青年急性心肌梗死患者住院期间血尿酸水平与Killip分级严重程度的关系研究

Relationship between serum uric acid and Killip classification in young patients and acute myocardial infarction

目的:通过分析青年急性心肌梗死(AMI)患者不同程度Killip分级的血尿酸(SUA)等临床资料的特点,探讨青年AMI患者Killip分级严重程度相关影响因素。方法:连续入选2016年12月1日至2018年12月31日经首都医科大学附属北京安贞医院急诊科收住的45岁以下成年AMI患者430例,采用心功能Killip分级评估全部青年患者发生AMI时住院期间心力衰竭的严重程度。依据Killip分级,分为Killip低分级组(Killip分级I级),设为对照组;和Killip高分级组(Killip分级II~IV级)设为试验组。比较2组间各项临床指标差异,分析SUA与Killip分级程度的相关性,采用Logistic回归方法分析青年AMI患者Killip分级严重程度的相关影响因素。结果:试验组SUA水平和心率(HR)明显高于对照组[(448.50±66.06)vs.(386.51±58.01)μmol/L和(83.86±14.53)vs.(73.97±15.50)次/min](均P<0.01)。青年AMI患者SUA水平与Killip分级严重程度呈直线正相关(r=0.618,P<0.001)。Logistic回归分析结果提示,SUA水平升高、HR增快和舒张压(DBP)增高是青年AMI患者出现Killip分级心功能严重恶化的重要危险因素(OR=1.050,95%CI:1.355~8.127,P=0.035;OR=1.053,95%CI:1.020~1.087,P=0.003和OR=1.075,95%CI:1.008~1.145,P=0.026)。结论:青年急性心肌梗死患者住院期间SUA水平与Killip分级严重程度密切相关,SUA水平升高是Killip分级严重程度的重要危险因素。

Objective: To analyze the characteristics of serum uric acid(SUA) and other clinical data of different Killip classes in young patients with acute myocardial infarction(AMI), and explore the relevant factors of the severity of Killip classification. Methods: From December 1 st, 2016 to December 31 st, 2018, a total of 430 young AMI patients admitted to the department of emergency of Beijing Anzhen Hospital were consecutively selected. The cardiac function of Killip classification was used to evaluate all young patients with AMI. According to the Killip classification, Killip class I was set as the control group;and the high Killip class(Killip classification II-IV) was set as the observation group. The differences of clinical indexes between the two groups were compared. Logistic regression was used to analyze the influencing factors of the severity of Killip class in young AMI patients. Results: The SUA level and heart rate(HR) of the experimental group were significantly higher than those of the control group [(448.50±66.06)vs.(386.51±58.01)μmol/L and(83.86±14.53)vs.(73.97±15.50)time/min](both P<0.01). There was a linear positive correlation between the SUA level and the severity of Killip classification in young AMI patients(r=0.618, P<0.001). Logistic regression result suggest that increased SUA level, increased HR, and increased DBP were important risk factors for high Killip class in young AMI patients(OR=1.050,95%CI: 1.355-8.127, P=0.035;OR=1.053,95%CI: 1.020-1.087,P=0.003和OR=1.075,95%CI: 1.008-1.145, P=0.026). Conclusions: The level of serum uric acid in young patients with acute myocardial infarction was closely related to the severity of Killip classification. Increased UA level was an important risk factor for the severity of Killip classification.