急性心肌梗塞患者血脂水平分析

目的探讨不同年龄急性心肌梗塞(AMI)患者血脂水平状况及冠心病(CHD)二级预防中的调脂治疗。方法对135例AMI患者和151例健康查体者的血脂水平进行对比。并将135例AMI患者分为中青年组、老年组、高龄老年组,分析各年龄组总胆固醇(TC)、甘油三脂(TG)水平,血脂增高检出率,强调了高胆固醇血症的治疗策略。结果AMI组高密度脂蛋白胆固醇(HDL-C)的均值明显低于健康对照组,HDL-C异常率明显高于对照组。TC和TG水平随AMI发病年龄增加而降低,TG水平与AMI发病年龄呈负相关(r=-0.4 03,P<0.01),中青年组及老年组TC均值极显著高于高龄老年组(P<0.01),中青年组TG均值显著高于其他两组(P<0.05),29.6％的AMI患者因TC增高需开始饮食疗法,23％的需开始药物疗法。结论HDL-C在稳定动脉粥样硬化(AS)斑块,预防AMI的发生方面起着重要作用。重视CHD,特别是中青年组病人的调脂治疗,调脂治疗为CHD二级预防的重要措施。     

不同年龄急性心肌梗死患者血脂水平分析

目的 研究本地区不同年龄急性心肌梗死(AMI)患者血脂水平状况及其伴随疾病与发病年龄的关系.方法 98例AMI患者分为中青年组(年龄38～59岁,25例),老年组(年龄60～70岁,46例),高龄老年组(年龄71～87岁,27例);分析对比各年龄组血脂水平、伴随疾病与AMI发病年龄之间的关系.结果 甘油三脂(TG)和总胆固醇(TC)水平随AMI发病年龄增加而降低,TG和TC水平与AMI发病年龄之间呈负相关,相关系数分别为r＝-0.41(P＜0.001)、r＝-0.25(P＜0.005),中青年组TC和TG均值显著高于老年组、高龄老年组(P＜0.001),χ2检验显示,TG增高检出率与AMI年龄有关(χ2＝8.20,P＜0.05),AMI的伴随疾病高血压病、脑血管病随着AMI发病年龄的增加而增加.结论 重视冠心病(CHD)患者、特别是中青年组患者的调脂治疗,同时控制相关的危险因素,为冠心病二级预防的重要措施.     

青年男性急性心肌梗死危险因素和冠状动脉造影特征

目的 探讨青年男性急性心肌梗死(AMI)发病危险因素及冠状动脉(冠脉)病变特点.方法 回顾性分析247例AMI男性患者临床资料.其中,青年(年龄21-44岁)患者88例(A组),中年(年龄45-59岁)患者159例(B组),分析两组AMI相关发病危险因素及冠脉病变年龄差异.结果 A组早发冠心病家族史、超重、不良生活方式患者比例及血清总胆固醇(TC)和低密度脂蛋白(LDL)水平均高于B组(P＜0.05).A组单支病变、冠脉Gensini总积分＜4分者多于B组,而多支病变者、冠脉Gensini总积分、罪犯血管Gensini积分少于B组(P＜0.05).结论 早发冠心病家族史、超重、不良生活习惯及高TC和LDL水平为青年早发AMI的关键因素,其中不良生活习惯为最重要因素.     

白细胞计数对急性心肌梗塞近期预后的探讨(附203例临床分析)

白细胞(WBC)增多(除外感染等因素)与急性心肌梗塞(AMI)的近期(入院30天内)预后关系国内报道尚少。我院近年来收治203例AMI患者,均经确定的心电图改变和部分病人进行心肌酶学等检查确诊,入院后作常规WBC检查,以发病一周内WBC计数平均值分为3组,即高组(WBC≥9×10~9/L)、低组(WBC≤6×10~9/L)和中组(WBC介于高低两组之间)。现对这3组病例的有关资料进行分析。     

超敏C反应蛋白、心脏型脂肪酸结合蛋白、肌酸激酶同工酶、肌红蛋白及肌钙蛋白联合检测对急性心肌梗死的诊断价值

目的 探讨超敏C反应蛋白(hs-CRP)、心脏型脂肪酸结合蛋白(H-FABP)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)及肌钙蛋白I(cTnI)联合检测对急性心肌梗死(AMI)诊断价值.方法 选择临床诊断为AMI患者46例(AMI组)和健康体检正常者96例(对照组),检测两组hs-CRP、H-FABP、CK-MB、MYO、cTnI水平,并观察比较AMI组在入院2、4、6h时各项观察指标变化情况.结果 AMI组患者入院2h时血清中hs-CRP、H-FABP、CK-MB、MYO、cTnI等水平明显高于对照组(t=46.0,均P＜0.01),AMI组在入院4h时各项观察指标明显高于入院2h时(t=46.0,均P＜0.01),入院6h时明显高于4h时(t=46.0,均P＜0.01);且hs-CRP、H-FABP、CK-MB、MYO、cTnI联合检测时,对AMI诊断的灵敏度为98.9％、特异性100％、阳性预测值100％.结论 hs-CRP、H-FABP、CK-MB、MYO、cTnI联合检测对AMI的诊断有重要临床价值.     

胰岛素抵抗性与急性心肌梗塞患者预后的关系

目的研究非糖尿病性急性心肌梗死(AMI)病人入院时胰岛素抵抗性、胰岛素敏感指数与预后的关系.方法89例非糖尿病AMI患者入院时根据Killip分级评判心功能状况.KillipⅠ级(B组)5 3例,KillipⅡ级(C组)14例,Killip Ⅲ级(D组)12例,KillipⅣ级(E组)10例.以对58例健康正常人(A组)为正常对照.所有研究对象均分别检测其空腹血糖(FPG),空腹胰岛素(FINS)水平,计算胰岛素敏感指数(ISI),以稳态模型(Homa Model)公式评估胰岛素抵抗(IR),并计算住院病死率.结果IR及FPG随着Killip分级的升高而升高,而ISI则显著逐渐下降;多元Logistic回归分析显示入院时的IR与Killip分级及住院病死率相关.结论AMI患者入院时的胰岛素抵抗性越强预示着AMI的严重程度,胰岛素抵抗性越强病死率越高.     

老年与中青年急性心肌梗死患者临床特点对比观察

目的对比中青年人和老年人急性心肌梗死(AMI)的临床特点。方法将118例AMI患者分为中青年组(<45岁)26例和老年组(≥45岁)92例,对2组患者进行回顾性分析。结果 2组男性发病率均高于女性(P<0.05或P<0.01),且老年组女性患病率显著增加(P<0.05)。中青年组吸烟、酗酒、家族史、肥胖及精神压力为发病主要危险因素的比例显著高于老年组,差异均有统计学意义(P<0.05)。中青年组血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)值低于老年组,差异有统计学意义(P<0.05);2组三酰甘油(TG)值比较差异无统计学意义(P>0.05)。结论不同年龄组AMI患者的危险因素及冠状动脉病变有不同的特点,既要对多种危险因素进行综合干预,亦应有针对性的进行。     

急性心肌梗塞预后因素的Cox模型分析

本文应用Cox模型分析52例急性心肌梗塞(AMI)患者近期的预后因素。三项变量因素(年龄、入院时心率、室性心律失常)建立急性期(8周内)预后模型,对存活组和死亡组的预测正确率分别达到100％和83.3％。     

急性心肌梗死患者PCI治疗后心动过缓发生情况分析

目的 分析急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)治疗后心动过缓发生的影响因素。方法 选择2019年1月—2021年3月焦作市人民医院收治的98例AMI患者为研究对象,患者均在本院接受PCI治疗,观察患者PCI后24 h内心动过缓发生情况并分组,分为发生组与未发生组,统计两组基线资料,通过logistic回归分析检验AMI患者PCI治疗后心动过缓发生的影响因素。结果 全部98例患者中,23例发生心动过缓,占23.47%;发生组右冠状动脉病变占比(65.22%)、合并糖尿病占比(52.17%)高于未发生组(38.67%、21.33%),入院时血清超敏C反应蛋白(hs-CRP)水平[(15.79±2.83)ng/L]高于未发生组[(11.46±2.46)ng/L],差异有统计学意义(P<0.05);经logistic回归分析结果显示,右冠状动脉病变、合并糖尿病、入院时血清hs-CRP高表达均为AMI患者PCI治疗后心动过缓发生的影响因素(P<0.05)。结论 右冠状动脉病变、合并糖尿病、入院时血清hs-CRP高表达均为AMI患者PCI治疗后心动过缓发生的影响因素。     

经急诊PCI治疗的急性心肌梗死患者血浆N氨基末端脑钠肽前体水平变化的临床意义

目的 探讨血浆N氨基末端脑钠肽前体(NT-proBNP)在行急诊经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者的临床意义.方法 荧光免疫法检测72例行急诊PCI治疗的AMI患者入院时血浆NT-proBNP和肌钙蛋白Ⅰ(cTnI)浓度及入院第7天血浆NT-proBNP浓度,经超声心动图测定入院1周时左心室射血分数(LVEF)及左心室舒张末期内径(LVEDD).随访观察发病3月内是否发生心衰、再梗死、梗死后心绞痛、心血管死亡等心血管事件,比较心血管事件组与无心血管事件组之间相关指标的差别.分析两组入院时血浆NT-proBNP和cTnI及入院第七天血浆NT-proBNP和LVEF、LVEDD的相关性.结果 45例患者末发生心血管事件,27例患者发生心血管事件,且两组患者入院时血浆NT-proBNP均与cTnI呈正相关,入院第7天血浆NT-proBNP浓度较入院时明显降低(P<0.05),入院第7天血浆NT-proBNP与LVEDD呈正相关、与LVEF呈负相关.结论 血浆NT-proBNP浓度是反映左心室功能不良的更敏感和特异的指标,可以反映心肌坏死程度并预测AMI患者近期预后.     

Trends of acute myocardial infarction admissions over a decade, Tikur Anbessa Hospital

This is a case series analysis undertaken to evaluate the importance of acute myocardial infarction (AMI) as a cause of admission at the Tikur Anbassa medical intensive care unit (MICU) and the trend of that importance over a decade (1988-1997). Clinical presentations and the frequencies of major coronary risk factors in the individual patient were also assessed for the later half of the decade (1993-1997). In the decade under study 2313 patients were admitted to MICU according to its register. Overall AMI was the third commonest cause of admission and accounted for 8.8% (N = 203) of all MICU cases. AMI annual admissions increased consistently over the years. Of the 122 AMI admissions during the second half of the decade, 92 charts were available for detailed analysis. 86% (79/92) fulfilled the stated criteria for the diagnosis. The mean age of these patients was 55.1 +/- 13.0 years. Males constituted 82% of all AMI cases. Eighty seven percent (69/79) of the cases were first admissions with the diagnosis of AMI. Ninety-four percent (74/79) of them were brought to the emergency room due to chest discomfort and 20% were in frank pulmonary oedema. Nineteen percent died in hospital. 81% and 34% of the patients had one or more and two or more major coronary risk factors excluding age and gender respectively. Raised total cholesterol and hypertension were commonest risk factors being reported in 69% and 47% of AMI patients respectively. In conclusion, this study has demonstrated that AMI is indeed on the rise at least at Tikur Anbassa Teaching Hospital, and possibly at other health institutions. The conventional coronary risk factors seem to operate in the Ethiopian series as well. The study highlights the need for coronary risk factors surveys at least in the susceptible population group to assess the gravity of the problem.     

Myocardial infarction and histamine release

On the basis of previous data suggesting the involvement of cardiac histamine in ischemic heart disease (IHD), we evaluated plasma histamine (H) and creatine-kinase isoenzyme (CK-MB) level in cardiac and healthy subjects. 20 patients with acute myocardial infarction (AMI) (10 developing AMI in Hospital, thus making possible the detection of plasma H level before acute event), 10 patients with IHD not developing AMI and 10 presumably healthy subjects were admitted to the study. 15 of all patients with AMI showed a correlated H and CK-MB trend during AMI reaching the highest peak 24 hours after onset of pain. 7 of the patients with IHD who developed AMI in Hospital showed a slightly higher plasma H level, before AMI, than those with IHD who did not develop AMI. A possible role of histamine in the pathogenesis of AMI is discussed.     

巴曲抗栓酶治疗急性心肌梗死

目的：观察巴曲抗栓酶对急性心肌梗死（ＡＭＩ）的疗效。方法：２４例ＡＭＩ病人（男性１８例，女性６例；年龄６９±ｓ９ａ），其中８８％为发病１２ｈ内入院。入院即刻给阿司匹林０．３ｇ，ｐｏ，ｑｄ×３ｄ，再改为０．１ｇ，ｐｏ，ｑｄ；入院即ｉｖ输注巴曲抗栓酶２０ＢＵ溶于０．９％氯化钠液１００ｍＬ，１ｈ内滴完，以后每隔１ｄ（即入院ｄ３，ｄ５）再用巴曲抗栓酶１０ＢＵ，１次。结果：冠状动脉再通率为５０％（６ｈ内入院者为６９％），住院病死率为１２％，未见出血等不良反应。用药后凝血因子Ｉ有显著降低。结论：巴曲抗栓酶治疗ＡＭＩ是安全有效的。     

Patterns of practice for acute myocardial infarction in a population from ten countries

Background: There is conclusive evidence from large scale randomized clinical trials (RCTs) that several treatments administered in the acute phase of a myocardial infarction (AMI) reduce mortality. However, only a minority of patients admitted with AMI receives at the appropriate treatments. Objectives: This study aims at (1) describe the utilization patterns for AMI; (2) determine the appropriateness of prescribing, measured as adherence to the ACC/AHA guidelines; and (3) determine which factors are associated with the administration of thrombolytic agents. Methods: The study was a multi-center survey carried out in ten countries (nine European and one Canadian province) over a 3-month period. Data were prospectively collected by clinical pharmacists. All consecutive patients admitted to the participating hospitals during the study period with a diagnosis of suspected AMI were included in the study. Rates of use were calculated as “overall utilization” and “adjusted utilization” (e.g., accounting for eligibility). Results: Data were available on 1976 patients from 56 participating centers. The mean age of the patients was 65 years (range 25–95, SD = 12.6) and 29.7% were women. Adjusted utilization rates were 63.7% for thrombolysis, 88% for aspirin, and 65.9% for β-adrenergic blocking agents. The most utilized thrombolytic agent was streptokinase (65.9%). The main reasons given by physicians for not administering thrombolysis was the delay from chest pain onset to admission. Patients admitted to teaching hospitals were less likely to receive aspirin than patients admitted to general hospitals (adjusted rate 90.1% vs 86%, P = 0.007), but they were more likely to undergo a primary invasive procedure (11.0% vs 2.5% P = 0.001). Multivariate analysis showed that age greater than 74 years, delay, prior myocardial infarction, and Killip scale were correlated with the non-utilization of thrombolysis. Conclusion: Recommended treatments are still underutilized in patients with AMI. Increased utilization is required, particularly for elderly people. There is a wide variability among hospitals with different affiliations (teaching vs non teaching), demonstrating the different patterns of practice in various settings. Received: 2 February 1998 / Accepted in revised form: 8 August 1998     

联合检测血浆和肽素与肌钙蛋白在急性心肌梗死诊断中的应用

目的:观察急性胸痛患者血浆和肽素(Copeptin)与肌钙蛋白(cTnI)水平的变化,寻找早期快速诊断急性心肌梗死(AMI)的方法。方法:收集急诊科2010年11月—2012年5月就诊的100例发病6h内的急性胸痛患者,其中AMI者48例,不稳定心绞痛32例,非心源性胸痛20例,进行血浆Copeptin及cTnI的定量测定。结果:AMI组血浆Copeptin水平较其他两组明显升高,差异有统计学意义(P<0.05),cTnI阴性AMI患者血浆Copeptin水平明显高于cTnI阳性AMI患者。结论:AMI患者早期Copeptin水平明显升高,血浆cTnI浓度变化与Copeptin水平呈负相关,故联合检测血浆和肽素与肌钙蛋白,有助于急诊科胸痛的排查,提高AMI早期诊断率。     

中、青年男性急性心肌梗塞患者危险因素及冠脉造影的比较分析

目的探讨青年男性急性心肌梗塞（AMI）患者危险因素及冠脉造影特点。方法对年龄≤44岁的青年男性AMI患者33例（青年组）与同期同病同性别年龄≥45岁、〈65岁（中年组）的AMI患者就其危险因素及冠脉造影进行对比分帆结果冠心病危险因素青年组高血压、糖尿病明显少于中年组；吸烟青年组高于中年组，低密度脂蛋白胆固醇、阳性家族史两组无明显差别；冠脉造影青年组单支病变多，累及回旋支（LCX）、右冠状动脉（RCA）少；中年组双支及双支以上病变多，多累及LCX、RCA。结论年轻心梗患者大量吸烟者多，单支病变多，有糖尿病高血压病史者少。     

Influence of statin treatment on mortality of patients with myocardial infarction

Dyslipidaemia is a major risk factor of cardiovascular diseases, the role of serum total cholesterol (Chol) especially LDL-Chol is well established in the pathogenesis of atherosclerosis and ischemic heart disease. Use of cholesterol lowering drugs within the first 24 h of hospitalization for acute myocardial infarction (AMI) is associated with a lower rate of cardiogenic shock, arrhythmias, cardiac arrest and recurrent myocardial infarction. We assessed data of 416 patients admitted to hospital with AMI in a 2 year period (2001-2003) focusing on statin therapy. We have not found a correlation between serum lipid parameters and mortality of patients with AMI. Chronic statin treatment used before AMI (in 36 patients) did not influence mortality of patients. Chol level of patients with ST-elevation myocardial infarction (STEMI) was significantly higher (p = 0,043). Mortality of patients who did not receive statin treatment after AMI was significantly higher. These data highlight the importance of early aggressive statin treatment in patients with AMI and necessity of statins in patients with hypercholesterolaemia.     

吸烟对急性心肌梗死男性患者氯吡格雷抑制血小板功能的影响

目的评价吸烟对急性心肌梗死男性患者服用氯吡格雷后血小板聚集率的影响。方法选取因急性心肌梗死住院的男性患者并成功接受急诊冠状动脉内支架置入术82例,术前给予氯吡格雷300mg负荷量口服,术后75mg/d口服。比浊法检测术前、术后24hADP(浓度5μmol/L)诱导的血小板聚集率结果。结果吸烟组患者介入术后24h血小板聚集抑制率≤10%(ΔA24h)明显高于不吸烟组(55%和35%,P<0.01),但不同吸烟量之间ΔA24h≤10%的比例差异无统计学意义(吸烟量<10支:吸烟量≥10支为53%:55%,P>0.05)。多因素回归分析结果显示吸烟后氯吡格雷服用后ΔA24h≤10%比例增加与年龄、合并糖尿病、合并高血压、支架植入数及C反应蛋白水平无关。结论吸烟可以增加氯吡格雷抵抗发生率,但吸烟数量与氯吡格雷抵抗发生率无关。     

急性心肌梗死患者合并肺部感染63例临床分析

目的分析急性心肌梗死（AMI）住院患者发生肺部感染的相关危险因素,以便制定相应预防措施。方法对医院收治的AMI并发肺部感染患者的病历资料进行回顾性分析。结果整理、查阅AMI患者病历1142例,发生肺部感染63例,对63例AMI合并肺部感染患者相关因素分析中,老年、糖尿病、大面积心肌梗死、血管再通等与肺部感染发病明显相关,有显著性差异（P〈0．01）。结论AMI患者发生肺部感染的危险因素较多,发生率相对较高,对AMI患者的危险因素等应引起高度重视,积极预防和治疗肺部感染。     

Khat chewing is a risk factor for acute myocardial infarction: a case-control study

AIM: Khat chewing is a common habit in Yemen and east African countries. Millions of people chew khat leaves daily for its euphoric and energetic effects and to increase alertness. Cathinone, the main active substance in fresh khat leaves, has sympathomimetic effects which increase heart rate and blood pressure. The aim was to examine the hypothesis that khat chewing is a risk factor for acute myocardial infarction (AMI) using a hospital-based matched case-control study. METHOD: Between 1997 and 1999, we selected 100 patients admitted to the Al-Thawra teaching hospital Sana'a ICU, Yemen with acute myocardial infarction. 100 control subjects, matched to cases for sex and age, were recruited from the outpatients clinics of the same hospital. A questionnaire was completed for case and control groups covering personal history of khat chewing, smoking, hypertension, diabetes and any family history of myocardial infarction. A blood sample was collected for performing lipid profiles. Cases and controls were compared by analysis conducted using conditional logistic regression which corrected for baseline imbalances leading to less biased estimations of odds ratio (OR). The risk associated with each classical factor and khat chewing habits was then investigated. OR values greater than 2.5 indicated a significant risk factor. RESULTS: Khat chewing was significantly higher among the AMI case group than control group (OR = 5.0, 95% CI 1.9-13.1). A dose-response relationship was observed, the heavy khat chewers having a 39-fold increased risk of AMI. CONCLUSION: This study indicates that khat chewing is associated with AMI and is an independent dose-related risk factor for the development of myocardial infarction.