内蒙古地区饮酒与男性初次急性心肌梗死的关系研究

Association of alcohol drinking with initial acute myocardial infarction of male patients in Inner Mongolia area

目的 探讨不同饮酒量与初次急性心肌梗死（AMI）男性患者的危险因素、生化指标、冠状动脉病变严重程度、心功能及6个月再发心血管事件的关系.方法 连续入选明确诊断为初次AMI的男性患者186例,根据饮酒量不同分为不饮酒组、适量饮酒组、大量饮酒组.对比分析其各项临床资料并随访6个月时心血管事件发生情况.结果 不饮酒组及适量饮酒组的平均年龄明显高于大量饮酒组[（60.30±11.87）、（62.52±10.05）岁与（54.77±11.37）岁,P均＜0.05];与不饮酒组比较,大量饮酒组吸烟率（97.10％与78.38％）.、血清天冬氨酸氨基转移酶[58.24（13.48） mmol/L与45.36（11.32）mmol/L]、丙氨酸氨基转移酶[56.34（12.98） mmol/L与36.25（9.62） mmol/L]及血尿酸水平[（326.77±67.72） μmol/L与（293.68 ±52.29） μmol/L]显著升高,左心室射血分数[（49.51±9.62）％与（54.35±8.61）％]、左心室短轴缩短率[（28.09±4.89）％与（30.86±5.08）％]及E/A值（0.83 ±0.31与1.01±0.43）明显降低（P均＜0.05）;大量饮酒组较适量组高密度脂蛋白胆固醇明显降低[（0.94±0.23）mmol/L与（1.12±0.39） mmoL/L],甘油三酯明显升高[2.18（0.65） mmol/L与1.46（0.46） mmol/L],差异均有统计学意义（P均＜0.05）;适量饮酒组较不饮酒组高密度脂蛋白胆固醇明显升高[（1.12±0.39）mmol/L与（0.95 ±0.30） mmol/L],差异有统计学意义（P＜0.05）;大量饮酒组心血管事件发生率明显高于其他两组[25.72％ （18/70）与13.51％ （10/74）与9.50％（4/42）],差异均有统计学意义（P均＜0.05）;Logistic回归分析提示吸烟（OR=3.648,95％ CI：1.025～12.968,P=0.046）、糖尿病（OR=7.068,95％ CI：1.049 ～ 15.284,P=0.013）是新发心血管事件的独立预测因素.结论 大量饮酒患者AMI发病年龄较轻、血脂异常发生率较高、心脏的收缩及舒张功能较差;吸烟和糖尿病与6个月再发心血管事件呈正相关;通过改善血脂异常,适量饮酒可能对AMI的发病有一定保护作用.

Objective To investigate the relationship of alcohol consumption with risk factors,biochemical indexes,severity of coronary stenosis,cardiac function and recurrent cardiovascular events after a fellow up of 6 months in male patients with initial Acute Myocardial Infarction（AMI）.Methods One hundred and eighty-six male patients were selected as our subjects who were initially diagnosed as AMI.Thepatients were divided into non alcohol group,moderate drinking group and heavy drinking group.They were conducted 6 month follow up.The clinical data and the occurrence of recurrent cardiovascular events were recorded.Results Average age of non-drinker group and moderate drinking group were （60.30 ± 11.87） year and （62.52 ± ± 10.05） year,older than that of heavy drinking group （（54.77 ± 11.37） year; P 〈 0.05））.Percentage of smoking in heavy drinking group was 97.10%,higher than that in non-drinker group （78.38%） （P 〈 0.05）.Meanwhile,the levels of serum aspartate aminotransferase,alanine aminotransferase,urea in heavy drinking group were 58.24 （13.48） mmol/L,56.34 （12.98） mmol/L,（326.77 ± 67.72） μmol/L respectively,higher than that in non-alcohol group（45.36（11.32） mmol/L,36.25（9.62） mmol/L,（293.68 ±52.29） μmol/L;P 〈 0.05）.However,the left ventricular ejection factor,fractional shortening,E/A were （49.51 ± 9.62） %,（28.09 ± 4.89）%,（0.83 ± 0.31） in heavy drinking group,lower than that in non alcohol group（（54.35 ± ± 8.61） %,（30.86 ± 5.08） %,1.01 ± 0.43 ; P 〈 0.05）.High-density lipoproteincholesterol levels were significantly lower while triglyceride levels were much higher in heavy drinking group than moderate drinking group （（0.94±0.23 mmol/Lvs.（1.12 ±0.39） mmol/L;2.18（0.65） mmol/L vs.1.46（0.46） mmol/L;P 〈0.05）.Serum levels of high-density lipoproteincholesterol in moderate drinking group was （1.12 ± 0.39） mmol/L,significantly higher than that in non-alcohol group （（0.95 ±0.30） mmol/L,P 〈0.05）.The highest percentage of recurrent cardiovascular events in the heavy drinking groups was 25.72% （18/70）,higher than other two groups （13.51% （10/74）,9.5% （4/42） ; P 〈 0.05）.Logistic regression analysis indicated that smoking （OR =3.648,95 % CI：1.025-12.968,P =0.046）,diabetes （OR =7.068,95 % CI：1.049-15.284,P =0.013） were both independent predictors of the recurrent cardiovascular events.Conclusion Patients with heavy drinking show younger ages with initial AMI,higher incidences of dyslipidemia,and poorer cardiac systolic/diastolic function.Recurrent cardiovascular events in a 6 month follow up were positively correlated with smoking and diabetes.Moderate drinking might be helpful to improve the disorders of lipid metabolism in AMI patients.