摘要
目的研究急性心肌梗死(AMI)伴消化道出血患者的临床特点及预后。方法将427例确诊为AMI的患者分为心肌梗死(MI)对照组(404例)、MI后消化道出血组(15例)和消化道出血后MI组(8例),分析MI伴消化道出血患者的临床特点及1年心血管死亡和因再发心绞痛、非致死性MI、心衰和中风而住院的复合终点结果。结果 (1)MI后消化道出血组和消化道出血后MI组患者有消化道疾病史的比例高于MI对照组(13.3%、12.5%vs.5.2%),消化道出血后MI组非ST段抬高的心肌梗死(NSTEMI)患者所占比例高于MI对照组(62.5%vs.43.6%),但差异均无统计学意义(P>0.05)。(2)MI后消化道出血组的估测肾小球滤过率(eGFR)显著低于MI对照组[(57.1±23.5)ml.min-1.1.73-2vs.(74.6±26.4)ml.min-1.1.73-2],差异有统计学意义(P<0.05)。Logostic回归分析显示,eGFR降低对MI患者发生消化道出血的相对危险为0.975[95%CI(0.957,0.995),P<0.05]。(3)消化道出血后MI组抗血小板、抗凝治疗的比例以及MI后消化道出血组阿司匹林使用的比例均显著低于MI对照组,差异有统计学意义(P<0.05)。消化道出血后MI组的血红蛋白显著低于MI后消化道出血组[(7.2±1.3)g/dl vs.(11.3±2.5)g/dl],差异有统计学意义(P<0.01),接受输血治疗的比例显著高于后者(75.0%vs.26.7%),差异有统计学意义(P<0.05);MI后消化道出血组介入或溶栓治疗的比例低于MI对照组(53.3%vs.76.0%),但差异无统计学意义(P>0.05),而消化道出血后MI组介入或溶栓治疗的比例显著低于MI对照组(12.5%vs.76.0%),差异有统计学意义(P<0.01)。(4)MI后消化道出血组的1年心血管死亡和因再发心绞痛、非致死性MI、心衰和中风而住院的复合终点明显高于MI对照组(40.0%vs.15.3%),差异有统计学意义(P<0.05)。结论 eGFR降低是MI患者发生消化道出血重要的预测因素。MI患者伴发消化道出血常使抗血小板、抗凝和冠脉再通治疗困难,且多预后不良。
Objective To investigate the clinical characteristics and prognosis of patients with acute myocardial infarction（AMI） and gastrointestinal bleeding（GIB）.Methods All 427 patients with AMI were divided into MI group（n=404,without GIB）,MI-GIB group（n=15,AMI followed by GIB）group and GIB-MI group（n=8,GIB followed by AMI）group.the clinical characteristics and combined end points of one-year cardiovascular death and hospitalization for recurrent angina pectoris,non-deadly MI,heart failure and stroke were analyzed.Results（1）Compared with MI group,the percentage of the patients with a history of GIB was higher in both MI-GIB and GIB-MI groups（13.3%,12.5% vs.5.2%）,and the percentage of non-ST-elevation MI was higher in GIB-MI group（62.5% vs.43.6%）,but with no statistical differences（P0.05）.（2） The estimated glomerular filtration rate（eGFR） in MI-GIB group was significantly lower than that in MI group [（57.1±23.5） ml·min-1·1.73 m-2 vs.（74.6±26.4） ml·min-1·1.73 m-2,P0.05].Logostic regression analysis with eGFR revealed that the hazard ratio for patients′ development of GIB after AMI was 0.975 [95%CI（0.957,0.995）,P0.05].（3） The ratio of adopting anti-platelet and anti-coagulant medications in GIB-MI group and the ratio of aspirin usage in MI-GIB group was significant lower as compared with in MI group,respectively（P0.05）.The level of hemoglobin in GIB-MI group was significantly lower than that in MI-GIB group [（7.2±1.3） g/dl vs.（11.3±2.5）g/dl,P0.01],but the ratio of blood transfusion was significantly higher（75.0% vs.26.7%,P0.05）.The ratio of percutaneous coronary intervention（PCI） or thrombolytic therapy in GIB-MI group was lower than that in MI group,but with no statistical differences（53.3% vs.76.0%,P0.05）;while the ratio of adopting PCI or thrombolytic therapy in GIB-MI group was significantly lower than that in MI group（12.5% vs.76.0%,P0.01）.（4）The combined end points of cardiovascular death and hospitalization for recurrent angina pectoris,non-deadly MI,heart failure and stroke in MI-GIB group were significantly higher than those in MI group（40.0% vs.15.3%,P0.05）.Conclusion The reduced eGFR is an important predictor for patients with MI complicated by GIB.It is difficult to take anti-platelet and anti-coagulant medication and to receive revascularization treatment for patients with MI and gastrointestinal bleeding,and the prognosis is usually bad.
出处
《中国全科医学》
CAS
CSCD
北大核心
2011年第22期2507-2512,共6页
Chinese General Practice
关键词
心肌梗死
消化道出血
临床特点
预后
Myocardial infarction
Gastrointestinal bleeding
Clinical characteristics
Prognosis
