社区获得性肺炎对急性心肌梗死住院患者近期预后的影响

The short-term prognosis for hospitalized acute myocardial infarction patients： the impact of complication by community-acquired pneumonia

目的回顾性分析社区获得性肺炎（CAP）对急性心肌梗死（AMI）住院患者近期预后的影响。方法收集解放军总医院1993年1月至2009年12月所有的AMI住院病例，根据入院时是否合并CAP分为两组；比较两组患者病史、临床特点等情况，应用logistic回归法对其近期预后影响因素进行分析。结果共分析5524例AMI患者，其中合并CAP组477例（8．6％），未合并CAP组5047例（91．4oA）。与非CAP组相比，CAP组患者年龄（岁）较大（74．3±6．5比67．8±4．5），更易合并陈旧性心肌梗死（20．8％比11．5％）、高血压（54．3％比48．9％）、糖尿病（32．7％比22．6％）、脑血管病（8．2％比3．5％）、慢性肾衰竭（10．5％比3．O％）等基础疾病，而合并高脂血症患者的比例显著降低（18．9％比30．6％，P〈0．05或P〈0．01）。合并CAP的AMI患者住院期间较未合并CAP者更容易发生心律失常（8．8％比4．6％）、消化道出血（5．0％比0．8％）、休克（8．6％比3．1％）等并发症（均P〈0．01）。CAP组30d全因病死率显著高于非CAP组（32．1％比9．7％，P〈0．01）。多变量logistic回归分析显示，CAP、慢性肾衰竭是增加AMI患者30d全因病死率的独立危险因素（CAP的优势比（OR）3．693，95％可信区间（95％CI）2．340～5．829，P〈0．01；慢性肾衰竭的OR12．608，95％CI4．448-35．739，P〈0．01）。结论入院时合并CAP的AMI患者年龄较大，合并症多，近期病死率高CAP是增加AMI住院患者近期病死率的独立危险因素。

Objective To analyze the correlation between the complication by community-acquired pneumonia （CAP） and the short-term prognosis in hospitalized acute myocardial infarction （AMI） patients. Methods Five thousand five hundred and twenty-four AMI patients hospitalized in the PLA General Hospital from January 1993 to December 2009 were enrolled for clinical data, incidence of complications and 30-day mortality. The data from patients with and without CAP complications were compared. Multivariate logistic regression analysis was employed to assess the impact of CAP on the short-term prognosis of these patients. Results In all 5 524 AMI patients studied, 477 cases of CAP was found （8.6%） . In comparison with those without CAP complication, these patients had higher age （74. 34-6. 5 vs. 67. 84- 4. 5）. The incidence of comorbidities （including old myocardial infarction （20. 8% vs. 11.5%）, hypertension （54. 3% vs. 48.9%）, diabetic mellitus （32.7% vs. 22.6%）, cerebral-vascular disease （8.2% vs. 3.5%）, chronic renal dysfunction （10. 5% vs. 3.0%）3, and complications （including arrhythmia （8. 8% vs. 4.6%）, gastrointestinal bleeding （5.0% vs. 0.8%） and shock （8. 6% vs. 3.1%）3 were all significantly higher, and hyperlipidemia （18.9% vs. 30.6%） was significantly lower （P〈0. 05 or P〈0. 01） in CAP complicated patients. The 30-day mortality was also significantly higher （32.1% vs. 9.7%, P〈 0.01）. Multivariate logistic regression analysis identified CAP and chronic renal dysfunction as an independent predictor of short-term mortality （odds ratio （OR） of CAP 3. 693, 95 % confidence interval （95 %CI） 2. 340-5. 829, P〈0.01; OR of chronic renal dysfunction 12.608, 95%CI 4. 448- 35. 739, P〈0.013. Conclusions The incidence of CAP complication was higher in AMI patients with higher age. CAP complicated patients were more likely to develop eomorbidities/eomplieations, and had higher short-term mortality. CAP was an independent risk factor of short-term mortality.