急性ST段抬高型心肌梗死吸烟患者的临床特点

Clinical characteristics of smokers with acute ST-elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死（STEMI）吸烟患者的临床特点。方法回顾性分析收治的STEMI患者132例,比较吸烟组（n=57）患者与非吸烟组（n=75）患者的临床基本资料及实验室检查的各项参数;多因素Logistic回归分析吸烟等与LVEF〈40%的相关性。结果与非吸烟组患者比较,吸烟组患者年龄[（59.6±10.9）岁vs.（64.9±8.9）岁,P=0.007]较低,CRP（30.09 mg/L vs.21.14 mg/L,P=0.010）增高,合并前壁（14.0%vs.8.0%）及广泛前壁心肌梗死比例（50.9%vs.25.3%）更高,LVEF[（40.3±8.7）vs.（53.0±10.6）,P〈0.001]降低,CK-MB峰值[（174.37±114.73）U/L vs.（145.88±112.44）U/L,P=0.015]、脑钠肽前体[（2 293±1 165）pg/L vs.（1 872±662）pg/L,P=0.025]增高,使用主动脉球囊反搏（IABP）（22.8%vs.9.3%,P=0.032）比例更高;多因素Logistic回归显示吸烟（OR=3.423,95%CI 1.694~8.735,P=0.019）与LVEF〈40%相关（P〈0.05）。结论吸烟可能使STEMI早发,心功能更差,合并的炎症反应更强。

Objective To investigate the clinical characteristics of smokers with acute ST-elevation myocardial infarction（ STEMI）. Methods A retrospective study including 132 STEMI patients admitted to the Second People＇s Hospital of Lechang was conducted. All patients were divided into two groups according to smoke history： smokers（ n = 57） and non-smokers（ n = 75）. Baseline clinical data and laboratory examination parameters were statistically compared between both groups. The correlation between smoking and LVEF 40% was assessed by using multivariate logistic regression. Results Compared with non-smokers,the age of smokers was significantly younger（ 59. 6 ± 10. 9 years vs. 64. 9 ± 8. 9 years,P = 0. 007）,the level of C response protein（ CRP） was significantly higher（ 30. 09 mg / L vs. 21. 14 mg / L,P = 0. 010）,the percentage of anterior（ 14. 0% vs. 8. 0%） and extensive anterior MI（ 50. 9% vs. 25. 3%） were apparently higher,LVEF was dramatically reduced（ 40. 3 ± 8. 7 vs. 53. 0 ± 10. 6,P 0. 001）,peak value of NT-pro BNP（ 2 293 ±1 165 pg / L vs. 1 872 ± 662 pg / L,P = 0. 025） and CK-MB（ 174. 37 ± 114. 73 U / L vs. 145. 88 ± 112. 44 U / L,P = 0. 015） were significantly elevated and the percentage of use of IABP was equally obviously higher（ 22. 8% vs. 9. 3%,P = 0. 032）. Multivariate logistic regression revealed that smoking was significantly correlated with the incidence of LVEF 40%（ OR = 3. 423,95% CI 1. 694-8. 735,P = 0. 019）. Conclusions Smoking may lead to earlier onset of STEMI,worse cardiac function and more severe inflammatory responses.