|
急性ST段抬高型心肌梗死患者溶栓成功后左室射血分数下降的相关因素研究
|
Abstract:
目的:研究急性ST段抬高型心肌梗死患者溶栓成功后左室射血分数下降的影响因素。方法:选取2020年1月至2022年8月海南医学院第二附属医院心血管内科收治的急性ST段抬高型心肌梗死且溶栓成功的患者147例为研究对象,将患者分为左心室收缩功能正常组及下降组;通过比较组间基线特征差异,使用Spearman双侧相关分析及二元Logistic回归分析差异具有统计学意义的变量。结果:Spearman双侧相关分析结果表明前壁心梗(r = 0.220, P < 0.01)、左前降支病变(r = 0.204, P < 0.05)、心室节段性室壁运动异常(r = 0.389, P < 0.01)与LVEF均呈显著相关。二元Logistic回归分析结果表明心室节段性室壁运动异常与左室射血分数独立相关(P < 0.01)。结论:前壁心梗、前降支病变、心室节段性室壁运动异常与LVEF均呈显著相关;心室节段性室壁运动异常是急性ST段抬高型心肌梗死患者溶栓成功后左室射血分数下降的独立预测因子。
Objective: To investigate the influencing factors of left ventricular ejection fraction decrease in pa-tients with acute ST-segment elevation myocardial infarction after successful thrombolysis. Meth-ods: A total of 147 patients with acute ST-segment elevation myocardial infarction with successful thrombolysis admitted to the Department of Cardiovascular Medicine of the Second Affiliated Hos-pital of Hainan Medical University from January 2020 to August 2022 were selected as the study subjects. The patients were divided into normal left ventricular systolic function group and de-creased group (LVEF male < 52%, female < 53%). The differences in baseline characteristics be-tween groups were compared, Spearman bilateral correlation analysis and binary Logistic regres-sion analysis were used to analyze the variables with statistical significance (P < 0.05). Results: Spearman bilateral correlation analysis showed that anterior wall myocardial infarction (r = 0.220, P < 0.01), left anterior descending branch lesion (r = 0.204, P < 0.05), ventricular segmental wall motion (r = 0.389, P < 0.01) were significantly correlated with LVEF. Binary Logistic regression analysis showed that ventricular segmental wall motion abnormalities were independently corre-lated with left ventricular ejection fraction (P < 0.01). Conclusion: There was significant correlation between anterior wall myocardial infarction, anterior descending branch myocardial infarction and ventricular segmental wall motion and LVEF. Ventricular segmental wall motion abnormalities are independent predictors of left ventricular ejection fraction decrease in patients with acute ST-segment elevation myocardial infarction after successful thrombolysis.
[1] | 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019) [J]. 中华心血管病杂志, 2019, 47(10): 766-783. |
[2] | 张翠侠. 心肌梗死后不同射血分数患者的一般状况分析及CD163/NF-κB表达情况的研究[D]: [硕士学位论文]. 厦门: 厦门大学, 2020. https://doi.org/10.27424/d.cnki.gxmdu.2020.000687 |
[3] | 王张生, 唐增, 朱文青, 等. 左心室射血分数极度降低的心肌梗死患者心功能恢复影响因素分析[J]. 上海医学, 2018, 41(1): 5-8. |
[4] | 颜红兵, 向定成, 刘红梅, 等. ST段抬高型急性心肌梗死院前溶栓治疗中国专家共识[J]. 中国介入心脏病学杂志, 2018, 26(4): 181-190. |
[5] | P?yh?nen, P., Kylm?l?, M., Vesterinen, P., Kivist?, S., et al. (2018) Peak CK-MB Has a Strong Associ-ation with Chronic Scar Size and Wall Motion Abnormalities after Revascularized Non-Transmural Myocardial Infarc-tion—A Prospective CMR Study. BMC Cardiovascular Disorders, 18, Article No. 27.
https://doi.org/10.1186/s12872-018-0767-7 |
[6] | 杨博森, 黄宝涛, 陈飞, 等. 急性心肌梗死合并左室射血分数降低患者远期死亡的预测模型[J]. 华西医学, 2022, 37(3): 388-396. |
[7] | Khaled, S. and Matahen, R. (2018) Cardi-ovascular Risk Factors Profile in Patients with Acute Coronary Syndrome with Particular Reference to Left Ventricular Ejection Fraction. Indian Heart Journal, 70, 45-49.
https://doi.org/10.1016/j.ihj.2017.05.019 |
[8] | Yahud, E., Tzuman, O., Fink, N., Goldenberg, I., et al. (2020) Trends in Long-Term Prognosis According to Left Ventricular Ejection Fraction after Acute Coronary Syndrome. Jour-nal of Cardiology, 76, 303-308.
https://doi.org/10.1016/j.jjcc.2020.03.012 |
[9] | 中华医学会超声医学分会超声心动图学组, 中国医师协会心血管分会超声心动图专业委员会. 超声心动图评估心脏收缩和舒张功能临床应用指南[J]. 中华超声影像学杂志, 2020, 29(6): 461-477. |
[10] | 窦克非, 王虹剑. 2019年中国成人急性ST段抬高型心肌梗死医疗质量控制报告[J]. 中国循环杂志, 2020, 35(4): 313-325. |
[11] | Chamtouri, I., Amdouni, N., Abdallah, W., et al. (2022) Features and IN-Hospital Prognosis of Reduced or Preserved Ejection Fraction in St-Segment Elevation Myocardial Infraction Man-aged by Primary Percutaneous Coronary Intervention. Journal of Hypertension, 40, e165-e166. https://doi.org/10.1097/01.hjh.0000837048.87172.a2 |
[12] | Legallois, D., Hodzic, A., Milliez, P., Manrique, A., Dolladille, C., Saloux, E. and Beygui, F. (2022) Left Atrial Strain Quantified after Myocardial Infarction Is Associated with Early Left Ventricular Remodeling. Echocardiography, 39, 1581-1588. https://doi.org/10.1111/echo.15492 |
[13] | 黄宇鹏, 杨国康, 金红艳, 等. 冠状动脉内溶栓联合PCI治疗急性心肌梗死的疗效及对心功能、内皮功能的影响[J]. 中西医结合心脑血管病杂志, 2021, 19(24): 4334-4336. |
[14] | 况志彬. 尿激酶溶栓对AMI患者心功能、凝血及纤溶系统的影响[J]. 海南医学院学报, 2017, 23(12): 1610-1612.
https://doi.org/10.13210/j.cnki.jhmu.20170627.017 |
[15] | 中国医师协会心血管内科医师分会, 中国心血管健康联盟, 心肌梗死后心力衰竭防治专家共识工作组. 2020心肌梗死后心力衰竭防治专家共识[J]. 中国循环杂志, 2020, 35(12): 1166-1180. |
[16] | 谢华磊, 冯泽瑞, 吕振环, 等. 急诊溶栓治疗STEMI的疗效及对患者心功能、心肌细胞坏死指标和炎性指标的影响[J]. 中华全科医学, 2019, 17(1): 63-65+120. https://doi.org/10.16766/j.cnki.issn.1674-4152.000600 |
[17] | 陈宏丹. 斑点追踪成像评价射血分数保留的急性前壁心肌梗死后左室重构[D]: [硕士学位论文]. 广州: 暨南大学, 2017. |
[18] | 张小花, 韩素华, 门光明, 姜志荣. 实时三维超声心动图对左前降支经皮冠状动脉介入术后左室节段收缩功能与同步性的评价[J]. 临床超声医学杂志, 2016, 18(8): 517-520.
https://doi.org/10.16245/j.cnki.issn1008-6978.2016.08.005 |
[19] | Antonelli, L., Katz, M., Bacal, F., et al. (2015) Heart Failure with Preserved Left Ventricular Ejection Fraction in Patients with Acute Myocardial Infarction. Arquivos Brasileiros de Cardiologia, 105, 145-150.
https://doi.org/10.5935/abc.20150055 |
[20] | 中国医师协会胸痛专业委员会, 中华心血管病杂志(网络版)编辑委员会, 急性心肌梗死后心室重构防治专家共识起草组. 急性心肌梗死后心室重构防治专家共识[J]. 中华心血管病杂志(网络版), 2020, 3(1): 1-7. |
[21] | 凌倜. 芪苈强心对缺氧心肌微血管内皮和心肌梗死后心衰大鼠心脏的保护作用及机制研究[D]: [硕士学位论文]. 上海: 复旦大学, 2014. |
[22] | Rahimah, A.F., Pikir, B.S. and Imatsu, O. (2020) Correlation between Wall Motion Score Index (WMSI) and Anatomical M-Mode (AAM) Systolic Thickening with Functional Capacity in Heart Failure among Post-Myocardial Infarction Patients. IOP Conference Series: Earth and En-vironmental Science, 441, Article ID: 012162.
https://doi.org/10.1088/1755-1315/441/1/012162 |
[23] | 王海龙, 王卓众, 田进伟. 前降支或非前降支ST段抬高型心肌梗死患者经皮冠状动脉介入术后左心室射血分数低的危险因素及预后[J]. 中国动脉硬化杂志, 2020, 28(10): 833-840. |
[24] | Chen, Z.-W., Yu, Z.-Q., Yang, H.-B., et al. (2016) Rapid Predictors for the Occurrence of Reduced Left Ventricular Ejection Fraction between LAD and Non-LAD Related ST-Elevation Myocardial Infarction. BMC Cardiovascular Disorders, 16, Article No. 3. https://doi.org/10.1186/s12872-015-0178-y |
[25] | Khan, T.A., Chowdhury, A.W., Khan, H.L.R., Amin, M.G., Sabah, K.M.N. and Hossain, M. (2016) Echocardiographic Comparison of Regional Wall Motion Abnormality between Patients with Acute Anteroseptal and Acute Extensive Anteior ST Seg-ment Elevation Myocardial Infarction. Bangladesh Medical Research Council Bulletin, 41, 35-40.
https://doi.org/10.3329/bmrcb.v41i1.30232 |
[26] | 王国良, 马光, 滕伟, 等. 血清sST2结合左心室射血分数对急性心肌梗死后心力衰竭的预测价值[J]. 安徽医学, 2019, 40(4): 384-388. |
[27] | 谢鑫权, 董晓云. 超声对50例急性前壁心肌梗死患者左室收缩功能的评估价值[J]. 影像研究与医学应用, 2021, 5(21): 28-29. |
[28] | 胡茜, 石增刚, 姜亦瑶, 王琳. 急性前壁心肌梗死患者心电图碎裂QRS波与左室收缩功能相关性的研究[J]. 临床和实验医学杂志, 2021, 20(24): 2600-2603. |
[29] | Jurado-Román, A., Agudo-Quílez, P., Rubio-Alonso, B., et al. (2019) Superiority of Wall Motion Score Index over Left Ventricle Ejection Fraction in Predicting Cardiovascular Events after an Acute Myocardial Infarction. European Heart Journal: Acute Cardiovascular Care, 8, 78-85. https://doi.org/10.1177/2048872616674464 |
[30] | Sharma, Y.P., Krishnappa, D., Kanabar, K., et al. (2019) Clinical Characteristics and Outcome in Patients with a Delayed Presentation after ST-Elevation Myocardial Infarction and Com-plicated by Cardiogenic Shock. Indian Heart Journal, 71, 387-393. https://doi.org/10.1016/j.ihj.2019.11.256 |
[31] | 田翠燕. 心肌梗死后心衰大鼠炎症损伤机制及干预的研究[D]: [硕士学位论文]. 天津: 天津医科大学, 2016. |
[32] | Wang, W., Zhao, H., Wan, F., et al. (2022) Inhomogeneous Distribution of Regional Myocardial Work Effi-ciency Predicts Early Left Ventricular Remodeling after Acute Anterior Myocardial Infarction Treated with Primary Per-cutaneous Intervention. Frontiers in Cardiovascular Medicine, 9, Article 922567. https://doi.org/10.3389/fcvm.2022.922567 |