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目的 了解首次Q型急性心肌梗死 (QAMI)患者血浆C 反应蛋白 (CRP)动态变化的临床意义 ,并评价其与预后的关系。方法 动态测定 78例QAMI患者血浆肌酸磷酸激酶 (CK)及CRP水平 ,并评价院内并发症与血浆CRP峰值水平的关系。结果 (1)老年患者 (≥ 70 )、无或缺乏梗死前心绞痛及溶栓治疗失败的患者血浆CRP峰值明显增高 (P <0 0 1,P <0 0 5 ) ;(2 )AMI后发生泵衰竭、左室室壁瘤和住院期间 4 8h后死亡的患者 ,其血浆CRP峰值水平与CK峰值水平均明显高于无泵衰竭和左室室壁瘤形成及出院存活的患者 (P <0 1,P <0 0 5 ) ;(3)心脏破裂的患者血浆CRP峰值水平明显高于无心脏破裂的患者 (P <0 0 1) ;而血浆CK峰值水平在二组间差异无明显意义 (P >0 0 5 ) ;(4)血浆CRP峰值水平≥ 2 0mg/dl是AMI后发生心脏破裂、左室室壁瘤形成的独立预测因子。结论 血浆CRP峰值水平≥ 2 0mg/dl对AMI后发生心脏破裂、左室室壁瘤具有高度预测价值
Objective To investigate the clinical significance of dynamic changes of plasma C-reactive protein (CRP) in patients with first Q-AMI and to evaluate its relationship with prognosis. Methods The plasma levels of creatine phosphokinase (CK) and CRP in 78 patients with QAMI were measured dynamically. The relationship between nosocomial complications and peak plasma CRP level was evaluated. Results (1) The peak plasma CRP was significantly higher in elderly patients (≥ 70), without or with pre-infarction angina and failure of thrombolysis therapy (P <0.01, P <0.05); (2) Patients with failure, left ventricular aneurysm and death after 48 h hospitalization had significantly higher peak plasma levels of CRP and CK than those without pump failure and left ventricular aneurysm formation and survival (P <0.01) , P <0.05). (3) The plasma levels of CRP in patients with heart rupture were significantly higher than those in patients without cardiac rupture (P <0.01), whereas there was no significant difference in peak plasma levels of CK between the two groups > 0 0 5). (4) The plasma CRP peak level ≥20mg / dl is an independent predictor of cardiac rupture and left ventricular aneurysm after AMI. Conclusions The plasma CRP peak level ≥20mg / dl has a cardiac rupture after AMI, and the left ventricular aneurysm has a high predictive value