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目的分析急性心肌梗死(AMI)并发急性脑梗死(AIS)的危险因素及临床特点。方法回顾性分析2010年1月~2015年4月我院收治住院的75例AMI并发AIS患者为病例组,随机选择同期住院的单纯AMI和单纯AIS患者各80例为对照组,对比分析3组临床资料。结果单因素分析显示,AMI并发AIS组与单纯AMI组比较,既往脑梗死病史、外周血管病史、血肌酐水平显著高于对照组,高密度脂蛋白胆固醇(HDL-C)显著低于对照组,差异有统计学意义(P<0.05);与单纯AIS组比较,男性、既往心肌梗死病史、外周血管病史、血肌酐水平显著高于对照组,入院收缩压与舒张压显著低于对照组,差异有统计学意义(P<0.05);多因素Logistic回归分析表明,男性、既往脑梗病史、血肌酐为AMI并发AIS的独立危险因素(P<0.05,OR>1),入院舒张压为其保护性因素(P<0.01,OR<1)。临床特点分析表明,KILLIP分级≥Ⅱ级高于两对照组(44%vs.16%vs.1%,P<0.01),多发脑梗死高于单纯AIS组(46%vs.16%,P<0.01),PCI患者冠状动脉3支病变显著高于单纯AMI组(76%vs.52%,P<0.05)。结论男性、入院舒张压降低、既往脑梗病史、血肌酐水平升高为AMI并发AIS的独立危险因素,心功能不全、多发脑梗死为其临床特点,冠状动脉3支病变为PCI术后并发急性脑梗死患者的临床特点。
Objective To analyze the risk factors and clinical features of acute myocardial infarction (AMI) complicated with acute cerebral infarction (AIS). Methods A retrospective analysis of 75 AMI patients with AIS admitted to our hospital from January 2010 to April 2015 was selected as the case group. 80 AMI patients with simple AMI and AIS patients were randomly selected as the control group. Three groups were compared clinical information. Results Univariate analysis showed that the past history of cerebral infarction, peripheral vascular disease and serum creatinine were significantly higher in patients with AMI complicated with AMI than those in AMI alone. The levels of HDL-C in AMI complicated with AMI were significantly lower than those in control group, (P <0.05). Compared with the AIS group, the history of male and previous myocardial infarction, the history of peripheral vascular disease and serum creatinine were significantly higher than those of the control group, and the systolic and diastolic blood pressure of admission were significantly lower than those of the control group (P <0.05). Multivariate Logistic regression analysis showed that men, previous history of cerebral infarction, serum creatinine were independent risk factors for AMI complicated by AIS (P <0.05, OR> 1), and diastolic blood pressure was the protective factor Sexual factors (P <0.01, OR <1). Clinical characteristics analysis showed that KILLIP grade ≥ Ⅱ was higher than the two control groups (44% vs.16% vs.1%, P <0.01), multiple cerebral infarction was higher than the AIS group (46% vs.16%, P < 0.01). The three coronary lesions in PCI patients were significantly higher than those in AMI patients (76% vs.52%, P <0.05). Conclusions Men, decreased diastolic blood pressure, history of previous cerebral infarction and elevated serum creatinine are independent risk factors for AMI complicated by AIS. Cardiac insufficiency and multiple cerebral infarction are their clinical features. Three lesions of coronary artery are complicated by acute Clinical characteristics of patients with cerebral infarction.