摘要
目的 分析老年急性ST段抬高型心肌梗死后新发房颤患者危险因素及红细胞分布宽度（RDW）变化的意义。方法 选取2010年1月—2015年6月在首都医科大学宣武医院综合科和心脏科住院的老年急性ST段抬高型心肌梗死患者328例,根据入院7 d内是否发生心房颤动分成房颤组（42例）和非房颤组（286例）,同时收集患者的临床资料、心脏彩色超声等结果,比较2组的差异并进行相关性分析。结果（1）基线资料比较：房颤组的性别、年龄、吸烟、合并高血压、人院时心率、RDW、hs-CRP、NT-proBNP、LAD、LVEF和Killp≥3级、前壁心肌梗死发生率、使用β受体阻滞剂均显著高于非房颤组（χ^2=2.096、4.728、3.165、4.792、3.182、2.026、3.562、4.082、2.804、3.092、14.817、15.241、13.469,P=0.037、0.020、0.038、0.024、0.002、0.028、0.001、0.001、0.012、0.008、0.001、0.001、0.001）。（2）以是否发生房颤为因变量,多因素Logistic回归分析显示,年龄、入院心率、RDW、hs-CRP、NT-proBNP、Killip≥3级、前壁心肌梗死发生率、LAD、使用β受体阻滞剂是急性ST段抬高型心肌梗死后新发房颤的独立危险因素（OR=1.658、2.561、3.841、3.209、4.946、1.954、3.815、4.350、2.245,95%CI=1.245~3.907、1.641~9.720、1.186~13.228、1.209~11.958、0.947~20.109、1.665~3.842、1.167~11.498、1.016~17817、1.736~3.248）。（3）Spesarman相关分析显示RDW与hs-CRP、NT-proBNP呈正相关（r=0.31、0.28,P=0.001、0.001）,RDW与LAD呈弱正相关（r=0.14,P=0.041）。结论 RDW是老年急性ST段抬高型心肌梗死后新发房颤的独立危险因素,其机制可能与炎性反应和左心功能不全有关。
Objective To investigate the relationship between red blood cell distribution width and new onset atrial fi -brillation after acute ST segment elevation myocardial infarction in elderly patients .Methods A total of 328 patients diag-nosed with AMI in hospitalized elderly patients between January 2010 to June 2015 in Xuanwu Hospital of Capital University of Medical Sciences , department of Cardiology were enrolled .The patients were divided into AF group （42 cases） and non AF group （286 cases） by the presence or absence of AF .Clinical manifestations and echocardiography data were also evaluated in all patients.Results （1）Single factor analysis found that in the atrial fibrillation group the age , admission heart rate, RDW, high sensitive CRP （hs-CRP）, NT-proBNP, left atrial diameter （LAD）, LVEF, gender, smoking, the incidence of compli-cated with hypertension , killp grading of heart function , the incidence of anterior wall myocardial infarction , the use of beta blocker were significantly higher than the non-atrial fibrillation group.（ t =2.096, t =3.182, t =2.026, t =3.562, t =4.082, t =2.804, t =3.092, P =0.037, P =0.002, P =0.028, P =0.001, P =0.001, P =0.012, P =0.008,χ^2 =4.728,χ^2 =3.165,χ^2 =4.792,χ^2 =14.817,χ^2 =15.241,χ^2 =13.469, P =0.020, P =0.038, P =0.024, P =0.001, P =0.001, P =0.001）.（2）Multivariate logistic regression analysis showed that age , RDW, hs-CRP, NT-proBNP, LAD, the incidence of anterior wall myocardial infarction , the use of beta blocker were the independent predictive factors of the emerging of atrial fibrillation （ OR=1.658, OR=2.561, OR=3.841, OR=3.209, OR=4.946, OR=1.954, OR=3.815,OR=4.350,OR=2.245,95%CI 1.245-3.907,95%CI 1.641-9.720, 95%CI 1.186-13.228, 95%CI 1.209-11 .958 , 95%CI 0 .947 -20 .109 , 95%CI 1 .665-3 .842 , 95%CI 1 .167 -11 .498 , 95%CI 1 .016 -17 .817 , 95%CI 1.736-3.248）.（3）Spesarman correlation analysis showed that RDW was positively correlated with inflammatory markers and NT-proBNP（ r =0.31, r =0.28, P =0.001, P =0.
出处
《疑难病杂志》
CAS
2016年第9期904-907,911,共5页
Chinese Journal of Difficult and Complicated Cases
