非ST段抬高型急性冠脉综合征患者发生恶性室性心律失常的危险因素分析

Risk factors of malignant ventricular arrhythmia in patients with non-ST-segment elevation acute coronary syndrome

目的探讨非ST段抬高型急性冠脉综合征(NST-ACS)患者发生恶性室性心律失常(MVA)的危险因素。方法选取2015年2月至2016年9月舟山医院收治的256例NST-ACS为研究对象,按照住院期间是否发生MVA分为MVA组(71例)及非MVA组(185例)。比较两组一般临床资料之间的差异。采用logistic回归方程分析NST-ACS患者发生MVA发生的相关因素。结果单因素分析提示MVA组与非MVA组在贫血、经皮冠状动脉介入(PCI)开通犯罪血管(IRA)、冠状动脉病变支数、甘油三酯、血糖、白细胞计数、C反应蛋白(CRP)、血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、D-二聚体、左心室射血分数(LVEF)、氨基末端脑钠肽前体(NT-proBNP)、血钾水平差异均有统计学意义(均P<0.05)。logistic回归分析亦显示:冠状动脉病变支数、白细胞计数、CRP、cTnI、NT-proBNP、D-二聚体是NST-ACS患者住院期间发生MVA的高危因素。结论冠状动脉病变支数较多、机体高水平白细胞计数、CRP、cTnI、NT-proBNP及D-二聚体均是MVA发生的高危因素。

Objective To investigate the risk factors of malignant ventricular arrhythmia（MVA） in patients with non-ST-segment elevation acute coronary syndrome（NST-ACS）. Methods A total of 256 patients with NST-ACS were enrolled from February 2015 to September 2016 and divided into group A（MVA, n = 71） and group B（non-MVA, n = 185）according to whether MVA occurred during hospitalization. The differences of clinical data between the two groups were analyzed. Logistic regression equation was used to analyze the related factors ofMVA in patients with NST-ACS. Results Univariate analysis showed that the history of anemia, successful percutaneous coronary intervention in culprit arteries, the number of coronary artery disease, triglyceride（TG）, blood sugar, white blood cell count（WBC）, C-reactive protein（CRP）,plasma troponin I（cTnI）, creatine kinase isoenzyme（CK-MB）, D-dimer, left ventricular ejection fraction（LVEF）,NT-proBNP and potassium levels were significantly different between the two groups（all P〈0.05）. Logistic regression analysis showed that the vessel number of coronary artery lesion（OR=1.131, 95% CI： 1.089～1.378, P〈0.05）, WBC（OR=1.889, 95% CI：1.193～3.760, P〈0.05）, CRP（OR=1.450, 95% CI： 1.110～2.461, P〈0.05）, cTnI（OR=2.167,95% CI：1.554～4.298, P〈0.05）, NT-proBNP（OR=1.526, 95% CI： 1.224～2.263, P〈0.05）, and D-dimer（OR=1.342, 95% CI：1.165～3.893, P〈0.05） were risk factors of MVA during hospitalization. Conclusion Multiple coronary artery lesions, high level ofWBC, CRP, cTnI, NT-proBNP and D-dimer are risk factors ofMVA.