急性心肌梗死患者远期预后因素分析

Analysis of prognostic factors in patients with acute myocardial infarction

目的：对急性心肌梗死（AMI）患者进行随访调查，了解其远期预后情况，探讨影响AMI患者远期预后因素。方法：回顾性分析三家三甲医院2003年1月～2013年12月初次确诊的AMI患者4887例，收集其病例资料和初次实验室检查结果，电话随访患者出院后的服药及临床转归。根据临床结局的不同，将患者分为预后良好组和预后不良组，探讨可能影响AMI患者远期预后的因素。结果：4887例患者中，预后良好患者3829例（78．4％）；预后不良1058例（21．6％），包括死亡116例，再发心肌梗死32例，心力衰竭910例。①预后不良组患者的性别，体质量，心率，收缩压水平，舒张压水平，左室舒张末内径（LVEDD），心肌钙蛋白T（cTnT），脑钠尿肽（BNP），餐后2h血糖（Ph2PG），低密度脂蛋白胆固醇（LDL—C），总胆固醇（TC）水平与预后良好组之间有显著性差异（P〈0．05或P〈0．01）；②预后不良组患者的高血压病，糖尿病，慢性肺部疾病，心房颤动，恶性肿瘤的发生率均高于预后良好组，差异有统计学意义（P〈0．05或P〈0．01）。多变量Logistical回归分析显示影响长期预后的因素为LVEDD（OR=3．10，P〈0．01，CI2．83—186．44），LDL．C（OR=2．90，P〈0．01，CI2．08—156．87）。结论：增大的LVEDD，增高的LDL—C可能为影响AMI患者远期预后因素。

AIM： To investigate the long-term prognosis and the related factors in patients with acute myocardial infarction （AMI）. METHODS： Clinical data of 4 887 cases diagnosed as AMI between January 2003 and December 2013 in our three hospitals in Hubei Province were analyzed. Medical records, initial laboratory test results, medication compliance after discharge and clinical outcomes were collected. According to different clinical outcomes, patients were divided into good outcome group and poor outcome group. Single and multiple factor logistic regression analyses were performed to explore the risk factors that may affect the long-term prognosis. RESULTS： Among the 4 887 AMI cases, 3 829 cases had good outcomes and 1 058 had poor outcomes, including 116 deaths, 32 recurrent myocardial infractions and 910 heart failures. Gender, weight, heart rate, systolic blood pressure, diastolic blood pressure, left ventricular diameter, cTnT, BNP, Glu-2h, LDL-C, and cholesterol in the poor outcome group were significantly higher than those in the good outcome group （ P 〉 0. 05 ）. Incidence rates of hypertension, diabetes mellitus, COPD, atrial fibrillation and therioma in the poor outcome group were higher than those in the good outcome group （70.5% vs. 38.9, P〈0.05; 59.9% vs. 33.4%, P〈0.05; 19.5% vs. 4. 9%, P 〈 0. 05 ; 1.1% vs. 0. 3 %, P 〈 0. 05 ）. Multivariate logistic regression analysis revealed that left ventricular diameter （ OR = 3. 10, P 〈 0. 01, CI 2. 83 - 186. 44） and LDL-C （ OR = 2. 90, P 〈 0. 01, CI 2. 08 - 156. 87） were the risk factors affecting the long-term prognosis of AMI. CONCLUSION： Enlarged left ventricular diameter and LDL-C are the risk factors affecting the long-term prognosis in patients with acute myocardial infarction.