关于急性心肌梗死早期阴离子间隙的研究

目的:探讨急性心肌梗死（AMI）与阴离子间隙（AG）的关系。方法:对352例AMI患者和268例不稳定型心绞痛（UA）患者进行回顾性分析。比较两组初始AG的差异；将AMI组按左室射血分数（LVEF）水平分为射血分数减低的心力衰竭（HFrEF），射血分数中间值的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）3个亚组，观察AG与AMI患者院内心力衰竭程度的关系。结果:与UA组相比，AMI组AG明显升高（P＜0.001），二氧化碳结合力（CO2CP）明显降低（P＜0.001）。AMI亚组分析发现初始AG水平与院内心力衰竭程度呈正相关，组间比较均有统计学差异（P＜0.05）。Logistic回归分析表明，AMI院内心力衰竭程度与初始AG水平有关（OR=1.156，P=0.004，95%CI:1.047~1.275）。结论:初始AG水平可作为AMI的临床状态和危重度的评估，也是AMI患者发生心功能损害轻重的独立预测因子。

Association between initial anion gap and acute myocardial infarction

Objective: To investigate the relationship between acute myocardial infarction(AMI) and anion gap (AG). Methods: 352 patients with AMI and 268 patients with unstable angina (UA) were retrospectively analyzed. The difference of initial anion gap (AG) between the two groups was compared. The AMI group was divided into three subgroups according to the level of LVEF: HFrEF, HFmrEF and HFpEF. The relationship between AG and the degree of in-hospital heart failure in AMI patients was observed. Results: Compared with UA group, AG in AMI group was significantly increased (P<0.001), while CO2CP was decreased (P<0.001). AMI subgroup analysis showed that initial AG was positively correlated with the degree of in-hospital heart failure, and there were statistical differences between groups (P<0.05). Logistic regression analysis showed that the degree of in-hospital heart failure in AMI patients was related to initial AG（OR=1.156, P=0.004,95%CI:1.047-1.275）. Conclusion: The initial AG level can be used as an assessment of the clinical status and severity of AMI，and is also an independent predictor of the severity of cardiac impairment in AMI patients.