梗死前心绞痛有益作用影响因素的临床研究

山东大学学报(医学版)

梗死前心绞痛有益作用影响因素的临床研究

刘黎明¹,丁士芳²,王青³,高巍¹,张运²,周聊生³,李继福²

1. 山东大学第二医院急症科，山东济南 250033； 2. 山东大学齐鲁医院心内科，山东济南 250012；3. 山东省千佛山医院心内科，山东济南 250014

收稿日期:2006-04-28 修回日期:1900-01-01 出版日期:2007-04-24 发布日期:2007-04-24
通讯作者: 刘黎明

Prodromal angina pectoris beneficial factors for patients with acute myocardial infarction

LIU Li-ming¹,DING Shi-fang²,WANG Qing³,GAO Wei¹,ZHANG Yun²,ZHOU Liao-sheng³,LI Ji-fu²

1. Department of Emergency， Second Hospital of Shandong University, Jinan 250033；2. Department of Cardiology， Qilu Hospital of Shandong University, Jinan 250012；3. Department of Cardiology， Shandong Qianfo Mountain Hospital, Jinan 250014

Received:2006-04-28 Revised:1900-01-01 Online:2007-04-24 Published:2007-04-24
Contact: LIU Li-ming

摘要/Abstract

摘要： 目的:探讨影响急性心肌梗死（AMI）前发生先兆性心绞痛（AP）患者近期预后的因素。方法：① 在489例住院的首次AMI患者中，分析伴有AP（A组,n=234）及不伴有AP（B组,n=255）的临床资料及院内终点事件（心原性死亡，左室功能减退、心律失常、再梗死）;② 分析A组经静脉溶栓（A₁组,n=147）、冠脉介入（A₂组,n=87）及B组经静脉溶栓（B₁组,n=70）、冠脉介入（B₂组,n=185）的临床资料及院内终点事件。结果：① A、 B两组的临床资料及院内终点事件无差异;② A1组肌酸激酶（CK）及其同工酶（CK-MB）峰值均降低［（2386±1271）IU/L vs（3060±1241）IU/L,P＜0.001；（166±94）IU/L vs（198±127 ）IU/L, P＜0.05］；左室功能减退、再梗死及复合终点事件发生率均低于B₁组（10.9% vs 25.7%, P＜0.01；6.8% vs 18.6%,44.9% vs 60.0%, P均＜0.05）。A1组患者心原性死亡、心律失常、再梗死与糖尿病、入院时高血糖有关（P＜0.01、 P＜0.05、P＜0.05）。心律失常与高龄、冠心病史有关（P＜0.05、P＜0.01）。多元Logistic 回归分析显示:左室功能减退增加与心律失常、再梗死独立相关（OR值:14.9, CI:4.39-50.39, P＜0.001；OR值:26.4,CI:15.73-121.64, P＜0.01）；心原性死亡增加与左室功能减退独立相关（OR值:84.0,CI:9.20-767.31,P＜0.01）；心律失常增加与左室功能减退、血糖浓度独立相关（OR值:14.71,CI:4.57-47.62,P＜0.001；P＜0.001）；③　A2、B2两组院内终点事件无差异。结论：梗死前心绞痛可减少经静脉溶栓的AMI患者院内终点事件,而对介入治疗患者的院内终点事件无影响。糖尿病及入院后高血糖可抵消，而高龄、冠心病史、左室功能减退可减弱经静脉溶栓的AMI前心绞痛的有益作用。

Abstract: Objective： To explore the factors affecting short-term prognosis of acute myocardial infarction(AMI) patients with prodromal angina pectoris( AP).Methods： From October 2001 to December 2004, 234 AMI patients with previous angina pectoris(AP) (group A)and 255 AMI patients without AP (group B)were studied. In group A, 147 patients received intravenous thrombolysis( A₁ group) and 87 received PCI( A₂ group). In group B, 70 patients received intravenous thrombolysis (B₁group) and 185 received PCI (B2 group). The clinical data and the presence of cardial death, left ventricle function failure, arrhythmia, recurrent myocardial infarction were analyzed. Result： ① The clinical and combined endpoint events were not different between A and B group; ② The peak creatine kinase (CK) and CK-MB［(2386±1271)IU/Lvs(3060±1241) IU/L, P＜0.001；(166±94)IU/Lvs(198±127) IU/L, P＜0.05］ were lower, left ventricle function failure, recurrent myocardial infarction, cardial death and combined endpoint events were all lower in A group［10.9%　vs　25.7%, P＜0.01;6.8%　vs　18.6%;44.9%　vs　60.0%,　all P＜0.05］. Diabetes, hyperglycemia correlated with cardial dearth, arrhythmia, recurrent myocardial infarction （P＜0.01、　P＜0.05、 P＜0.05 respectively ）,　the elder, coronary heart disease correlated with arrhythmia(P＜0.05、　P＜0.01 respectively) In A group. Multivariate Logistic regression indicated that left ventricle function failure Independent correlates with arrhythmia, recurrent myocardial infarction(OR: 14.9,CI:4.39-50.39, P＜0.001; OR:26.4,CI: 15.73-121.64, P＜0.01); cardial death is independently related with left ventricle function failure (OR: 84.0,CI :9.20-767.31, P＜0.01); arrhythmia correlates with left ventricle function failure, hyperglycemia independently (OR: 14.71,CI:4.57-47.62, P＜0.001; P＜0.001)；　③ The combined endpoint events were no difference between A₂group B₂ group. Conclusions： AP can reduce the combined endpoint events of AMI that received intravenous thrombolysis. But diabetes and hyperglycemia can counteract the profitable effect of AP in patients with AMI received intravenous thrombolysis. The elder、 coronary heart disease、 left ventricle function failure can decrease the profitable effect of AP in patients with AMI received intravenous thrombolysis.

Key words: Myocardial infarction, Angina, Preinfartion, Isohemic Preconditioning, Prognosis

中图分类号:

R542.2

刘黎明,丁士芳,王青,高巍,张运,周聊生,李继福 . 梗死前心绞痛有益作用影响因素的临床研究[J]. 山东大学学报(医学版), 2007, 45(4): 348-352.

LIU Li-ming,DING Shi-fang,WANG Qing,GAO Wei,ZHANG Yun,ZHOU Liao-sheng,LI Ji-fu. Prodromal angina pectoris beneficial factors for patients with acute myocardial infarction[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(4): 348-352.

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