急性ST段抬高型心肌梗死静脉尿激酶溶栓治疗并发出血事件的相关因素

The relevant factors analysis of intravenous urokinase thrombolysis in the treatment of acute ST elevation myocardial infarction hemorrhage incident

目的 回顾性分析急性ST段抬高型心肌梗死（STEMI）静脉尿激酶溶栓治疗并发出血事件的相关因素,为预防出血事件提供临床指导。方法 以2008年2月至2013年4月西安市高新医院收治的75例STEMI静脉尿激酶溶栓治疗的患者为研究对象,根据在急诊室是否发生出血事件分为对照组（61例）与病例组（14例）,记录患者的一般临床资料和实验室检测结果,比较两组间相关因素的差异,将差异具有统计学意义的指标纳入多因素Logistic回归模型,分析上述因素与出血事件的相关性,考虑时间因素对逻辑回归的影响,又进一步采用多因素Cox回归模型分析上述因素与出血事件的相关性。结果 两组患者在性别构成及年龄方面差异无统计学意义（P〉0.05）。单因素分析中,两组患者的身高、吸烟史、高血压病史、糖尿病史、高脂血症病史、慢性胃炎病史、陈旧性脑梗死病史（〉1年）、killip分级等比较,差异不具有统计学意义（P〉0.05）,而体重差异具有统计学意义（P〈0.05）;实验室检测指标中HGB、Cr、UA、LVEF差异具有统计学意义（P〈0.05）,其中LVEF差异极为显著（P〈0.01）,提示上述组间差异具有显著性的指标与出血事件可能具有相关性。应用多因素Logistic回归模型对病例组发生出血事件可能的相关因素进行多因素分析,带入单因素分析中差异具有统计学意义的变量,即体重、HGB、Cr、UA、LVEF,结果显示,高水平的LVEF成为出血事件的保护性因素（B=原0.13,OR=0.98,95%CI：1.53~2.83,P〈0.05）;多因素Cox回归模型分析结果同样显示高水平的LVEF成为出血事件的保护性因素（B=原0.11,OR=0.98,95%CI：1.56~2.89,P〈0.05）。结论高水平的LVEF是出血事件的保护性因素,而低水平LVEF的STEMI患者发生出血事件的风险高;STEMI发病早期检测LVEF在评估溶栓并发出血方面具有临床指导意义。

Objective A retrospective analysis was used to study the relevant factors of intravenous urokinase thrombolysis in the treatment of acute ST elevation myocardial infarction （STEMI） hemorrhage incident, and to provide clinical guidance for preventing hemorrhage incidents. Methods Seventy-five eases of STEMI patients accepted intravenous urokinase thrombolysis in Xi＇an Gaoxin Hospital from FebruaiT 2008 to April 2013 were selected as study objects, and divided into control group （61 eases） and case group （14 cases） according to whether the patients suffered with a hemorrhage incident in the emergency department. General clinical data and laboratory inspection were recorded, and the relevant factors were compared between the two groups. Statistically significant index was included in the muhi- factor logistic regression model to analyze, the factors associated with hemorrhage incident. Considering the effect of time factors on logistic regression, muhi-factor Cox regression model were further used for analysis the relevance of hemorrhage incidents with the above factors. Results It showed no significant differences in age and gender composition between the two groups （P〉0.05）. Single factor analysis showed that the two groups had no significant difference in factors of patient height, history of smoking, hypertension, diabetes, hyperlipidemia, chronic gastritis, cerebral infarction over one years and Killip grading （P〉O.05）, while there was significant difference in patients＇ weight （P〈0.05）. Differences in HGB, Cr, UA, LVEF were significant between the two groups （P〈0.05）, among which the difference of LVEF was very significant （P〈0.01）. It suggested that hemorrhage incidents were related with the upper factors. Multi-factor Logistic regression model revealed that high level of weight, HGB, Cr, UA, LVEF played as protection factors in hemorrhage incidents （B=-0.13, OR=0.98, 95%CI： 1.53-2.83, P〈0.05）. The result was just consistent with that of the multi-factor Cox regression model analysis on LVEF （B=-0.11, OR=0.98, 95%CI： 1.56-2.89, P〈0.05）. Conclusion High LVEF level acts as a protective factor in STEMI patients, while low LVEF patients have a higher risk on the contrary. LVEF detection of early STEMI patients has a significant value in evaluating the hemorrhage risk of thrombolysis.