【作者】 陈欣；

【导师】 张遵城；

【作者基本信息】 天津医科大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 目的探讨在急性ST段抬高型心肌梗死(STEMI)患者中发病初期的血清醛固酮(A1d)水平是否可以预测血管病变的范围,是否与近期预后有关。方法入选天津医科大学第二医院心脏科2008年3月-10月于CCU连续收入院的67例急性ST段抬高型心肌梗死患者,行经皮冠状动脉介入治疗术(PCI),术前股动脉穿刺后留取血清,采用放射免疫法(RIA)测定血清醛固酮水平。采集患者的病史,记录冠脉造影术中前降支病变比率、起始0级TIMI血流数量、病变长度、血栓分级等,并观察住院期间及发病后30 d包括死亡、再梗死、脑卒中、心衰加重、急诊搭桥或再次PCI等心血管事件情况。按血清醛固酮水平分成2组：A组(醛固酮<150μg/L)和B组(醛固酮≥150μg/L),比较两组患者的冠脉病变支数,采用多变量Logistic回归分析判断醛固酮是否可以预测急性心肌梗死患者的近期预后。结果与低血清醛固酮水平组(A组)患者比较,高醛固酮水平组(B组)发病-介入时间长(P<0.05),累及平均病变冠脉血管支数增加(P<0.05),并有不良心脏事件增加之势。此外经多变量Logistic回归分析中,除糖尿病(HR 2.934,95%CI 1.314 to 6.548,p=0.0086)外,血清醛固酮水平(HR 0.705,95%CI0.573 to0.868,p=0.0010)也是病变血管范围的独立预测因子。结论急性ST段抬高型心肌梗死患者早期血清醛固酮水平增高预示累及病变血管多,可能增加不良心脏事件的发生。提示急性心肌梗死早期药物降低血清醛固酮水平,可能改善患者的近期预后。更多还原

【Abstract】 Objective To assess the value of serum aldosterone levels measure before percutaneous coronary intervention(PCI) in predicting multiple diseased coronary vessels and short-term clinical prognosis in patients with acute ST segment elevation myocardial infarction(STEMI).METHODS The study included 67 consecutive patients with acute STEMI undergoing PCI in CCU in the Second Hospital of Tianjin Medical University from March 2008 to October 2008. Blood samples were drawn through the femoral arterial sheath before cardiac catheterization with the patients in the supine position. Serum aldosterone levels were measured with a commercially available radioimmunoassay (RIA)kit. The patients history were collected the morbid change ratio of anterior descending branch, the length of morbid change and thrombus classification were noted down. All patients were tracked for subsequent cardiovascular events including cardiac death, myocardial infarction, heart failure,second PCI, coronary artery bypass and stroke during in-hospital and 30-day follow-ups. According to the serum aldosterone levels, the patients were divided into 2 groups, group A:serum aldosterone levels< 150μg/L, group B:serum aldosterone levels≥150μg/L. Quantity of diseased coronary vessels in the two groups of acute STEMI patients was compared, and multivariate Logistic regression analysis was used to judge whether the serum aldostrone levels can predict the short-term clinical prognosis in the patients with acute STEMI.RESULTS The patients with higher levels of serum aldosterone spent longer time of occurrence to PCI, and more multiple diseased coronary vessels compared than that with/lower aldosterone levels. And it had been found that there was an a increasing trend of cardiovascular serum events in the patients with higher serum aldosterone levels during follow ups. Logistic analysis showed that the diagnosis of diabetes (HR 2.934,95%CI 1.314 to 6.548, p=0.0086) and serum aldosterone level (HR 0.705,95%CI 0.573 to 0.868, p=0.0010) were independent prognostic factors after adjustment of all entered baseline variables.CONCLUSION The higher serum aldosterone level was associated with the increase of diseased coronary vessels and may be responsible for subsequent short-term cardiovascular events following PCI.更多还原