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急性心肌梗死后左心室血栓的危险因素

Risk factors for left ventricular thrombosis after acute myocardial infarction

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目的 探讨急性心肌梗死后左心室血栓(LVT)的危险因素.方法 回顾性分析2019年1月至2022年1月上海市徐汇区中心医院收治的300例急性心肌梗死患者的临床资料,根据超声心动图检查结果将患者分为LVT组(27例)和非LVT组(273例).采用单因素分析及多因素logistic回归分析筛选急性心肌梗死后LVT形成的影响因素,通过受试者工作特征(ROC)曲线分析各指标预测LVT形成的价值.结果 两组患者性别、年龄、BMI、吸烟史、饮酒史、高血压、糖尿病、胸痛持续时间<12 h、白细胞计数(WBC)、血小板计数(PLT)、心肌型肌酸激酶同工酶(CK-MB)、肌酐、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较差异无统计学意义(均P>0.05),两组患者中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、C反应蛋白(CRP)、脑钠肽(BNP)水平及左心室射血分数(LVEF)、左室舒张末期内径(LVDD)比较差异具有统计学意义(均P<0.05);NLR、PLR、CRP、BNP、LVEF、LVDD预测急性心肌梗死后LVT形成的曲线下面积分别为0.707、0.771、0.859、0.754、0.875、0.796(均 P<0.05),预测 LVT 形成临界值分别为 3.571、121.761、45.215 mg/L、415.196 pg/ml、51.271%、43.364 mm;多因素分析结果显示,PLR ≥ 121.761、CRP≥45.215 mg/L、BNP≥415.196 pg/ml、LVEF≤51.271%、LVDD ≥43.364 mm 为急性心肌梗死后LVT形成的独立危险因素(均P<0.05).结论 PLR、CRP、BNP、LVEF、LVDD为急性心肌梗死后LVT形成的独立危险因素.
Objective To explore the risk factors of left ventricular thrombosis(LVT)after acute myocardial infarction.Methods A retrospective analysis was conducted on the clinical data of 300 patients with acute myocardial infarction admitted to the Xuhui District Central Hospital in Shanghai from January 2019 to January 2022.Based on the results of echocardiography,the patients were divided into LVT group(27 cases)and non LVT group(273 cases).Single factor analysis and multivariate logistic regression analysis were used to screen for the influencing factors of LVT formation after acute myocardial infarction.The value of predicting LVT formation was analyzed through receiver operating characteristic(ROC)curve analysis of each indicator.Results There was no significant difference between the two groups in gender,age,body mass index(BMI),smoking history,drinking history,hypertension,diabetes,duration of chest pain<12 h,white blood cell count(WBC),platelet count(PLT),myocardial creatine kinase isoenzyme(CK-MB),creatinine,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)(all P>0.05),The differences in neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),C-reactive protein(CRP),brain natriuretic peptide(BNP)levels,left ventricular ejection fraction(LVEF),and left ventricular end diastolic diameter(LVDD)between the two groups of patients were statistically significant(all P<0.05);The area under the curve predicted by NLR,PLR,CRP,BNP,LVEF,and LVDD for LVT formation after acute myocardial infarction were 0.707,0.771,0.859,0.754,0.875,and 0.796(all P<0.05),respectively.The predicted critical values for LVT formation were 3.571,121.761,45.215 mg/L,415.196 pg/ml,51.271%,and 43.364 mm,respectively;The results of multivariate analysis showed that PLR ≥ 121.761,CRP ≥ 45.215 mg/L,BNP ≥ 415.196 pg/ml,LVEF ≤51.271%,and LVDD ≥43.364 mm were independent risk factors for LVT formation after acute myocardial infarction(all P<0.05).Conclusions PLR,CRP,BNP,LVEF,and LVDD are independent risk factors for LVT formation after acute myocardial infarction.

Myocardial infarctionLeft ventricular thrombosisRisk factor

徐欢乐、张慧斌、王巧娣

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浙江中医药大学,杭州 310053

上海市徐汇区中心医院心内科,上海 200031

心肌梗死 左心室血栓 危险因素

浙江省医药卫生科技计划项目

2020381311

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(1)
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