急性心肌梗死并发急性脑梗死危险因素及临床特点

目的 分析急性心肌梗死（AMI）并发急性脑梗死（AIS）的危险因素及临床特点。 方法 回顾性分析2010年1月~2015年4月我院收治住院的75例AMI并发AIS患者为病例组，随机选择同期住院的单纯AMI和单纯AIS患者各80例为对照组，对比分析3组临床资料。 结果 单因素分析显示，AMI并发AIS组与单纯AMI组比较，既往脑梗死病史、外周血管病史、血肌酐水平显著高于对照组，高密度脂蛋白胆固醇（HDL-C）显著低于对照组，差异有统计学意义（P<0.05）；与单纯AIS组比较，男性、既往心肌梗死病史、外周血管病史、血肌酐水平显著高于对照组，入院收缩压与舒张压显著低于对照组，差异有统计学意义（P<0.05）；多因素Logistic回归分析表明，男性、既往脑梗病史、血肌酐为AMI并发AIS的独立危险因素（P<0.05，OR>1），入院舒张压为其保护性因素（P<0.01，OR<1）。临床特点分析表明，KILLIP分级≥Ⅱ级高于两对照组（44% vs. 16% vs. 1%，P<0.01），多发脑梗死高于单纯AIS 组（46% vs. 16%，P<0.01），PCI患者冠状动脉3支病变显著高于单纯AMI组（76% vs. 52%，P<0.05）。 结论 男性、入院舒张压降低、既往脑梗病史、血肌酐水平升高为AMI并发AIS的独立危险因素，心功能不全、多发脑梗死为其临床特点，冠状动脉3支病变为PCI术后并发急性脑梗死患者的临床特点。

The risk factors and clinical characteristics of acute myocardial infarction complicated with acute ischemic stoke

AIM To analyse the risk factors and clinical characteristics of acute myocardial infarction (AMI) complicated with acute ischemic stroke (AIS). METHODS A retrospective analysis was carried out in 75 patients with AMI complicated with AIS in our hospital from January 2010 to April 2015, and clinical date of 80 cases with AMI and 80 cases with AIS were analyzed. RESULTS Single factor analysis showed that compared with the AMI group, patients with AMI complicated with AIS were significantly higher in history of ischemic stoke, history of Peripheral Artery Disease (PAD), serum creatinine (Cr), and were significantly decreased in high-density lipoprotein cholesterol (P<0.05). Compared with the AIS group, patients with AMI complicated with AIS were significantly higher in male, history of myocardial infarction, PAD, Cr, and were significantly lower in systolic blood pressure (SBP) and diastolic blood pressure (DBP, P<0.05). Logistics regression analysis showed that the independent risk factors are male, higher in history of ischemic stoke, Cr (P<0.05, OR>1), and DBP is a protective factor (P<0.01, OR<1). Clinical characteristics analysis showed that patients with AMI complicated with AIS are significantly higher in Killip classification ≥Ⅱ (44% vs. 16% vs. 1%, P<0.01) and multi-cerebral infarction (46% vs. 16%, P<0.01), and patients after PCI are significantly higher in coronary artery triple vessel lesion (76% vs. 52%, P<0.05). CONCLUSION The incidence risk factors of AMI complicated with AIS are male, decrease of DBP in admission, history of ischemic stoke, increase of serum creatinine, and cardiac dysfunction, multi-cerebral infarction as its clinical characteristics. Coronary artery triple vessel lesion is the clinical characteristics in patients after PCI.