血乳酸、乳酸清除率与急性心肌梗死患者冠状动脉病变严重程度及预后相关性分析

Correlation Analysis of Blood Lactic Acid and Lactate Clearance Rate with the Severity of Coronary Artery Lesions and Prognosis in Patients with Acute Myocardial Infarction

目的探究血乳酸、乳酸清除率与急性心肌梗死(AMI)患者冠状动脉病变严重程度及预后的相关性。方法选取2022年11月—2023年12月收治的150例AMI作为研究对象,所有患者入院后行动脉血乳酸检查,根据入院时乳酸水平分为对照组(乳酸正常)66例与观察组(乳酸升高)84例,2组均进行冠状动脉造影检查,比较2组一般资料、冠状动脉病变严重程度、预后情况,并采用多因素Logistic回归分析探究乳酸与AMI患者冠状动脉病变严重程度及预后的关系。结果观察组吸烟、高血压病、糖尿病比例以及B型脑钠肽、肌钙蛋白、血乳酸水平高于对照组,左心室射血分数、乳酸清除率低于对照组(P<0.05,P<0.01);观察组单支病变比例低于对照组,多支病变比例高于对照组(P<0.05);观察组主要心血管不良事件总发生率高于对照组(P<0.05)。多因素Logistic回归分析结果显示:AMI患者冠状动脉病变支数(OR=3.271;95%CI:1.487,7.192;P=0.003)、预后(OR=2.622;95%CI:1.233,5.577;P=0.013)与乳酸升高有关。结论血乳酸水平、乳酸清除率与AMI患者冠状动脉病变严重程度、预后存在密切联系,入院时乳酸水平检测有利于临床对AMI病情与预后进行判断。

Objective To explore the correlation of blood lactic acid and lactate clearance rate(LCR)with the severity of coronary artery lesions and prognosis in patients with acute myocardial infarction(AMI).Methods A total of 150 patients with AMI admitted from November 2022 to December 2023 were selected as the research subjects.According to blood lactic acid level at admission,the patients were divided into the control group(66 cases,with normal lactic acid level)and the observation group(84 cases,with elevated lactic acid level).Both groups received coronary angiography.General information,severity of coronary artery lesions and prognosis were compared between the two groups.The relationship between lactic acid and the severity of coronary artery lesions and prognosis in patients with AMI was discussed.Results The proportion of smokers,hypertensive patients and diabetic patients and the levels of B-type natriuretic peptide and troponin were higher in the observation group than in the control group,while left ventricular ejection fraction and LCR were lower than those in the control group(P<0.05,P<0.01).The proportion of single-vessel disease in the observation group was lower than that in the control group,while the proportion of multi-vessel disease was higher than that in the control group(P<0.05).The total incidence of major adverse cardiovascular events in the observation group was higher than that in the control group(P<0.05).Multivariate logistic regression analysis found that number of coronary artery lesions(OR=3.271,95%CI:1.487,7.192,P=0.003)and prognosis(OR=2.622,95%CI:1.233,5.577,P=0.013)were related to elevated lactic acid level in patients with AMI.Conclusion Blood lactic acid level and LCR are closely related to the severity of coronary artery lesions and prognosis in patients with AMI.Detecting blood lactic acid level at admission is beneficial for clinical judgment of condition and prognosis of AMI.