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目的分析心肌梗死溶栓再通后心力衰竭的相关危险因素。方法选取2011年5月至2015年5月延安大学附属医院收治的心肌梗死溶栓再通患者152例,根据再通后是否发生心力衰竭,将患者分为心力衰竭组(40例)和非心力衰竭组(112例)。比较两组一般资料与各临床指标。分析心肌梗死溶栓再通后发生心力衰竭的相关危险因素。结果两组患者的年龄、性别、体质指数、就诊到溶栓时间及高血压患者比例比较差异无统计学意义(P>0.05)。心力衰竭组中糖尿病患者比例、梗死前心绞痛比例均显著高于非心力衰竭组[42.5%(17/40)比7.1%(8/112),60.0%(24/40)比41.1%(46/112),P<0.05或P<0.01]。心力衰竭组患者的白细胞计数、空腹血糖、γ-谷氨酰转肽酶(GGT)、高敏C反应蛋白(hs-CRP)、脑钠肽水平与左心室舒张末期内径均显著高于非心力衰竭组[(10.2±2.5)×10~9/L比(8.7±2.1)×10~9/L,(12.3±3.6)mmol/L比(6.7±1.2)mmol/L,(60±7)U/L比(28±8)U/L,(4.95±0.52)mg/L比(2.64±0.27)mg/L,(356±58)ng/L比(172±45)ng/L,(56±9)mm比(51±7)mm,P<0.05]。心力衰竭组患者的左心室射血分数显著低于非心力衰竭组[(41±5)%比(54±7)%,P<0.05]。GGT(OR=1.067,95%CI 1.032~1.103)、hs-CRP(OR=1.402,95%CI 1.078~1.823)、空腹血糖(OR=1.246,95%CI 1.059~1.466)是心肌梗死溶栓再通患者发生心力衰竭的危险因素。结论 GGT、hs-CRP、空腹血糖为心肌梗死溶栓再通患者发生心力衰竭的危险因素。
Objective To analyze the risk factors of heart failure after thrombolytic and recanalization of myocardial infarction. Methods From May 2011 to May 2015, 152 patients with myocardial infarction thrombolytic recanalization admitted to Yan’an University Affiliated Hospital were divided into heart failure group (40 cases) and non-cardiac group Failure group (112 cases). Compare the two groups of general information and each clinical index. Analysis of risk factors for heart failure after thrombolytic recanalization of myocardial infarction. Results There was no significant difference in the age, sex, body mass index, the time of treatment between thrombolysis and hypertension in the two groups (P> 0.05). The proportion of patients with diabetes and the rate of pre-infarction angina in heart failure group were significantly higher than those in non-heart failure group (42.5%, 17/40), 7.1% (8/112), 60.0% (24/40), 41.1% 112), P <0.05 or P <0.01]. The white blood cell count, fasting plasma glucose, glutamyl transpeptidase (GGT), high-sensitivity C-reactive protein (hs-CRP), brain natriuretic peptide and left ventricular end-diastolic diameter in patients with heart failure were significantly higher than those in non-heart failure (10.2 ± 2.5) × 10 ~ 9 / L (8.7 ± 2.1) × 10 ~ 9 / L, (12.3 ± 3.6) mmol / L vs 6.7 ± 1.2 mmol / L and (60 ± 7) U L ratio was (28 ± 8) U / L, (4.95 ± 0.52) mg / L vs (2.64 ± 0.27) mg / L, (356 ± 58) ng / L vs 172 ± 45 ng / L, ± 9) mm (51 ± 7) mm, P <0.05]. The left ventricular ejection fraction in patients with heart failure was significantly lower than that in patients without heart failure [(41 ± 5)% vs (54 ± 7)%, P <0.05]. The fasting blood glucose (OR = 1.246, 95% CI 1.059-1.466) was significantly higher in patients with myocardial infarction than those with GGT (OR = 1.067,95% CI 1.032-1.103) Risk factors for heart failure in patients. Conclusions GGT, hs-CRP and fasting plasma glucose are the risk factors of heart failure in patients with thrombolytic recanalization of myocardial infarction.