左心房容积指数在预测急性非ST段抬高型心肌梗死预后中的价值

Value of Left Atrial Volume Index in Judging Prognosis of Non-ST Segment Elevation Myocardial Infarction

目的 评价左心房容积指数（left atrial volume index,LAVI）预测急性非ST段抬高型心肌梗死（non-ST segment elevation myocardial infarction,NSTEMI）患者预后的价值。方法 对150例NSTEMI患者进行超声心动图检测,按LAVI值分为2组：Ⅰ组79例为LAVI≥32mL·m^-2患者,Ⅱ组71例为LAVI〈32mL·m^-2患者,以患者住院及出院后12个月内发生主要不良心血管事件（major adverse cardiovascular events,MACE）为研究终点。比较2组的基本资料、相关临床血清学参数[包括肌酸激酶（creatine kinase,CK）、肌酸激酶同工酶（creatine kinaseMB,CK-MB）及总胆固醇]及超声参数[包括左心房前后径（D1）、左心房上下径（D2）、左室舒张末期内径（left ventricular end-diastolic diameter,LVEDd）、左室收缩末期内径（left ventricular end-systolic diameter,LVEDs）、射血分数（EF）、四腔心左房面积（A4）及两腔心左房面积（A2）]。采用多元回归分析（Logistic）确定MACE的独立预测因子。结果 Ⅰ组高血压与糖尿病发生率、接受PCI术率及CK、CK-MB、LVEDd、LVEDs、A4、A2、D1、D2均显著高于Ⅱ组（P〈0.05）。随访12个月,Ⅰ组MACE发生率较Ⅱ组显著增加（50.6%比21.1%,P〈0.05）。单因素方差分析结果显示,NSTEMI患者发生MACE与LAVI、LVIDd、LVIDs、CK、CK-MB、糖尿病、未接受PCI治疗等因素有关;多元回归分析结果显示,预测NSTEMI患者发生MACE的危险因素为：LAVI、CK、CK-MB,其中LAVI的OR值为1.299,95%CI为1.127~1.329（P〈0.05）;线性相关分析结果显示,LAVI和CK、CK-MB呈正相关（r=0.689,r=0.475,P〈0.05）。结论 LAVI是一个相对可靠的预测NSTEMI患者发生MACE的参数,LAVI越大,NSTEMI患者预后越差。LAVI对NSTEMI预后评估具有重要临床参考价值,能够一定程度上指导临床进行早期干预。

Objective To evaluate the value of left atrial volume index（LAVI）in judging the prognosis of non-ST elevation myocardial infarction（NSTEMI）.Methods A total of 150 patients with NSTEMI underwent ultrasound echocardiography.According to the LAVI,these patients were divided into two groups：LAVI≥32mL·m^-2（group I,n=79）and LAVI〈32 mL·m^-2（group Ⅱ,n=71）.The study endpoint was the occurrence of major adverse cardiovascular events（MACE）within 12 months after discharge from hospital.Basic data,serum levels of creatine kinase（CK）,CK-MB and total cholesterol（TC）,and ultrasonic measurements of left atrial anteroposterior diameter（D1）,left atrial vertical diameter（D2）,left ventricular end-diastolic diameter（LVEDd）,left ventricular end-systolic diameter（LVEDs）,ejection fraction（EF）,four-chambered left atrial area（A4）and two-chambered left atrial area（A2）were compared between the two groups.The independent predictors for MACE were confirmed by using multiple logistic regression analysis.Results Compared with group I,the incidence of hypertension and diabetes,percentage of patients receiving PCI,CK,CK-MB,LVEDd,LVEDs,A4,A2,D1,and D2 significantly increased in groupⅡ（P〈0.05）.After follow-up for 12 months,the incidence of MACE in group I was markedly higher than that in group Ⅱ（50.6% vs 21.1%,P〈0.05）.One-way analysis of variance showed that the occurrence of MACE was correlated with LAVI,LVIDd,LVIDs,CK,CK-MB,diabetes and non-PCI treatment in NSTEMI patients.Multiple logistic regression analysis showed that the risk factors for MACE included LAVI（OR：1.299,95%CI：1.127-1.329）,CK and CK-MB（P〈0.05）.Linear correlation analysis showed that the LAVI was positively correlated with CK and CK-MB（r=0.689 and 0.475,respectively;P〈0.05）.Conclusion The LAVI is a relatively reliable parameter for predicting MACE in NSTEMI patients.Patients with a greater LAVI have a worse prognosis.Therefore,LAVI has important clinical value for prognosis evaluation of NSTEMI and clinical guidance for early intervention.