摘要
目的 评估急性心肌梗死(AMI)患者新发心房颤动(NOAF)的危险因素及预后。方法 对2021年1月至12月于首都医科大学宣武医院就诊的628例AMI患者进行分析。NOAF定义为入院时或住院期间心电图上检测到的心房颤动。收集患者的人口统计学、临床、实验室、超声心动图和冠状动脉造影数据。采用多因素逻辑回归分析确定AMI患者NOAF的独立危险因素。结果 在628例AMI患者中,有48例NOAF,发生率为7.6%。两组患者白细胞、血小板计数、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、尿酸、糖化血红蛋白、病变支数、心肌梗死部位、高血压、糖尿病、陈旧性心肌梗死等方面差异无统计学意义(P>0.05)。NOAF组年龄显著高于非NOAF组(P<0.01),女性所占比例NOAF组高于非NOAF组(P<0.01)。NOAF组C反应蛋白(CRP)、N末端B型利钠肽原(NT-proBNP)、血肌酐峰值(Scr)、肌钙蛋白I峰值(TnI)、左心房内径等方面高于非NOAF组患者(P<0.05)。NOAF组心功能Killip分级劣于非NOAF组(P<0.01)。NOAF组患者体重低于非NOAF组(P=0.028)。NOAF组患者血红蛋白、估算肾小球滤过率(eGFR)、左心室射血分数等方面低于非NOAF组患者(P<0.01)。NOAF组患者住院时间明显长于非NOAF组患者[(12.46±8.05)d比(8.66±4.53)d,P<0.01]、院内死亡(10.4%比1.4%,P<0.01)高于非NOAF组患者。Logistic多因素回归分析显示,年龄(OR=1.052,95%CI 1.005~1.102,P=0.031)、CRP(OR=1.026,95%CI1.007~1.046,P=0.007)、NT-proBNP(OR=1.796,95%CI 1.473~2.191,P<0.01)及左心房内径(OR=1.087,95%CI1.029~1.148,P=0.003)是AMI后NOAF的独立预测因素。结论 高龄、CRP、NT-proBNP水平升高以及左心房增大预示AMI患者院内发生NOAF的风险可能增加。
Objective To explore the risk factors associated with newly diagnosed atrial fibrillation(NOAF)in patients with acute myocardial infarction(AMI).Methods A total of 628 patients with AMI who were admitted to Xuanwu Hospital of Capital Medical University from January 2021 to December 2021 were included.NOAF was defined as atrial fibrillation detected by electrocardiogram at admission or during hospitalization.The demographic,clinical,laboratory,echocardiography and coronary angiography data were collected.The independent risk factors of NOAF in AMI patients were determined by multivariate logistic regression analysis.Results Among the 628 AMI patients,48 had NOAF,with an incidence rate of 7.6%.There were no significant differences in white blood cell count,platelet count,triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,uric acid,hemoglobin A1c,lesion number,infarction site,hypertension,diabetes and old infarction between the NOAF and non-NOAF groups(P>0.05).The percentage of woman was higher in the NOAF group and subjects in this group were significantly elder than those in the non⁃NOAF groups(P<0.01).The C-reactive protein(CRP),N-terminal pro-brain natriuretic peptide(NT-proBNP),serum creatinine peak value(Scr)and troponin I peak value(TnI)were significantly higher in the NOAF group than in the non ⁃ NOAF group (P<0.05). Killip grade in the NOAF group was worse than that in the non-NOAFgroup (P<0.01). Body weight in the NOAF group was lower than that in the non-NOAF group (P<0.05);hemoglobin and estimated glomerular filtration rate (eGFR) in the NOAF group were lower than those in thenon-NOAF group (P<0.01). The hospital stay in the NOAF group was significantly longer than that in thenon-NOAF group [(12.46 ± 8.05) days vs. (8.66 ± 4.53) days, P<0.01], and the in-hospital mortality (10.4% vs.1.4%, P<0.01) was higher than that in the non-NOAF group. Logistic multivariate regression analysis showed thatage (OR=1.052, 95%CI 1.005-1.102, P=0.031), CRP (OR=1.026, 95%CI 1.007-1.046, P=0.007), NT⁃pro⁃BNP (OR=1.796, 95%CI 1.473-2.191, P<0.01) and left atrial diameter (OR=1.087, 95%CI 1.029-1.148, P=0.003) were theindependent predictors of NOAF after AMI. Conclusion Advanced age, increased CRP,NT⁃proBNP levels andenlarged left atrium indicate an increased risk of NOAF in patients with AMI.
作者
陈莹
夏经钢
CHEN Ying;XIA Jing-gang(Department of Cardiology,Xuanwu Hospital of the Capital Medical University,Beijing 100053,China)
出处
《中国心血管病研究》
2025年第5期453-457,共5页
Chinese Journal of Cardiovascular Research
关键词
急性心肌梗死
心房颤动
C反应蛋白
Myocardial infarction
Atrial fibrillation
C⁃reactive protein
