首次Q型急性心肌梗死血浆C反应蛋白增高的临床意义

Clinical study of serum C-reactive protein level elevation after a first Q-wave myocardial infarction

目的 了解首次Q型急性心肌梗死 (QAMI)患者血浆C 反应蛋白 (CRP)动态变化的临床意义 ,并评价其与预后的关系。方法 动态测定 78例QAMI患者血浆肌酸磷酸激酶 (CK)及CRP水平 ,并评价院内并发症与血浆CRP峰值水平的关系。结果 (1)老年患者 (≥ 70 )、无或缺乏梗死前心绞痛及溶栓治疗失败的患者血浆CRP峰值明显增高 (P <0 0 1,P <0 0 5 ) ;(2 )AMI后发生泵衰竭、左室室壁瘤和住院期间 4 8h后死亡的患者 ,其血浆CRP峰值水平与CK峰值水平均明显高于无泵衰竭和左室室壁瘤形成及出院存活的患者 (P <0 1,P <0 0 5 ) ;(3)心脏破裂的患者血浆CRP峰值水平明显高于无心脏破裂的患者 (P <0 0 1) ;而血浆CK峰值水平在二组间差异无明显意义 (P >0 0 5 ) ;(4)血浆CRP峰值水平≥ 2 0mg/dl是AMI后发生心脏破裂、左室室壁瘤形成的独立预测因子。结论 血浆CRP峰值水平≥ 2 0mg/dl对AMI后发生心脏破裂。

Objective To determine prognostic significance of serum C reactive protein(CRP)level elevation after a first Q wave myocardial infarction.Methods Serum CRP and creatine kinase(CK) levels were measured in 78 patients with a first Q wave myocardial infarction.In hospital complications were assessed in relation to peak CRP levels.Results (1)Peak CRP levels were increased in patients of older age(≥70 years)and with absense of preinfarction angina and failed thromblytic therapies( P <0 01, P <0 05 respectively).(2)Peak levels of both CRP and CK were higher in patients with pump failure,left ventricular aneurysm than in those without pump failure,left ventricular aneurysm( P <0 01, P <0 05 respectively).Similarly,peak levels of both CRP and CK were higher in patients with in hospital cardiac death than in those the survivors( P <0 01).(3)Peak CRP levels in patients with cardiac rupture were higher than in those without cardiac rupture ( P <0 01),whereas no significant difference was noted in peak CK levels between two groups.(4)Multivariate analysis confirmed that peak CRP level ≥20mg/dl was an independent predictor of cardiac rupture and left ventricular aneurysm formation.Conclusion Serum peak CRP levels≥20ml/dl might predict the occurrence of cardiac rupture and left ventricular aneurysm formation.