急性心肌梗死后发生医院获得性贫血的影响因素及预后

Influencing Factor and Prognosis of Hospital-Acquired Anemia of Patients with Acute Myocardial Infarction

目的:研究急性心肌梗死(acute myocardial infarction,AMI)后发生医院获得性贫血(hospital acquired anemia,HAA)的影响因素及预后情况。方法:以1131例入院时血红蛋白质量浓度正常的AMI患者为回顾性研究对象,医院获得性贫血(HAA)定义为:AMI患者入院时无贫血,而在住院期间最低血红蛋白质量浓度达到贫血的诊断标准。根据最低血红蛋白值将HAA划分为轻度HAA组(110 g/L<Hb<正常值下限)、中度HAA组(90 g/L≤Hb≤110 g/L)、重度HAA组(Hb<90 g/L),并将其与无HAA组进行对比,采用卡方检验比较各组间的预后差异及相关因素。所有患者在出院后1、2、3年进行随访,四组患者的远期病死率、心衰再住院率采用用卡方检验及Kaplan-Meier法。结果:在符合入选标准的HAA患者中,轻度HAA 440例(77.6%),中度HAA 105例(18.5%),重度HAA 22例(3.8%)。AMI患者发生HAA的相关因素包括年龄、女性、心力衰竭、PCI治疗、Cr、超敏C反应蛋白、左室射血分数(EF)、β-受体阻滞剂、低分子肝素、螺内酯(p<0.001)。随着HAA程度的加重,病死率明显升高,而其与心衰的发生无明显相关性。结论:年龄、女性、心力衰竭、PCI治疗、Cr、超敏C反应蛋白、左室射血分数(EF)、β-受体阻滞剂、低分子肝素、螺内酯可能是AMI后发生HAA的影响因素,随着HAA程度的加重,患者病死率明显升高,但HAA的发生与严重程度与出院后心衰的发生无明显相关性。

Objective： To study the influencing factors and prognosis of hospital-acquired anemia after acute myocardial infarction （AMI）. Methods： 1131 cases of hospitalized patients with initial diagnosis of acute myocardial infarction and normal hemoglobin concentrations on admission were enrolled in this retrospective study. Hospital-acquired anemia was defined as the lowest hemoglobin mass concentration anemia during hospitalization diagnostic criteria but normal hemoglobin concentrations at admission. According to the lowest hemoglobin values during hospitalization, the HAA patients were divided into three group： mild HAA group （110g / L 〈Hb 〈lower limit of normal）, moderate HAA group （90 g / L -〈 Hb≤110 g / L）, severe HAA group （ Hb 〈90 g / L）. The different Prognostic with those without HAA using LSD test. All patients were followed up at 1, 2 and 3 years after acute myocardial infarction, using the Kaplan-Meier method to calculate the adverse events （case-fatality, heart failure hospitalized） incidence during follow-up. Results： In all AMI patients met the inclusion criteria, there were 440 cases （77.6%） with mild HAA patients, 105 cases （18.5%） with moderate HAA, 22 cases （3.8%） with severe HAA. By compared with the group without HAA, we concluded that in patients with AMI, HAA-relevant factors included age, female gender, heart failure, PCI treatment ,creatinine, hypersensitivity C-reactive protein, left ventricular ejection fraction, beta-blockers, low-molecular-weight heparin, spironolactone （P〈0.001）. As the HAA severity aggravates the mortality rises up significantly, while no obvious correlation was found in the incidence of heart failure between different groups. Conclusion： Age, female gender, heart failure, PCI treatment, creatinine, hypersensitivity, C-reactive protein, left ventricular ejection fraction, beta-blockers, low-molecular-weight heparin, spironolactone might be the influencing factors of HAA after AMI. With the aggravation of the HAA degree, the pations fatality rate was significantly increased, but the heart failure after discharge had no obvious correlation with the occurrence and severity of HAA.