海南南部地区候鸟人群与本地人群急性心肌梗死流行病学特点及预后的对比分析

Comparative analysis of epidemiological characteristics and prognosis of acute myocardial infarction between migratory bird population and local population in southern Hainan

目的探讨海南南部地区候鸟人群与本地人群急性心肌梗死流行病学特点及预后。方法回顾性分析2015年1月-2018年1月海南省第三人民医院收治的357例因不同气候带迁徙所致急性ST段抬高型心肌梗死(STEMI)并行直接经皮冠状动脉介入术(PCI)治疗的患者,其中候鸟人群215例,本地人群142例。分析两组患者的基本资料、危险因素、临床检查结果及院内转归情况。结果候鸟人群多发病于冬季刚到海南的第1~2个月内,本地人群无时间规律,候鸟人群与本地人群在性别比例、平均年龄方面比较差异无统计学意义(P>0.05)。在危险因素方面,候鸟人群以冠状动脉粥样硬化性心脏病、糖尿病、高血压、高血脂为主,本地人群青壮年患者以高血压、糖尿病、吸烟为主,高龄患者则以吸烟、高血压为主。候鸟人群血肌酐(Scr)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CKMB)、N端前脑钠肽(NT-proBNPN)、超敏C-反应蛋白(hs-CRP)水平与本地人群比较差异有统计学意义(P<0.05),多合并冠状动脉多支病变(P<0.05),同时,心肌梗死后综合征者比例高(P<0.05),痊愈率低(P<0.05),需要用主动脉球囊反搏术(IABP)的心源性休克比例及整体死亡率候鸟人群稍高,但差异无统计学意义(P>0.05)。结论海南南部地区候鸟人群STEMI患者,多合并冠状动脉多支病变,炎症因子水平高,心肌梗死后综合征者比例高,预后差。

Objective To investigate the characteristics and prognosis of acute myocardial infarction in migratory bird population and local population in southern Hainan. Methods A retrospective analysis of 357 patients with acute ST-elevation myocardial infarction(STEMI) induced by different climatic zone migrations from January2015 to January 2018 in our hospital was performed with direct percutaneous coronary intervention(PCI), including215 cases of migratory birds and 142 cases of local populations. The basic data, risk factors, clinical examination results, and outcomes in the hospital of the two groups were analyzed. Results In the first to second months after the arrival of winter in Hainan, there was no regularity in the local population. There was no significant difference in the sex ratio and average age between the migratory birds and the local population(P > 0.05). In terms of risk factors, the population of migratory birds is mainly coronary atherosclerotic heart disease, diabetes, hypertension, and hyperlipidemia. The majority of young people in the local population are mainly hypertension, diabetes, and smoking,while the elderly are smokers and hypertension. The levels of SCr, cTnT, CKMB, NT-proBNP, and hs-CRP in the migrant population were significantly different from those in the local population(P < 0.05), and more multi-vessel coronary lesions(P < 0.05). Meanwhile, the proportion of post-myocardial infarction syndrome was high(P < 0.05), the rate of recovery was low(P < 0.05), the proportion of cardiogenic shock requiring IABP and the overall mortality rate of migratory birds was slightly higher, but no significant difference(P > 0.05). The overall proportion of cardiogenic shock and mortality need IABP birds crowd higher, but the difference was not statistically significant(P > 0.05). Conclusions STEMI patients in the southern part of Hainan have multiple coronary artery disease with high inflammatory factors, high proportion of patients with post-myocardial infarction syndrome and poor prognosis.