作者：刘莉莉1 ，冯雷 2 ，王立君 1 ，杜超 1 ，秦利强 1 ，卢炜 1

单位：

1.050011 河北省石家庄市第三医院心内科　2.050011 河北省石家庄市第三医院心胸外科

Units：

1.Department of Cardiology，the Third Hospital of Shijiazhuang，Shijiazhuang 050011，China2.Cardiothoracic Surgery，the Third Hospital of Shijiazhuang，Shijiazhuang 050011，China

关键词：

心肌梗死；新发心房颤动；危险因素

Keywords：

Myocardial infarction；New-onset atrial fibrillation；Risk factors

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.021

Funds：

摘要：

背景　急性心肌梗死（AMI）是新发心房颤动（NOAF）的急性病因，而 NOAF 又可导致 AMI 病情恶化。因此，明确 AMI 患者 NOAF 的危险因素并早期干预对改善患者预后、降低病死率具有积极意义。目的　探讨 AMI患者住院期间 NOAF 的危险因素，以期能早期识别伴有高危心房颤动的 AMI 患者。方法　本研究为回顾性研究。选取2014-06-01 至 2019-06-01 石家庄市第三医院收治的 648 例 AMI 患者，其中住院期间出现 NOAF 91 例（房颤组）；按照 1 ∶ 2 的比例从未出现 NOAF 的 557 例 AMI 患者中随机选取 182 例作为非房颤组。收集患者临床资料，包括一般资料、心脏超声检查结果、冠状动脉造影结果及住院期间严重临床事件发生情况。结果　房颤组患者年龄和左心房内径（LAD）大于非房颤组，脑血管病、陈旧性心肌梗死、中重度左房室瓣反流、室性心动过速 / 心室颤动、心源性死亡发生率及收缩压＜ 100 mm Hg、心率≥ 100 次 /min、左心室射血分数（LVEF）＜ 40% 者所占比例高于非房颤组，Killip 分级劣于非房颤组（P ＜ 0.05）。多因素 Logistic 回归分析结果显示，年龄≥ 70 岁〔OR=3.636，95%CI（1.928，6.858）〕、LAD ＞ 40 mm〔OR=3.013，95%CI（1.475，6.158）〕、收缩压＜ 100 mm Hg〔OR=5.056，95%CI（1.438，17.771）〕、Killip 分级≥ 2 级〔OR=4.130，95%CI（1.751，9.738）〕是 AMI 患者 NOAF 的独立影响因素（P ＜ 0.05）。结论　年龄≥ 70 岁、LAD ＞ 40 mm、收缩压＜ 100 mm Hg、Killip 分级≥ 2 级的 AMI 患者 NOAF 风险较高，应引起临床医生重视。

Abstract：

Background　Acute myocardial infarction（AMI） is an acute cause of new-onset atrial fibrillation（NOAF），which in turn might lead to the deterioration of AMI.Therefore，identifying the risk factors of NOAF and early intervention of them in patients with AMI have positive significance in improving prognosis and reducing mortality.Objective To investigate risk factors of NOAF in AMI patients during hospitalization，which might provide basis for early identification of AMI patients with high-risk atrial fibrillation.Methods　This is a retrospective study.A total of 648 AMI patients who werehospitalized in the Third Hospital of Shijiazhuang from June 1，2014 to June 1，2019 were selected as study subjects.Among them，91 patients with NOAF during hospitalization were assigned to AF group.182 patients were randomly selected from 557 AMI patients without NOAF were assigned to non AF group according to the ratio of 1 ∶ 2.The clinical data of all study subjects were collected，including general information，echocardiography results，coronary angiography results and serious clinical events during hospitalization.Results　Age and left atrium diameter（LAD）in AF group were greater than those in non AF group.The incidence of cerebrovascular disease，old myocardial infarction，moderate or severe mitral regurgitation，ventricular tachycardia/ventricular fibrillation，cardiac death，and the proportion of patients with systolic blood pressure（SBP） ＜ 100 mm Hg，heart rate ≥ 100 beats/min，left ventricular ejection fraction（LVEF） ＜ 40% in AF group were higher than those in non AF group. Killip grade in AF group was worse than that in non AF group（P ＜ 0.05）.Multivariate Logistic regression analysis showed that age ≥ 70 years old〔OR=3.636，95%CI（1.928，6.858）〕，LAD ＞ 40 mm〔OR=3.013，95%CI（1.475，6.158）〕，SBP ＜ 100 mm Hg〔OR=5.056，95%CI（1.438，17.771）〕，and Killip grade ≥ 2〔OR=4.130，95%CI（1.751，9.738）〕 were independent risk factors of NOAF in AMI patients（P ＜ 0.05）.Conclusion　AMI patients with age ≥ 70 years old，LAD ＞ 40 mm，SBP ＜ 100 mm Hg，or Killip grade ≥ 2 have higher risk of NOAF，which should be paid attention by clinicians.

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