探讨影响急性ST段抬高型心肌梗死患者Killip分级的危险因素

Effect of risk factors on Killip classification in patients with ST-segment elevation myocardial infarction

目的探讨影响急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者Killip分级的独立危险因素。方法收集2011年11月至2012年6月苏州大学附属第一医院325例STEMI患者的临床特征、冠状动脉造影(CAG)结果、Killip分级、Gensini积分。将患者分为Killip 1～2级(A组)274例及Killip 3～4级(B组)51例。应用多因素Logistic前向逐步回归分析影响急性STEMI患者Killip分级的危险因素。结果(1)与A组比较,B组年龄偏大,空腹血糖、尿酸、血肌酐、高敏C反应蛋白浓度和Gensini积分、双支及多支冠状动脉病变支数患者比例均明显升高,差异有统计学意义(P<0.05);收缩压、舒张压、肌酐清除率、射血分数明显下降,差异有统计学意义(P<0.05)。(2)多因素Logistic回归分析显示,高敏C反应蛋白、Gensini总积分是影响STEMI患者Killip分级的独立危险因素(OR=1.139,95%CI:1.003～1.292,P=0.040;OR=1.045,95%CI:1.020～1.071,P=0.000)。结论 STEMI患者Killip分级受多种因素影响,其中高敏C反应蛋白、Gensini总积分可能是影响急性STEMI患者Killip分级的危险因素。

Objectives To investigate the effect of risk factors on Killip classification in patients with ST-segment elevation myocardial infarction （STEMI）. Methods Clinical data, coronary angiography results, Killip classification, Gensini scores of 325 patients with acute coronary syndromes were collected from November 2011 to June 2012 in First Hospital Affiliated to Soochow University. The patients were divided into group A （Killip classification 1-2, n=274） and group B （Killip classification 3-4, n=51 ）. Multivariate Logistic regression analysis was performed to detect the possible factors of Killip classification in patients with STEMI. These factors were further analyed by stepwise regression method and multivariable Logistic regression anaslysis. Results Patients in group B were elder, had higher concentrations of fasting blood-glucose, blood uric acid, serum creatinine, high sensitivity C-reactive protein （hs-CRP）, and had higher Gensini score as well as higher percentage of double and multiple branches lesion coronary （P〈0.05） ; systolic blood pressure, diastolic blood pressure, glomerular filtration rate and left ventricular ejection fi＇action were significantly lower （P〈0.05）. Multivariable Logistic regression analysis indicated that hs-CRP and C, ensini score were independent risk factors of Killip classification （OR= 1.139, 95%CI ： 1.003-1.292, P=0.040 ; OR= 1.045, 95%CI ： 1.020-1.071, P=0.000） in patients with STEMI. Conclusions Killip classification in patients with STEMI is impacted with various factors. Among the factors, hs- CRP and Gensini score are independent risk factors of Killip classification in patients with STEMI.