慢性心绞痛史及梗死前心绞痛对急性心肌梗死心肌损伤及预后的影响

目的探讨有无慢性心绞痛史及梗死前心绞痛对急性心肌梗死患者心肌损伤及预后的影响。方法选择2003年1月至2007年12月确诊为急性心肌梗死而收住院的93例急性心肌梗死患者，根据其急性心肌梗死发病前心绞痛病史情况分为4组，慢性心绞痛组（Ⅰ组）、梗死前心绞痛组（Ⅱ组）、慢性心绞痛伴梗死前心绞痛组（Ⅲ组）、无心绞痛组（Ⅳ组），分别观察心肌梗死范围，测定心脏肌酸磷酸激酶（CPK）、同功酶（CK—MB）、血清肌钙蛋白（CTnT）、C-反应蛋白（CRP）和尿微自蛋白分泌率（AER）变化，以及住院期间严重心脏并发症（严重心律失常、KillipⅡ级以上心力衰竭、心源性休克）、心源性病死率、梗死后心绞痛发生率。结果小面积心肌梗死前发生率Ⅰ、Ⅱ、Ⅲ组明显高于Ⅳ组，差异有统计学意义（P〈0．05）；CK、CK—MB、CTnT峰值浓度、CRP、AER变化，Ⅰ、Ⅱ、Ⅲ组明显低于Ⅳ组，差异有统计学意义（P〈0．05）；严重心脏并发症，除心律失常外，Ⅰ、Ⅱ、Ⅲ组明显低于Ⅳ组，差异有统计学意义（P〈0．05），心律失常Ⅱ、Ⅲ组明显低于Ⅰ、Ⅳ组，差异有统计学意义（P〈0．05）；梗死后心绞痛及住院病死率Ⅰ、Ⅱ、Ⅲ组明显低于Ⅳ组，差异有统计学意义（P〈0．05）。结论梗死前有心绞痛史及梗死前心绞痛可减少其后发生急性心肌梗死时心肌损伤的程度，并影响预后。

Objective To evaluate the influence of the history of chronic angina pectoris and pre - infarction angina on myocardial injury and the prognosis during acute myocardial infarction. Methods 90 cases of hospitalized patients with acute myocardial infarction selected in January 2003 - December 2007 were diagnosed as acute myocardial infarction and the admission diagnosis and treatment, in accordance with its prior to the onset of acute myocardial infarction angina history divided into 4 groups ： Chronic angina pectoris group （ Ⅰgroup） , pre -infarction angina peetoris group （ Ⅱ group） , chronic angina and pre -infarction angina pectoris group （ Ⅲ group） , no angina pcctoris group （Ⅳ group）. The myocardial infarct size was observe separately, heart creatine phosphokinase （CPK） and its isoenzymes （ CK - MB）, serum troponin （CTnT）, C - reactive protein （CRP） and urinary micro- albumin excretion rate （AER） change were measured, and severe cardiac complications during hospitalization （severe arrhythmia, Killip Ⅱ above class of heart failure, cardiogenic shock） , cardiac mortality and the incidence of postinfarction angina were also monitored. Results The incidence of small area myocardial infarction, group Ⅰ , Ⅱ, Ⅲ were significantly higher than that group Ⅳ, the differences between the groups were significant （P 〈 0. 05 ）. CK, CK - MB, CTnT peak concentration, C - reactive protein （CRP） and urinary micro -albumin excretion rate （AER） Change, group Ⅰ ,Ⅱ , Ⅲ were significantly lower than groupⅣ, there is significant difference comparison （ P 〈 0. 05 ）. Comparison of serious cardiac complications in addition to abnormal heart rate outside the group Ⅰ , Ⅱ, Ⅲ were significantly lower than group Ⅳ（P 〈0. 05）. Abnormal heart rate group Ⅱ, Ⅲ were significantly lower than the groupⅠ, Ⅳ（P 〈0. 05）. Postinfarction angina and hospital mortality groupⅠ, Ⅱ, Ⅲ were significantly lower than group Ⅳ, significant difference （ P 〈 0. 05 ）. Conclusions The history of pre - infarction angina and pre - infarction angina can reduce the myocardial injury and can affect prognosis during subsequent occurrence of acute myocardial infarction.