急性心肌梗死心室重构及心功能与脂联素水平的相关性研究

Relationship between ventricular remodeling, heart function and adiponectin in the patients with acute myocardial infarction

目的分析急性心肌梗死（AMI）患者血清脂联素（APN）水平与心室重构及心功能的关系。方法对我院心内科CCU病房2004-07－2008-10收治的270例资料完整的AMI患者进行了回顾性分析，根据患者入院后24-48h血清APN水平最高值分为三组，即A组（APN水平≥8.5mg／L）、B组（APN水平5.5－8.5mg／L）和C组（APN水平≤5.5mg／L），比较各组心肌酶、心肌梗死面积、心功能及住院病死率。结果①住院病死率：A组8％（5／66），B组8％（13／161），C组21％（9／43），C组显著高于A组和B组（P〈0.05）。②肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）和心肌梗死面积：C组高于A组和B组（P〈0.05）。③住院期间死亡27例，存活243例，存活组和死亡组血清APN水平分别为（6.1.±1.2）mg／L和（3.6±1.3）mg／L，两组比较差异有统计学意义（P〈0.01）。④对AMI后30d住院期间死亡危险因素进行多闲素Logistic回归分析发现，血清APN水平与AMI后30d住院期间病死率相关，30d住院期间病死率随着血清APN水平降低而升高。结论血清APN水平可能与AMI预后具有相关性。

Objective To evaluate the relationship between ventricular remodeling, heart function and adiponectin in the patients with acute myocardial infarction （AMI）. Methods 270 patients with AMI in Coronary Care Unit of our hospital from July 2004 to October 2008 were divided into three groups according to serum adiponectin concentration within 24 - 48 hours following the onset of AMI- group A, adiponectin≥8.5 mg/L;group B, adiponectin 5.5 - 8.5 mg/L; group C, adiponectin≤5.5 mg/L. The data of myocardial enzymes, myocardial infarction size, heart function and inhospital mortality were analyzed respectively. Results①The inhospital mortality of each group ： group A was 8% （5/66） , group B was 8% （13/161） , group C was 21% （9/43）. The difference was significant between group C and group B, group A （P〈0.05）.②There were significant differences in the activities of serum creatine kinase, serum creatine kinase isoenzymes - MB and myocardial infarction size among the 3 groups （ P 〈 0.05）.③27 cases died and 243 cases recovered in the duration of hospital stay. Serum adiponectin concentrations were （6.1±1.2） mg/L in the survival and （3.6±1.3） mg/L in the dead （P 〈0.01）.④In a multivariate Logistic regression analysis, serum adiponectin was associated with 30 - day mortality in the patients with AMI. In analysis of the correlation between the level of serum adiponectin and outcome, we observed that the risk of 30 - day mortality increased with the severity of decreased serum adiponectin levels. Conclusion The prognosis in the patients with AMI may be related to serum adiponectin levels.