急性心肌梗死并发急性脑梗死的危险因素及临床特征分析
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摘要
目的分析急性心肌梗死并发急性脑梗死的危险因素及临床特征。方法将2015年1月至2017年1月本院心内科收治的急性心肌梗死并发急性脑梗死患者150例作为本次研究中的并发组,将同期于本院进行治疗的单纯急性心肌梗死患者160例设为单纯急性心肌梗死组、单纯急性脑梗死患者160例作为对照组。回顾性分析3组患者的临床资料,分析危险因素以及临床特征。结果分析单因素方面发现,并发组的既往脑梗死病史、外周血管病史、血肌酐水平为(112.14±41.62)μmol/L均高于单纯急性心肌梗死组与对照组,差异有统计学意义(P<0.05);并发组入院舒张压为(75.34±12.01)mmHg、收缩压为(125.26±24.33)mmHg,均低于对照组,差异有统计学意义(P<0.05);根据多因素回归分析发现,并发组患者的危险因素主要为男性、既往脑梗病史以及血肌酐水平(P<0.05,OR>1);其保护因素为入院舒张压。根据临床特征分析发现,并发组的Killip分级≥Ⅱ级占比44.00%,显著高于单纯急性心肌梗死组,差异有统计学意义(P<0.05);并发组的多发梗死占比42.67%,显著高于对照组(P<0.05)。结论对于急性心肌梗死并发急性脑梗死的独立危险因素,其主要为男性、入院舒张压降低、存在既往脑梗死以及血肌酐水平升高等,临床特征为心功能不全、多发脑梗死。
Objective Analysis the risk factors and clinical characteristics of acute myocardial infarction complicated with acute cerebral infarction. Methods 150 patients with acute myocardial infarction complicated with acute cerebral infarction admitted to department of cardiology in Liaoyang Centre Hospital from January 2015 to January 2017 were selected as the concurrent group in this study. 160 patients with simple acute myocardial infarction who were treated in Liaoyang Centre Hospital at the same time were divided into simple acute myocardial infarction group and simple acute cerebral infarction group. The clinical data of the three groups were analyzed retrospectively, and the risk factors and clinical characteristics were analyzed. Results Univariate analysis showed that the previous history of cerebral infarction, peripheral vascular disease, serum creatinine in concurrent group were(112.14±41.62)μmol/L, and was lower than that in the acute myocardial infarction group and the control group, the difference was statistically significant(P<0.05). The diastolic blood pressure and systolic blood pressure in the concurrent group were(75.34±12.01)mmHg and(125.26±24.33)mmHg, which were lower than those in the control group, the difference was statistically significant(P<0.05). According to the multivariate regression analysis, the main risk factors in concurrent group of the patients were male, history of cerebral infarction and serum creatinine level(P<0.05, OR>1), and the protective factors were diastolic blood pressure at admission. According to the analysis of clinical characteristics, the proportion of Killip grade(≥ II) in the concurrent group was 44.00%, which was significantly higher than that in the simple acute myocardial infarction group, the difference was statistically significant(P<0.05). The number of multiple infarcts in the concurrent group was 42.67%, which was significantly higher than that in the control group, the difference was statistically significant(P<0.05). Conclusion For the independent risk factors of acute myocardial infarction complicated with acute cerebral infarction, the main risk factors were male, decreased diastolic blood pressure at admission, the presence of previous cerebral infarction and elevated serum creatinine levels. The clinical features were cardiac insufficiency and multiple cerebral infarction.
Objective Analysis the risk factors and clinical characteristics of acute myocardial infarction complicated with acute cerebral infarction. Methods 150 patients with acute myocardial infarction complicated with acute cerebral infarction admitted to department of cardiology in Liaoyang Centre Hospital from January 2015 to January 2017 were selected as the concurrent group in this study. 160 patients with simple acute myocardial infarction who were treated in Liaoyang Centre Hospital at the same time were divided into simple acute myocardial infarction group and simple acute cerebral infarction group. The clinical data of the three groups were analyzed retrospectively, and the risk factors and clinical characteristics were analyzed. Results Univariate analysis showed that the previous history of cerebral infarction, peripheral vascular disease, serum creatinine in concurrent group were(112.14±41.62)μmol/L, and was lower than that in the acute myocardial infarction group and the control group, the difference was statistically significant(P<0.05). The diastolic blood pressure and systolic blood pressure in the concurrent group were(75.34±12.01)mmHg and(125.26±24.33)mmHg, which were lower than those in the control group, the difference was statistically significant(P<0.05). According to the multivariate regression analysis, the main risk factors in concurrent group of the patients were male, history of cerebral infarction and serum creatinine level(P<0.05, OR>1), and the protective factors were diastolic blood pressure at admission. According to the analysis of clinical characteristics, the proportion of Killip grade(≥ II) in the concurrent group was 44.00%, which was significantly higher than that in the simple acute myocardial infarction group, the difference was statistically significant(P<0.05). The number of multiple infarcts in the concurrent group was 42.67%, which was significantly higher than that in the control group, the difference was statistically significant(P<0.05). Conclusion For the independent risk factors of acute myocardial infarction complicated with acute cerebral infarction, the main risk factors were male, decreased diastolic blood pressure at admission, the presence of previous cerebral infarction and elevated serum creatinine levels. The clinical features were cardiac insufficiency and multiple cerebral infarction.
引文
[1]苏垒鑫,程康,赵志敬.急性心肌梗死并发急性脑梗死危险因素及临床特点[J].心脏杂志,2017,29(4):422-426.
[2]杨丽.急性心肌梗死患者PCI术后并发急性脑梗死的发生率及危险因素分析[J].中国实用神经疾病杂志,2017,20(3):99-101.
[3]缪黄泰,张明,刘子衿,等.急性心肌梗死患者并发不同部位心脏破裂的临床特征和预后分析[J].中华危重病急救医学,2016,28(12):1080-1085.
[4]宋丽萍,郭云飞,杨静文,等.急性心肌梗死后心力衰竭患者临床特征及预后分析[J].北京医学,2016,38(2):114-117.
[5]王芳,蔺雪梅,王清,等.西安市后循环脑梗死患者临床特征和危险因素分析[J].陕西医学杂志,2016,45(6):720-721.
[6]张莉莉,高阳,丁建,等.不同性别急性心梗患者的临床特征及院内治疗预后分析[J].现代生物医学进展,2016,16(7):1299-1302.
[7]孔强,张迎花,华琦,等.合并心脏瓣膜钙化的急性心肌梗死患者的临床特征及预后分析[J].中国心血管杂志,2016,21(4):262-267.
[8]霍连营,李可,王翠芹,等.老年急性心肌梗死患者合并消化道出血的临床特征及预后分析[J].中华老年多器官疾病杂志,2016,15(9):674-677.
[9]冯炜,王一锋,唐榕蔚,等.成人肾病综合征并发肺血栓栓塞的临床特征及危险因素分析[J].天津医药,2016,44(3):353-356.
[10]谢一潋,褚金国,钱国清,等.COPD急性加重合并活动性肺结核患者的危险因素及临床特征分析[J].浙江医学,2016,38(5):339-341.
[11] Hyojeong Han, Hong Seog Seo, Byung Hwa Jung, et al.Substance P and Neuropeptide Y as Potential Biomarkers for Diagnosis of Acute Myocardial Infarction in Korean Patients[J]. Bulletin of the Korean Chemical Society, 2014,35(1):158-164.
[12] Trieb T, Mayr A, Klug G, et al. Patterns of myocardial perfusion in the acute and chronic stage after myocardial infarction:A cardiac magnetic resonance study[J]. European Journal of Radiology, 2012,81(4):767-772.
[13] Paradela-Dobarro B, Raposeiras-Roubín S, Rodio-Janeiro BK, et al. Statins modulate feedback regulation mechanisms between advanced glycation end-products and C-reactive protein:Evidence in patients with acute myocardial infarction[J]. European journal of pharmaceutical sciences, 2013,49(4):512-518.
[14] Suprun EV, Saveliev AA, Evtugyn GA, et al. Electrochemical approach for acute myocardial infarction diagnosis based on direct antibodies-free analysis of human blood plasma[J]. Biosensors& amp;Bioelectronics:The International Journal for the Professional Involved with Research, Technology and Applications of Biosensers and Related Devices,2012,33:158-164.
[15] Camerlingo M, Tudose V, Tognozzi M, et al. Predictors of re-canalisation in acute cerebral infarction from occlusion of the terminal internal carotid artery or of the middle cerebral artery mainstem treated with thrombolysis[J]. International Journal of Neuroscience, 2014,124(3):199-203.
[16]李志海.老年人急性心肌梗死合并急性脑梗死的特点和预后分析[J].当代医学,2014,20(34):33-34.
[17]孙丽.不同年龄组脑梗死患者危险因素及临床特点刍议[J].当代医学,2014,20(35):92-93.
[18] Deguchi I, Dembo T, Fukuoka T, et al. Usefulness of MRA-DWI mismatch in neuroendovascular therapy for acute cerebral infarction[J]. European journal of neurology:the official journal of the European Federation of Neurological Societies, 2012, 19(1):114-120.
[2]杨丽.急性心肌梗死患者PCI术后并发急性脑梗死的发生率及危险因素分析[J].中国实用神经疾病杂志,2017,20(3):99-101.
[3]缪黄泰,张明,刘子衿,等.急性心肌梗死患者并发不同部位心脏破裂的临床特征和预后分析[J].中华危重病急救医学,2016,28(12):1080-1085.
[4]宋丽萍,郭云飞,杨静文,等.急性心肌梗死后心力衰竭患者临床特征及预后分析[J].北京医学,2016,38(2):114-117.
[5]王芳,蔺雪梅,王清,等.西安市后循环脑梗死患者临床特征和危险因素分析[J].陕西医学杂志,2016,45(6):720-721.
[6]张莉莉,高阳,丁建,等.不同性别急性心梗患者的临床特征及院内治疗预后分析[J].现代生物医学进展,2016,16(7):1299-1302.
[7]孔强,张迎花,华琦,等.合并心脏瓣膜钙化的急性心肌梗死患者的临床特征及预后分析[J].中国心血管杂志,2016,21(4):262-267.
[8]霍连营,李可,王翠芹,等.老年急性心肌梗死患者合并消化道出血的临床特征及预后分析[J].中华老年多器官疾病杂志,2016,15(9):674-677.
[9]冯炜,王一锋,唐榕蔚,等.成人肾病综合征并发肺血栓栓塞的临床特征及危险因素分析[J].天津医药,2016,44(3):353-356.
[10]谢一潋,褚金国,钱国清,等.COPD急性加重合并活动性肺结核患者的危险因素及临床特征分析[J].浙江医学,2016,38(5):339-341.
[11] Hyojeong Han, Hong Seog Seo, Byung Hwa Jung, et al.Substance P and Neuropeptide Y as Potential Biomarkers for Diagnosis of Acute Myocardial Infarction in Korean Patients[J]. Bulletin of the Korean Chemical Society, 2014,35(1):158-164.
[12] Trieb T, Mayr A, Klug G, et al. Patterns of myocardial perfusion in the acute and chronic stage after myocardial infarction:A cardiac magnetic resonance study[J]. European Journal of Radiology, 2012,81(4):767-772.
[13] Paradela-Dobarro B, Raposeiras-Roubín S, Rodio-Janeiro BK, et al. Statins modulate feedback regulation mechanisms between advanced glycation end-products and C-reactive protein:Evidence in patients with acute myocardial infarction[J]. European journal of pharmaceutical sciences, 2013,49(4):512-518.
[14] Suprun EV, Saveliev AA, Evtugyn GA, et al. Electrochemical approach for acute myocardial infarction diagnosis based on direct antibodies-free analysis of human blood plasma[J]. Biosensors& amp;Bioelectronics:The International Journal for the Professional Involved with Research, Technology and Applications of Biosensers and Related Devices,2012,33:158-164.
[15] Camerlingo M, Tudose V, Tognozzi M, et al. Predictors of re-canalisation in acute cerebral infarction from occlusion of the terminal internal carotid artery or of the middle cerebral artery mainstem treated with thrombolysis[J]. International Journal of Neuroscience, 2014,124(3):199-203.
[16]李志海.老年人急性心肌梗死合并急性脑梗死的特点和预后分析[J].当代医学,2014,20(34):33-34.
[17]孙丽.不同年龄组脑梗死患者危险因素及临床特点刍议[J].当代医学,2014,20(35):92-93.
[18] Deguchi I, Dembo T, Fukuoka T, et al. Usefulness of MRA-DWI mismatch in neuroendovascular therapy for acute cerebral infarction[J]. European journal of neurology:the official journal of the European Federation of Neurological Societies, 2012, 19(1):114-120.