餐后无症状性心肌缺血与急性冠脉综合征相关研究

Study the Correlation between Myocardial Ischemia and Acute Coronary Artery Syndrome without Symptoms Postprandial

目的:探讨餐后无症状心肌缺血与急性冠脉综合征(ACS)发生相关性及比较,餐后无症状性心肌缺血在应用ABC(阿司匹林、倍他乐克、辛伐他汀)方案干预和不干预两组之间18个月内发展为ACS统计差异性,为ACS一级预防总结经验。方法:统计2006年12月至2009年6月在我院门诊及内科住院病人中45岁以上有冠心病高危因素(高血压、高血脂、糖尿病、吸烟、肥胖)患者182例,并排除以下之一作为入选病例:①有心梗、心绞痛、心脏手术史;②充血性心力衰竭心功能≥3级(NY-HA);③持续ST段下移;④左心肥厚、传导阻滞、心室激动、心脏起搏。将入选病例进行24h心电图检查,执行1X1X1(ST段呈水平型或下斜型下降≥0.1mv,持续时间超过1m in)标准诊断心肌缺血。筛选出有餐后无症状心肌缺血102例,无餐后心肌缺血者80例,以无餐后心肌缺血者80例做为正常对照组(A组)。再将有餐后心肌缺血病人随机分成非ABC干预组50例(B组),ABC干预组52例(C组)。以上组别病人分别在当天、第四周、第六个月、12个月、18个月进行24h心电图检查及心肌坏死标记物检测。根据心肌总缺血负荷及ST/HR比较,心肌坏死物结果,统计各组病人ACS发生概率。结果:A组与B组,B组与C组,在发展成为ACS终点事件中比较差异均有统计学意义(P≤0.01)。结论:①餐后无症状心肌缺血更容易发展为急性冠脉综合征,且冠状动脉病变部位和程度更严重。②ACS方案干预有效,且经济实用,值得进一步推广。

Objective： To research the correlation between myocardial ischemia without symptoms of postprandial and acute coronary artery syndrome （ACS） and then find out the prevention for ACS, we compared the group intervented with asprin, betaloc and simvastatin for myocardial ischemia without symptoms postprandial and that without intervention resulted in ACS during 18 months. Method： 182 cases oyer 45 years old with high fish of CHD such as hypertension, hyperlipidemia diabetes mellitus smoking and obesity were collected statistically from Dec. 2006 to Jun. 2009. While none of such symptome disease were included（1）with history of myocardial infarction, anginapectoris and surgery for heart disease ; （2）more than Ⅲ levels of congenital heart failure; （3）continousely ST decreased;（4）with left ventricular hypertrophy, conduct block, ventricular activation or cardiac pacing. All the cases were examined with 24 hours dynamic ECG, the myocardial ischemia diagnosed standard is 1X1X1. The control group （A group） was 80 cases without postprandial myocardial ischemia. Those 102 cases with postprandial without symptom myocardial ischemia were divided randomly into B group （50 cases intervented without ACB） and C group （with intervention of ABC for 52 cases） . All above cases were detected for markers of myocardial hecrosis and 24 hours dynamic ECG at that day, the fourth week, the sixth month, 12th month and 18th month respectively. The ACS occurrence rate were sumped up statistically according to the result of myocardial ischemia. Result： There＇s significant difference of myocardial endpoint accident resuh to ACS between A group and B group. B group and C group statistically （P≤0.01 ）. Conclusion： （1）It＇s easy to be ACS for myocardial ischemia without symptoms of postprandial esp for the site of coronary artery.（2）It＇s worth to spread ACS intervention method economically.