急性心肌梗死发病昼夜节律及院内结局的探讨

杨骁翰; 王东兴; 赵慧强; 刘锐锋

doi:10.13201/j.issn.1001-1439.2021.11.008

急性心肌梗死发病昼夜节律及院内结局的探讨

- 1. 首都医科大学第二临床医学院(北京, 100050);
- 2. 首都医科大学附属北京友谊医院心血管内科
基金项目:
国家自然科学基金青年基金(No:81600276)

详细信息

通讯作者: 刘锐锋,E-mail:fengziliu04@163.com

中图分类号: R542.2

收稿日期: 2021-07-02

Study on circadian variation and in-hospital outcomes of acute myocardial infarction

- 1. The Second Clinical Medical College of Capital Medical University, Beijing, 100050, China;
- 2. Department of Cardiology, Beijing Friendship Hospital, Capital Medical University

More Information

Corresponding author: LIU Ruifeng, E-mail: fengziliu04@163.com

Received Date: 02 July 2021

摘要

摘要: 目的:探究急性心肌梗死(AMI)患者发病的昼夜节律及其与住院期间结局的关系。方法:回顾性分析2013年4月—2017年4月连续就诊于首都医科大学附属北京友谊医院的1370例AMI患者,收集并分析其发病时间点、基线资料、超声心动图、冠状动脉造影资料、主要治疗以及主要心血管不良事件(MACE)等数据。结果:①将全天划分为24个1 h的时段,AMI发病高峰和低谷分别为10∶00~10∶59和13∶00~13∶59。将全天划分为6个4 h的时段,AMI发病低谷为0∶00~3∶59(8.20%),随后发病率逐渐增加并于8∶00~11∶59达到高峰(25.90%),此后又随时间逐渐递减至低谷。将AMI细分为ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)亚组后,整体的变化规律仍然存在,两组的低谷没有改变,但NSTMI组的高峰延迟至12∶00~15∶59。②按时间将全天分为6组(0∶00~3∶59;4∶00~7∶59;8∶00~11∶59;12∶00~15∶59;16∶00~19∶59;20∶00~23∶59),各组的基线资料、闭塞血管、狭窄程度、侧支循环情况,以及住院期间的主要治疗,总体无统计学差异。③在0∶00~3∶59组,中性粒细胞/淋巴细胞比值最高(P<0.05),STEMI发生的比例最高(P<0.05),肌酸激酶同工酶峰值和肌钙蛋白I峰值最高(P<0.05),肌红蛋白峰值显著升高(P<0.05),但6组之间N-末端脑钠肽前体峰值、射血分数、住院期间MACE无统计学差异。结论:8∶00~11∶59为AMI发病高峰,显示为白天多于夜间;而整体炎症程度、STEMI所占的比例、估测心肌梗死面积,则为AMI夜间重于白天;在目前的医疗条件下,各时段AMI患者的院内结局无明显差别。
- 急性心肌梗死 /
- 昼夜节律 /
- 预后
Abstract: Objective: To investigate the circadian variation of acute myocardial infarction(AMI) and the relationship between circadian variation and in-hospital outcome.Methods: This study retrospectively collected 1370 consecutive patients with AMI who had been admitted to Cardiac Care Unit at Beijing Friendship Hospital affiliated to Capital Medical University from April 2013 to April 2017. We analyzed onset time, baseline data such as age, gender, laboratory data, echocardiography, coronary angiography data, main treatment, major adverse cardiovascular event(MACE).Results: 1) The day was divided into 6 groups by time(0: 00-3: 59; 4: 00-7: 59; 8: 00-11: 59; 12: 00-15: 59; 16: 00-19: 59; 20: 00-23: 59). The peak of the incidence of AMI was 8: 00-11: 59(25.90%) and the trough of the incidence of AMI was 0: 00-3: 59(8.20%). After subdividing AMI into ST Elevated Myocardial Infarction(STEMI) and Non-ST Elevated Myocardial Infarction(NSTEMI) subgroups, the peak of the NSTEMI subgroup was delayed to 12: 00-15: 59.2) The baseline data, occlusion of blood vessels, degree of stenosis, collateral circulation, and main treatment during hospitalization were no statistical difference in each group. 3) In the 0: 00-3: 59 group, neutral lymphocyte to lymphocyte ratio was the highest(P<0.05), the proportion of STEMI occurrence was the highest(P<0.05), and creatine kinase MB peak and troponin I peak were the highest(P<0.05), myoglobin peak was significantly higher(P<0.05). There were no significant differences in the N-terminal pro-brain natriuretic peptide peak, ejection fraction, and MACE during hospitalization among 6 groups.Conclusion: The peak of the incidence of AMI was 8: 00-11: 59, and the circadian variation was more in daytime than in nighttime. However, the overall degree of inflammation, the proportion of STEMI, and the estimated size of myocardial infarction were more serious in nightime than in daytime.
- acute myocardial infarction /
- circadian variation /
- prognosis

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