de Winter综合征患者临床特征及1年预后

Analysis clinical features and prognosis of one-year patients with de Winter syndrome

目的探讨de Winter综合征患者的临床特征、院内及1年预后情况。方法选取首都医科大学大兴教学医院2019年1月至2020年1月确诊为de Winter综合征的患者18例作为观察组,选取同期收治的急性前壁ST段抬高型心肌梗死(STEMI)患者62例作为对照组,比较两组患者的临床特征、院内以及1年主要不良事件发生情况。结果观察组男性(94.4%比69.4%)和吸烟者(72.2%比41.9%)占比均高于对照组,平均年龄[(50.6±9.4)岁比(62.0±12.6)岁]、肌酸激酶峰值[1194.5(589.0,1850.5)U/L比1991.5(1399.5,3726.0)U/L]以及B型脑钠肽[111.0(53.0,238.7)pg/ml比218.0(147.7,315.0)pg/ml]均低于对照组,而左心室射血分数高于对照组[(56.0±7.2)%比(50.1±6.7)%],差异均有统计学意义(均P<0.05)。急诊冠状动脉造影提示观察组单支病变占比高于对照组(50.0%比24.2%),而术中及术后血管活性药物的使用率低于对照组(16.7%比46.8%),差异均有统计学意义(均P<0.05)。观察组入门至球囊扩张(D-to-B)时间长于对照组[(89.2±14.14)min比(74.0±18.12)min],而住院时间短于对照组[(8.8±2.4)d比(11.2±3.2)d],差异均有统计学意义(均P<0.05)。观察组住院期间心力衰竭发生率(16.7%比46.8%)以及1年再住院率(13.3%比49.1%)均明显低于对照组,差异均有统计学意义(均P<0.05)。结论de Winter综合征患者男性吸烟者多见,发病年龄小,院内心力衰竭发生率及1年再住院率低,但D-to-B时间长于STEMI患者,需要进一步加强重视。

Objective To investigate the clinical features,in-hospital and 1-year prognosis of patients with de Winter syndrome.Methods A retrospective analysis of 18 patients of with de Winter syndrome in Daxing teaching hospital of Capital Medical University form January 2019 to January 2020 were selected as the observation group,62 patients with acute anterior ST-segment elevation myocardial infarction admitted in the same period were selected as the control group.The clinical features,in-hospital and 1-year major adverse events of the two groups were compared.Results The proportion of male(94.4%)and smokers(72.2%)in the observation group was high,the average age was low[(50.6±9.4)years old vs.(62.0±12.6)years old,P=0.005],the peak value of CK[1194.5(589.0,1850.5)U/L vs.1991.5(1399.5,3726.0)U/L,P=0.020]and BNP[111.0(53.0,238.7)pg/ml vs.218.0(147.7,315.0)pg/ml,P=0.033]were signifi cantly lower than those in thecontrol group,and the left ventricular ejection fraction(LVEF)was significantly higher than that in the control group[(56.0±7.2)%vs.(50.1±6.7)%,P=0.034].Emergency coronary angiography(CAG)showed that the proportion of single vessel lesions in the observation group was high(50%vs.24.2%,P=0.035),and the utilization rate of vascular active drugs during and after operation was lower than that in the control group(16.7%vs.46.8%,P=0.022).Compared with the control group,the D-to-B time of the observation group was higher than that of the control group[(89.2±14.14)min vs.(74.0±18.12)min,P=0.010],and the hospitalization time of the observation group was lower than that of the control group[(8.8±2.4)d vs.(11.2±3.2)d,P=0.017].The incidence of heart failure(16.7%vs.46.8%,P=0.043)and 1-year readmission rate(13.3%vs.49.1%,P=0.028)in the observation group were signifi cantly lower than those in the control group.Conclusions Patients with De Winter syndrome are more common in young male,the proportion of smokers was high,and the incidence of heart failure in-hospital and 1-year rehospitalization were lower,but the D-to-B time is higher than that in STEMI group,which needs further attention.