急性心肌梗死发生的高危因素分析

Analysis of High Risk Factors of Acute Myocardial Infarction

目的探讨急性心肌梗死发生的高危因素。方法选取2020年2—6月于石河子市人民医院胸痛中心接受治疗的急性心肌梗死患者134例(ST段抬高型心肌梗死77例、非ST段抬高型心肌梗死57例)作为观察组,另选取同期于医院接受治疗的心绞痛患者143例(不稳定型心绞痛100例、稳定型心绞痛43例)作为对照组进行回顾性分析。比较两组患者性别、年龄、体质量指数、吸烟史、高血压史、高血脂史、糖尿病史、既往心肌梗死等一般临床资料。比较两组患者入院时三酰甘油、高密度脂蛋白胆固醇、空腹血糖、收缩压、舒张压、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、糖化血红蛋白及肌钙蛋白水平。记录观察组患者在院期间治疗情况及主要心血管不良事件发生情况。采用多因素Logistic回归模型分析急性心肌梗死发生的独立危险因素。结果两组患者年龄、体质量指数及既往心肌梗死病史比例比较差异无统计学意义(P>0.05)。观察组男性、吸烟史、高血压史、高血脂史、糖尿病史比例均高于对照组,差异有统计学意义(P<0.05)。观察组患者CK-MB[(57.35±9.12)μg/L vs.(40.25±7.41)μg/L]、肌钙蛋白[(3.02±0.23)μg/L vs.(0.65±0.25)μg/L]、三酰甘油[(2.05±1.13)mmol/L vs.(1.52±0.84)mmol/L]、空腹血糖[(6.98±1.81)mmol/L vs.(5.46±1.22)mmol/L]、糖化血红蛋白水平[(6.75±1.16)%vs.(5.96±1.03)%]均高于对照组,高密度脂蛋白水平低于对照组[(1.02±0.26)mmol/L vs.(1.95±0.21)mmol/L],差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,男性、高血脂史、吸烟史、高血糖史、高血压史是发生急性心肌梗死的独立危险因素(P<0.05)。住院治疗期间,观察组4例患者出现术中出血事件,4例再次行血运重建手术,4例行三尖瓣置换术,4例出现心室颤动。结论男性、高血脂史、吸烟史、高血糖史、高血压史是急性心肌梗死的独立危险因素。

Objective To investigate the high risk factors of acute myocardial infarction.Methods From February to June 2020,a total of 134 patients with acute myocardial infarction(77 cases of ST-segment elevation myocardial infarction and 57 cases of non-ST-segment elevation myocardial infarction)admitted to People’s Hospital of Shihezi were selected as the observation group,and 143 cases of angina pectoris(100 cases of unstable angina pectoris and 43 cases of stable angina pectoris)in the hospital were selected as the control group.The general clinical data such as gender,age,body mass index,smoking history,hypertension history,hyperlipidemia history,diabetes mellitus history,previous myocardial infarction of patients in both groups were recorded.The levels of triacylglycerol,high-density lipoprotein cholesterol,fasting glucose,systolic blood pressure,diastolic blood pressure,creatine kinase isoenzyme(CK-MB)and glycated hemoglobin and troponin on admission were compared between the patients in the two groups.The treatment and major adverse cardiovascular events of patients in the observation group during hospitalization were recorded.Multivariate Logistic regression model was used to analyze the independent risk factors for acute myocardial infarction.Results There was no significant difference in age,body mass index and the proportion of previous myocardial infarction between the two groups(P>0.05).The proportion of male,smoking history,hypertension history,hyperlipemia and diabetes mellitus in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).In observation group,the level of CK-MB[(57.35±9.12)μg/L vs.(40.25±7.41)μg/L],troponin[(3.02±0.23)μg/L vs.(0.65±0.25)μg/L],triacylglycerol[(2.05±1.13)mmol/L vs.(1.52±0.84)mmol/L],fasting blood glucose[(6.98±1.81)mmol/L vs.(5.46±1.22)mmol/L],glycosylated hemoglobin[(6.75±1.16)%vs.(5.96±1.03)%]were higher than those of the control group,and the level of high-density lipoprotein was lower than that of the control group[(1.02±0.26)mmol/L vs.(1.95±0.21)mmol/L],the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that male,history of hyperlipidemia,smoking history,history of hyperglycemia and history of hypertension were independent risk factors of acute myocardial infarction.During hospitalization,4patients had intraoperative bleeding events,4 patients underwent repeat revascularization procedures,4 patients underwent tricuspid valve replacement,and 4 patients developed ventricular fibrillation.Conclusion Male,history of hyperlipidemia,smoking history,history of hyperglycemia and hypertension were independent risk factors of acute myocardial infarction.