急性消化道出血患者心肌损伤的危险因素分析

Risk Factors for Myocardial Injury with Concomitant Acute Gastrointestinal Hemorrhage

目的探讨急性消化道出血(GIB)患者心肌损伤的危险因素。方法选取本科室2016年1月至2016年12月320例急性GIB患者,根据入院72 h内血清肌钙蛋白Ⅰ或超敏肌钙蛋白T是否升高,分为心肌损伤组和无心肌损伤组。比较2组患者性别、年龄、首次外周静脉血红细胞计数、血红蛋白浓度(HGB)、血小板计数、谷丙转氨酶、血清碱性磷酸酶、总胆红素、血清白蛋白、血清尿素、血清肌酐、凝血酶原时间,活化部分凝血活酶时间和纤维蛋白原指标情况,并将上述单因素分析有显著性差异的因素纳入logistic回归多因素分析,以P<0.05为差异有统计学意义。对多因素分析得出的危险因素绘制受试者工作特征曲线,计算曲线下面积、截断值、灵敏度、特异度、阳性预测值和阴性预测值。结果 logistic回归多因素分析结果提示男性(OR=2.939,P=0.011)、年龄增加(OR=1.037,P=0.003),低HGB(OR=0.987,P=0.013)是急性GIB时心肌损伤发生的独立危险因素。结论年龄>60岁男性急性GIB患者,应适当放宽输血阈值以降低心肌损伤发生的风险。

Objective To analyze the risk factors for myocardial injury complicated with acute gastrointestinal hemorrhage(GIB).Methods We retrospectively studied 320 patients with acute GIB who presented to the Emergency Department of the First Hospital of China Medical University between January 2016 and December 2016.Based on whether their serum cardiac troponinⅠor high-sensitivity cardiac troponin T levels were elevated within the first 72 hours after admission,patients were divided into a myocardial injury and a non-myocardial injury group.Sex,age,red blood cell and platelet counts,hemoglobin(HGB),and serum levels of alanine aminotransferase,alkaline phosphatase,total bilirubin,albumin,blood urea,creatinine,as well as the prothrombin time,activated partial thromboplastin time,and plasma fibrinogen were analyzed.Factors showing significant differences were included in the multivariate logistic regression analysis,and P<0.05 was considered statistically significant.A receiver operating characteristic curve was plotted,and the area under the curve,cut-off values,sensitivity,specificity,and positive and negative predictive values were calculated.Results Multivariate logistic regression analysis showed that male sex(OR=2.939,P=0.011),increased age(OR=1.037,P=0.003),and low HGB levels(OR=0.987,P=0.013)were independent risk factors for myocardial injury with concomitant acute GIB.Conclusion In men aged>60 years with acute GIB,an appropriate increase in transfusion threshold may reduce the risk of myocardial injury.