急性心肌梗死并发室间隔穿孔内科保守治疗的短期预后影响因素分析

Ventricular septal rupture complicating acute myocardial infarction:Influencing factors associated with short-term prognosis after conservative treatment

目的研究内科保守治疗急性心肌梗死(acute myocardial infarction,AMI)并发室间隔穿孔(ventricular septal rupture,VSR)的短期(30 d)预后影响因素。方法回顾性分析2009年5月-2018年12月由解放军总医院第一医学中心心血管内科收治的急性心肌梗死并发室间隔穿孔患者,排除心肌梗死后30 d内进行外科手术及封堵术的患者,共21例;依据其30 d内是否死亡分为存活组(7例)及死亡组(14例),研究其临床特点。结果存活组年龄显著低于死亡组[(57.43±9.85)岁vs(72.43±9.10)岁,P<0.05]。死亡组白细胞计数(14.77±5.54 vs 8.94±2.00,P=0.003)、肌钙蛋白T(3.56 ng/ml vs 0.31 ng/ml,P=0.011)、肌酸激酶同工酶(52.70 ng/ml vs 3.70 ng/ml,P=0.017)水平显著高于存活组。存活组心梗后发生VSR中位时间时间更长(7.00 d vs 2.75 d),死亡组脑利钠肽前体中位水平高于存活组(9148 pg/ml vs 4255 pg/ml),但差异无统计学意义(P均>0.05);存活组患者VSR的直径较死亡组更小,差异无统计学意义[(10.71±3.40)mm vs(12.14±4.09)mm,P=0.436]。AMI后VSR保守治疗的患者30 d病死率为66.67%。结论年龄、白细胞数、肌钙蛋白T、肌酸激酶同工酶水平对AMI后VSR患者短期预后有一定影响。

Objective To investigate the influencing factors associated with short-term prognosis for patients received conservative treatment of ventricular septal rupture(VSR)complicating acute myocardial infarction(AMI).Methods Clinical data about 21 patients diagnosed with VSR after AMI in the first medical center of Chinese PLA General Hospital from May 2009 to December 2018 were retrospectively analyzed.The patients who received surgery or transcatheter closure within 30 days were ruled out.Totally 21 patients were included in our study,and they were divided into survival group(n=7)and death group(n=14)according to 30-day prognosis,and their clinical characteristics were investigated.Results Patients in death group were significantly older(57.43±9.85 years vs 72.43±9.10 years,P=0.003),had significantly higher level of WBC counts(14.77±5.54 vs 8.94±2.00,P=0.003),significantly higher level of Troponin T(Md,3.56 ng/ml vs 0.31 ng/ml,P=0.011)and CK-MB(52.70 ng/ml vs 3.70 ng/ml,P=0.017)than those in survival group.Patients in death group had greater interval between VSR and AMI(Md,7.00 d vs 2.75 d),higher level of pro-BNP(Md,9148 pg/ml vs 4255 pg/ml)and bigger diameter of VSR(10.71±3.40 mm vs 12.14±4.09 mm)than those in death group,however,the differences were not significant(all P>0.05).The 30-day mortality rate of VSR after AMI was 66.67%.Conclusion Age,WBC count,troponin T and CK-MB levels play potential roles in the short-term prognosis of patients with VSR after AMI.