急性ST段抬高型心肌梗死患者血清铁水平降低与院内急性心力衰竭的相关性

Depressed serum iron level in patients with in-hospital acute heart failure after acute ST-elevated myocardial infarction

目的观察急性ST段抬高型心肌梗死（STEMI）患者入院时血清铁（SF）水平与急性心力衰竭（AHF）发生率的相关性。方法对203例首次住院的急性STEMI患者资料进行回顾性分析,按住院期间是否发生AHF将患者分为AHF组和无AHF（NAHF）组,比较两组SF降低（〈8.95μmol/L）的百分率;按SF水平的四分位数分为Q1（〈6.1μmol/L）、Q2（6.1～9.2μmol/L）、Q3（9.3～12.8μmol/L）和Q4（〉12.8μmol/L）组,比较不同SF水平组的院内AHF发生率;分析SF水平与Hb、B型钠尿肽（BNP）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、C反应蛋白（CRP）水平和左室射血分数（LVEF）等参数的相关性。结果 AHF组SF降低的发生率比NAHF组高（55.6%vs 33.8%,P〈0.05）;Q1～Q4组院内AHF的发病率分别是78.4%、76.0%、56.9%和54.9%（P〈0.05）;在SF较低的组,前壁心肌梗死的发生率较高（P〈0.05）,CRP水平较高（P〈0.05）,LVEF较低（P〈0.05）。相关分析表明SF水平与CRP呈负相关（r=-0.571,P〈0.05）,与LVEF呈正相关（r=0.267,P〈0.05）,与BNP和住院天数呈负相关（r=-0.286、-0.233,P〈0.05）。结论急性STEMI患者入院SF水平越低,院内心力衰竭发病率越高。

Objective To observe serum iron（ SF） levels in the in-hospital patients with ST elevated myocardial infarction（ STEMI）and evaluate the correlation between serum SF levels and acute heart failure（ AHF）. Methods A retrospective study of involving 203 patients with first-time hospitalization for STEMI was conducted. All the patients were divided into 2 groups： in-hospital acute heart failure（ AHF） and non-AHF,and the percentages of SF depression were compared. The quartiles（ Q） of iron concentration were Q1（〈 6. 1 μmol/L）,Q2（ 6. 1 to 9. 2 μmol/L）,Q3（ 9. 3 to 12. 8 μmol/L） and Q4（ 〉12. 8 μmol/L）. The incidences of in-hospital AHF in different concentration of SF groups were compared andthe correlations between SF level and Hb,B-type natriuretic peptide（ BNP）,cardiac troponin I（ cTnI）,high sensitivity C-reactive protein（ CRP）,creatine kinase isoenzyme（ CK-MB）,left ventricular ejection fraction（ LVEF） were evaluated. Results The percentage of SF depression in AHF group was higher than that of in non-AHF group（ 55. 6% vs 33. 8%,P〈0. 05）. The incidences of in-hospital acute heart failure（ Killip≥Ⅱ） according to quartiles from Q1 to Q4 were 78. 4%,76. 0%,56. 9% and 54. 9%,respectively（ P〈0. 05）. The patients of Q1 group presented high incidence of anterior wall myocardial infarction,high CRP levels and low LVEF（ P〈0. 05）. SF levels correlated positively with LVEF（ r = 0. 267,P〈0. 05） and correlated inversely with CRP（ r =- 0. 571）,BNP（ r =- 0. 286,P〈0. 05） and hospitalization duration（ r =- 0. 233,P〈0. 05）. Conclusion The low SF level on admission should be very common in the patients with in-hospital acute heart failure with STEMI and associated with high incidence of AHF.