急性心肌梗死患者心室膨胀瘤的影响因素及其对患者预后的预测价值研究

背景心室膨胀瘤是急性心肌梗死(AMI)患者常见且危险的并发症,可增加主要不良心血管事件(MACE)发生风险,影响患者预后,但目前国内外鲜有关于AMI患者心室膨胀瘤影响因素的研究报道。目的探讨AMI患者心室膨胀瘤的影响因素及其对患者预后的影响。方法选取2017年7月—2018年7月空军军医大学第一附属医院收治的AMI患者104例,根据心室膨胀瘤发生情况分为发生组(n=30)和未发生组(n=74)。比较两组患者一般资料〔包括年龄,性别,体质指数(BMI),发病至治疗时间,入院时心率(HR),高血压、高脂血症、糖尿病发生情况,纽约心脏病协会(NYHA)分级,前壁梗死情况,病变血管支数,贫血发生情况,冠状动脉溶栓或介入治疗情况,药物使用史〕、白细胞计数(WBC)及心功能指标〔包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)〕、住院期间及出院后1年预后;AMI患者心室膨胀瘤的影响因素分析采用多因素Logistic回归分析;绘制受试者工作特征曲线(ROC曲线)以评价AMI患者心室膨胀瘤的影响因素对AMI患者预后的预测价值。结果(1)两组患者男性比例、BMI、入院时HR、高血压发生率、高脂血症发生率、糖尿病发生率、NYHA分级>Ⅱ级及病变血管支数≥3支者所占比例、贫血发生率、行冠状动脉溶栓或介入治疗及有药物使用史者所占比例、LVEDD、LVESD比较,差异无统计学意义(P>0.05);发生组患者年龄大于未发生组,发病至治疗时间长于未发生组,前壁梗死发生率、WBC高于未发生组,LVEF低于未发生组(P<0.05)。(2)多因素Logistic回归分析结果显示,年龄〔OR=2.849,95%CI(2.157,3.365)〕、发病至治疗时间〔OR=3.019,95%CI(2.053,4.162)〕、前壁梗死〔OR=2.408,95%CI(2.214,2.685)〕、WBC〔OR=2.680,95%CI(1.985,2.931)〕、LVEF〔OR=3.047,95%CI(2.013,4.121)〕是AMI患者心室膨胀瘤的影响因素(P<0.05)。(3)发生组患者住院期间预后不良者所占比例高于未发生组(P<0.05)。绘制ROC曲线发现,年龄、发病至治疗时间、前壁梗死、WBC、LVEF预测AMI患者住院期间预后不良的曲线下面积(AUC)分别为0.798、0.745、0.712、0.823、0.861。(4)发生组患者出院后1年预后不良者所占比例高于未发生组(P<0.05)。绘制ROC曲线发现,年龄、发病至治疗时间、前壁梗死、WBC、LVEF预测AMI患者出院后1年预后不良的AUC分别为0.701、0.734、0.796、0.772、0.812。结论高龄、发病至治疗时间延长、前壁梗死、高WBC、低LVEF是AMI患者心室膨胀瘤的危险因素,且上述因素对AMI患者短期预后具有一定预测价值。

Influencing Factors of Ventricular Aneurysm in Patients with Acute Myocardial Infarction and Their Predictive Value on Prognosis

Background Ventricular aneurysm,as one of common and dangerous complications in patients with acute myocardial infarction(AMI),may increase the risk of major adverse cardiovascular events(MACE)and even affect the prognosis,however,there are few reports about the influencing factors ventricular aneurysm in patients with AMI at home and abroad so far.Objective To investigate the influencing factors of ventricular aneurysm in patients with AMI and their predictive value on prognosis.Methods From July 2017 to July 2018,a total of 104 patients with AMI were selected in the First Affiliated Hospital of Air Force Military Medical University,and they were divided into occurrence group(n=30)and nonoccurrence group(n=74)according to the incidence of ventricular aneurysm.General information(including age,gender,BMI,duration between attack and treatment,HR at admission,incidence of hypertension,hyperlipidemia and diabetes,NYHA classification,incidence of anterior wall infarction,number of stenosed vessels,incidence of anemia,proportion of patients underwent coronary thrombolysis/interventional therapy and medication history),WBC,index of cardiac function(including LVEF,LVEDD and LVESD),prognosis during hospitalization and 1 year after discharge were compared between the two groups;multivariate Logistic regression analysis was used to analyze the influencing factors of ventricular aneurysm in patients with AMI,moreover ROC curve was drawn to evaluate the predictive value of influencing factors of ventricular aneurysm on prognosis in patients with AMI.Results(1)There was no statistically significant difference in male proportion,BMI,HR at admission,incidence of hypertension,hyperlipidemia or diabetes,proportion of patients with NYHA classification overⅡor number of stenosed vessels equal or over 3,incidence of anemia,proportion of patients underwent coronary thrombolysis/interventional therapy or with medication history,LVEDD,LVESD between the two groups(P>0.05);age in occurrence group was statistically significantly older than that in non-occurrence group,duration between attack and treatment in occurrence group was statistically significantly longer than that in non-occurrence group,incidence of anterior wall infarction and WBC in occurrence group were statistically significantly higher than those in non-occurrence group,while LVEF in occurrence group was statistically significantly lower than that in non-occurrence group(P<0.05).(2)Multivariate Logistic regression analysis results showed that,age〔OR=2.849,95%CI(2.157,3.365)〕,duration between attack and treatment〔OR=3.019,95%CI(2.053,4.162)〕,anterior wall infarction〔OR=2.408,95%CI(2.214,2.685)〕,WBC〔OR=2.680,95%CI(1.985,2.931)〕and LVEF〔OR=3.047,95%CI(2.013,4.121)〕were influencing factors of ventricular aneurysm in patients with AMI(P<0.05).(3)Proportion of patients with poor prognosis during hospitalization in occurrence group was statistically significantly higher than in non-occurrence group(P<0.05).ROC curve showed that,AUC of age,duration between attack and treatment,anterior wall infarction,WBC and LVEF in predicting poor prognosis during hospitalization in patients with AMI was 0.798,0.745,0.712,0.823 and 0.861,respectively.(4)Proportion of patients with poor prognosis 1 year after discharge in occurrence group was statistically significantly higher than in non-occurrence group(P<0.05).ROC curve showed that,AUC of age,duration between attack and treatment,anterior wall infarction,WBC and LVEF in predicting poor prognosis 1 year after discharge in patients with AMI was 0.701,0.734,0.796,0.772 and 0.812,respectively.Conclusion Advanced age,delay of duration between attack and treatment,anterior wall infarction,increase of WBC and decrease of LVEF are risk factors of ventricular aneurysm in patients with AMI,moreover above factors have predictive value on short-term prognosis in patients with AMI to some extent.