1.99 mmol/L） and 45 patients（3.5%）in group D（Ca^2＋ 〈 1.90 mmol/L）. The mortality of group A was 2.5 %, on the contrary, the mortality of the other groups was 7.8 %, 20.5 %, 17.8 %. The difference was significant. In multivariate logistic regression analysis, hypocalcemia was independently associated with 30-day mortality. Conclusions Hypocalcemia in patients with acute myocardial infarction is an independent predictor of 30-day morlality.