ST段抬高性心肌梗死直接PCI术后早期并发恶性室性心律失常危险因素的探讨

彭仲华; 刘增长; 殷跃辉; 易颖毅; 高兰英; 杨坤

doi:10.13201/j.issn.1001-1439.2013.03.017

ST段抬高性心肌梗死直接PCI术后早期并发恶性室性心律失常危险因素的探讨

- 1. 重庆医科大学附属第二医院心内科(重庆, 400010);
- 2. 中国人民解放军第三二四医院心内科

详细信息

通讯作者: 刘增长,E-mail:liuzengzhang666@163.com

中图分类号: R542.2

收稿日期: 2012-04-23

修回日期: 2012-10-13

Risk factors of malignant ventricular arrhythmias at early stage of ST-elevation myocardial infarction

- 1. Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China;
- 2. Department of Cardiology, PLA 324 Hospital

More Information

Corresponding author: LIU Zengzhang, E-mail: liuzengzhang666@163.com

Received Date: 23 April 2012

Revised Date: 13 October 2012

摘要

摘要: 目的:探讨急性ST段抬高性心肌梗死再灌注治疗后早期并发恶性室性心律失常(MVA)的相关风险因素,并确立其预测意义。方法:回顾分析302例明确诊断为急性ST段抬高性心肌梗死患者资料所有患者均接受PCI治疗,以直接PCI术后48h以内是否发生MVA将患者分为MVA组(38例)和非MVA组(264例)。先对两组进行单因素分析,筛选有统计学意义的危险因素,并纳入Logistic回归模型,探讨急性ST段抬高性早期心肌梗死再灌注治疗后发生MVA的独立危险因素。结果:单因素分析显示,MVA组入院时白细胞计数[(12.442±4.174)×10⁹/L:(9.469±3.494)×109/L,P<0.05]、中性粒细胞计数[(9.863±3.690)×10⁹/L:(7.435±3.233)×10⁹/L,P<0.05]及血糖浓度[(10.946±3.415)mmol/L:(8.375±3.498)mmol/L,P<0.05]较非MVA组明显升高;MVA组血钾浓度[(3.255±0.432)mmol/L:(3.730±0.585)mmol/L,P<0.05]较非MVA组明显下降;糖尿病(31.6%:17.4%,P<0.05)、无Q波型心肌梗死(63.2%:36.4%,P<0.05)和心功能Klil-lipⅣ级(21.1%:9.8%,P<0.05)在MVA组所占比例明显升高。多元Logistic逐步回归分析显示,入院时白细胞计数、中性粒细胞计数、血糖升高、血钾下降及心功能KlillipⅣ级是急性ST段抬高性心肌梗死直接PCI后早期发生MVA的独立危险因素。ROC曲线显示,入院时白细胞计数、中性粒细胞计数、血糖和血钾预测MVA发生的分割值分别为11.040×10⁹/L、8.115×10⁹/L、9.58mmol/L和3.13mmol/L,曲线下面积分别为0.724、0.701、0.775和0.755。结论:入院时白细胞计数、中性粒细胞计数、血糖升高和血钾下降、心功能KlillipⅣ级是急性ST段抬高性心肌梗死直接PCI后早期发生MVA的危险因素,具有一定的预测价值。
- 心肌梗死 /
- ST段抬高性 /
- 再灌注治疗 /
- 室性心律失常 /
- 恶性 /
- 危险因素
Abstract: Objective:To explore the risk factors of malignant ventricular arrhythmias(MVA) during the early stage of reperfusion therapy for ST-elevation myocardial infarction(STEMI),and to establish predictive values.302 patients with STEMI underwent PCI were divided into MVA group(n=38) and non-MVA group(n=264) according to the presence or absence of MVA within 48 h after PCI.Firstly,the risk factors were screened by univariate analysis between two groups.Then those MVA-influenced factors were further assessed by multiple Logistic regression analysis.Method:Univariate analysis showed that WBC count [(12.442±4.174)×10⁹/L vs(9.469±3.494)×10⁹/L,P<0.05],neutrophil count [(9.863±3.690)×10⁹/L vs(7.435±3.233)×10⁹/L,P<0.05] and serum glucose level [(10.946±3.415)mmol/L vs(8.375±3.498)mmol/L,P<0.05] were higher in MVA group than those in non-MVA group.Result:The serum potassium level [(3.255±0.432)mmol/L vs(3.730±0.585)mmol/L,P<0.05] was lower in MVA group than that in non-MVA group.Diabetes mellitus(31.6% vs 17.4%,P<0.05),Non-Q MI(63.2% vs 36.4%,P<0.05) and Killip Ⅳclass(21.1% vs 9.8%,P<0.05) were more common in MVA group than in non-MVA group.Multivariate analysis revealed that WBC count,neutrophil count,increased serum glucose level,hypokalemia and Killip Ⅳ class were the independent risk factors of MVA.ROC curves of WBC count,neutrophil count,serum glucose level and serum potassium level revealed that the area under the curves were 0.724,0.701,0.775 and 0.755 respectively,the cutoffs in predicting MVA occurred at the early stage of PCI were 11.040×10⁹/L,8.115×10⁹/L,9.58 mmol/L and 3.13 mmol/L respectively.Conclusion:The elevated WBC count,elevated neutrophil count,increased serum glucose level,hypokalemia and Killip Ⅳ class are the independent risk factors of MVA during the early stage of the patients with STEMI treated with PCI,and these factors can predict the development of MVA during the early stage of reperfusion therapies with PCI.
- myocardial infarction /
- ST-elevation /
- reperfusion therapy /
- malignant ventricular arrhythmias /
- risk factor /

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