血浆β-羟丁酸对ST段抬高型心肌梗死患者心源性死亡的影响

Effect of plasmaβ-hydroxybutyrate on cardiac death in patients with ST-segment elevation myocardial infarction

目的探讨血浆β-羟丁酸(β-HB)对ST段抬高型心肌梗死(STEMI)患者发生心源性死亡的影响。方法282例心内科住院的STEMI患者按血浆β-HB水平分为β-HB正常组(<0.3 mmol/L,n=189)和β-HB升高组(≥0.3 mmol/L,n=93),收集2组患者住院期间的临床资料(年龄、性别、既往史、现病史、用药情况、血运重建、心脏超声、血脂及血生化等);2组患者出院后随访3年,记录发生心源性死亡事件,采用Kaplan-Meir生存分析比较2组患者生存率,采用Cox回归模型评估血浆β-HB水平对STEMI患者心源性死亡的影响。结果β-HB正常组和升高组患者中发生心源性死亡分别为12例(6.3%)和19例(20.4%);Kaplan-Meier生存分析表明,β-HB正常组STEMI患者3年累积生存率明显高于β-HB升高组(P<0.001);Cox回归模型校正混杂因素后,血浆β-HB可增加STEMI患者的心源性死亡风险(HR为1.07,95%CI为1.01~1.19,P=0.029)。结论血浆β-HB是STEMI患者心源性死亡的独立危险因素。

Objective To investigate the effect of plasmaβ-hydroxybutyrate(β-HB)on cardiac death in patients with ST-segment elevation myocardial infarction(STEMI).Methods The 282 STEMI patients hospitalized in the cardiology department were divided into normal group ofβ-HB(<0.3 mmol/L,n=189)and elevatedβ-HB groups according to their plasmaβ-HB levels(≥0.3 mmol/L,n=93).Clinical data(age,gender,past history,current medical history,medication status,revascularization,cardiac ultrasound,blood lipid,and blood biochemistry)were collected from the 2 groups during hospitalization.The patients in two groups were followed up for 3 years after discharge,and cardiac death was recorded.A Kaplan-Meir survival analysis was used to compare the survival rates in two groups,and a Cox regression model was used to assess the effect of plasmaβ-HB levels on cardiac death in patients with STEMI.Results Cardiac death occurred in 12 cases(6.3%)and 19 cases(20.4%)of patients in the normal and elevatedβ-HB groups,respectively.The Kaplan-Meier survival analysis indicated that the 3-year cumulative survival rate of STEMI patients in the normalβ-HB group was significantly higher than that in the elevatedβ-HB group(P<0.001).After adjusting for confounders,plasmaβ-HB could increase the risk of cardiac mortality in patients with STEMI(HR=1.07,95%CI was 1.01-1.19,P=0.029).Conclusions Plasmaβ-HB is an independent risk factor for cardiac death in patients with STEMI.