急性心肌梗死并发恶性室性心律失常的危险因素分析

Risk factors of malignant ventricular arrhythmia in patients with acute myocardial infarction

目的探讨急性心肌梗死并发恶性室性心律失常(MVA)的相关危险因素。方法回顾性分析156例急性心肌梗死患者。其中并发MAV患者53例为MAV组,未并发MAV患者103例为非MAV组。对患者年龄、吸烟史、高血压、糖尿病、心肌梗死病史、心肌损伤标志物(CK、CK-MB、cTn)、血常规(WBC、RBC、PLT)、血脂(TG、TC、LDL-C、HDLC)、电解质(K+、Na+、Ca2+)、肾功能(BUN、Scr)、空腹血糖(GLU)、C-反应蛋白(CRP)、左室舒张末径(LVEDD)、室间隔厚度(LVS)、左室后壁厚度(LVP)、左心室射血分数(LVEF)等相关指标进行分析。结果 MVA组与非MVA患者年龄、CK、CK-MB、cTnI、WBC、TC、LDL-C、HDL-C、K+、Na+、Ca2+、Scr、GLU、CRP、LVEF比较差异均有统计学意义(P<0.05或P<0.01)。经Logistic回归分析,CK-MB、cTnI、K+、CRP、LVEF与急性心肌梗死并发MAV关系密切。结论高CK-MB和TnI水平、高CRP水平、低血钾、低LVEF,是急性心肌梗死并发MVA的相关危险因素,临床上应对具备相关危险因素的患者给予足够的重视。

Objective To investigate risk factors of malignant ventricular arrhythmia（MVA） in patients with acute myocardial infarction. Methods A retrospective study was performed on 156 patients with acute myocardial infarction. Taking 53 patients with MVA as the MVA group, other 103 patients without MVA as the non-MVA group. Observations and comparisons of age, smoking history, history of hypertension, history of diabetes, history of myocardial infarction,the levels of CK, CK-MB, cTn, WBC, RBC, PLT, TG, TC, LDL-C, HDL-C, K^＋、Na^＋、Ca^2＋, BUN, Scr, GLU, CRP, LVEDD, LVS, LVP, LVEF in both groups were made. Multivariate regression analysis was used to determine the main risk factors for MVA in Patients with acute myocardial infarction. Results Statistically significant differences in age, the levels of CK, CK-MB, cTnI, WBC, TC, LDL-C, HDL-C, K^＋、Na^＋、Ca^2＋, Scr, GLU, CRP and LVEF were observed in MVA group compared with the non-MVA group（P〈0.05 or P〈0.01）. By multivariate regression analysis the risk factors fir MVA in patients with acute myocardial infarction were noticed. Conclusion High levels of CK-MB and TnI and CRP, hypopotassemia, low level of LVEF are the risk factors for MVA in Patients with acute myocardial infarction. Clinically. those should be prevented in time according to changes of these factors. Adequate clinical attention should be paid to patients with the above risk factors of MVA.