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目的:探讨急性心肌梗死(AMI)患者合并恶性室性心律失常的危险因素。方法:回顾性分析我院接受急诊冠状动脉介入(PCI)的ST段抬高心肌梗死患者322例。分为恶性室性心律失常组(A组)68例和无恶性室性心律失常组(B组)254例。通过观察比较患者的一般临床情况,进行心脏超声检查,检测生化指标、C反应蛋白(CRP)及血浆脑钠肽(BNP)。并将可能的相关因素进行Logist多因素回归分析。结果:两组患者在年龄、性别构成、高血压、陈旧心肌梗死、既往血运重建病史、基础心率、血压等方面具有可比性。但A组患者的空腹血糖、CRP及BNP水平明显高于B组患者[空腹血糖(8.83±4.81)mmol/L∶(6.02±2.25)mmol/L,P=0.012;CRP(18.24±12.19)mg/L∶(11.06±10.06)mg/L,P=0.016;BNP(446.04±146.37)pg/L∶(315.01±121.11)pg/L,P=0.009]。Logist多因素回归分析示:BNP、CRP的升高是AMI患者合并恶性室性心律失常的独立危险因素(BNP:OR=1.416,95%CI:0.921~3.012,P=0.021;CRP:OR=1.367,95%CI:1.040~4.312,P=0.015)。结论:AMI患者BNP、CRP水平的升高可能预示发生恶性室性心律失常风险的增加。
Objective: To investigate the risk factors of malignant ventricular arrhythmia in patients with acute myocardial infarction (AMI). Methods: A retrospective analysis of our hospital received emergency PCI (coronary artery disease (PCI) of 322 patients with ST-elevation myocardial infarction. Divided into malignant ventricular arrhythmia group (A group) 68 cases and non-malignant ventricular arrhythmia group (B group) 254 cases. By observing and comparing the general clinical situation of patients, heart biopsy, biochemical indexes, C-reactive protein (CRP) and plasma brain natriuretic peptide (BNP) were detected. Logist multivariate regression analysis of possible related factors. Results: The two groups were comparable in terms of age, gender, hypertension, old myocardial infarction, previous history of revascularization, basal heart rate and blood pressure. However, the fasting blood glucose, CRP and BNP levels in group A were significantly higher than those in group B [fasting glucose (8.83 ± 4.81) mmol / L vs (6.02 ± 2.25) mmol / L, P = 0.012; CRP (18.24 ± 12.19) mg /L:(11.06]10.06)mg/L,P=0.016;BNP(446.04Å146.37)pg/L:(315.01 ± 121.11)pg/L,P=0.009]. Logistic multivariate regression analysis showed that elevated BNP and CRP were independent risk factors for AMI in patients with malignant ventricular arrhythmias (BNP: OR = 1.416, 95% CI: 0.921-3.012, P = 0.021; CRP: OR = 1.367 , 95% CI: 1.040 ~ 4.312, P = 0.015). CONCLUSIONS: Elevated BNP and CRP levels may indicate an increased risk of malignant ventricular arrhythmias in AMI patients.