急性ST段抬高型心肌梗死患者发生高危室性心律失常的相关危险因素分析

Analysis of Risk Factors for High Risk Ventricular Arrhythmia in Patients with Acute ST Segment Elevated Myocardial Infarction

目的:分析急性ST段抬高型心肌梗死(acute ST segment elevated myocardial infarction,ASTEMI)患者的入院指标,探讨高危室性心律失常的相关危险因素。方法:将190例行急诊冠状动脉经皮介入治疗术(PCI)的患者按照是否发生高危室性心律失常事件分为事件组(n=89)和非事件组(n=101)。纳入分析的指标包括性别、年龄、有无高血压、有无糖尿病、缺血性胸痛持续时间、梗死区域所累及的室壁、罪犯血管、病变血管数(包括1、2、3支病变)、心脏超声记录的左室射血分数值(LVEF)、入院血糖水平、糖化血红蛋白(HbA1C)、糖化白蛋白(GLA)、血电解质(钠、钾、氯)、血肌酐(SCr)、肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)、有无贫血等。结果:有无高血压、有无糖尿病、性别、年龄、HbA1C、病变血管数与高危室性心律失常的发生无关;血钾水平、GLA、CRP、cTnT、LVEF值、受累室壁、是否贫血与发生高危室性心律失常事件有相关性。结论:入院血钾≤3.5 mmol/L、入院血糖≥8 mmol/L、糖化白蛋白≥16%、CRP≥10 mg/L、cTnT≥5 ng/mL,LVEF值≤55%、受累室壁为心室前壁、贫血等为ASTEMI患者入院早期发生高危室性心律失常事件的高危因素。

Objective：To explore the risk factors for high risk ventrieular arrhythmia by analyzing the admission indexes of pa tients with acute ST-segment elevated myocardial infarction（ASTEMI）. Methods：The 190 patients undergoing emergency per- cutaneous coronary intervention were divided into event group（n = 89）and non event group（n = 101 ）according to the occurrence of high risk ventricular arrhythmia. The indicators brought into analysis included gender, age, hypertension, diabetes, dura tion of ischemie chest pain, infarction area involved ventricular wall, involvement of blood vessels, number of involved vessels （including 1,2,3 branch lesion）, left ventricular ejection fraction（LVEF） recorded by echocardiography, blood glucose level on admission, glycosylated hemoglobin（HbAlC）, glycated albumin（GLA）, blood electrolytes（sodium, potassium, chloride） , se- rum creatinine （SCr）, troponin（cTnT）, creatine kinase isoenzyme（CK-MB）, C-reactive protein（CRP）, and anemia. 2 test were carried out with software SPSS 19. 0. Results： Factors including hypertension, diabetes, gender, age, HbA1C, and num- bers of involved vessels were not related to occurrence of high risk ventricular arrhythmia, whi^e blood potassium, GLA, CRP, cTnT, LVEF, involved wall and anemia were correlated to occurrence of high risk ventricular arrhythmia events. Conclusions： Serum potassium concentration less than 3.5 mmol/L, blood sugar more than 8 mmol/L, proportion of GLA more than 16%, CRP more than 10 mg/L, cTnT more than 5 ng/mI., LVEF less than 55%, and involvement of anterior wall are the risk fac tors for high risk ventricular arrhythmia in ASTEMI patients at the early stage of admission.