作者单位：512229 乐昌，广东乐昌市第二人民医院内科

急性ST段抬高型心肌梗死吸烟患者的临床特点

张晓静

【摘要】目的探讨急性ST段抬高型心肌梗死(STEMI)吸烟患者的临床特点。方法回顾性分析收治的STEMI 患者132例，比较吸烟组(n=57)患者与非吸烟组(n=75)患者的临床基本资料及实验室检查的各项参数；多因素Logistic回归分析吸烟等与LVEF<40%的相关性。结果与非吸烟组患者比较，吸烟组患者年龄[(59.6±10.9)岁 vs.(64.9±8.9)岁,P=0.007]较低,CRP(30.09 mg/L vs.21.14 mg/L,P=0.010)增高，合并前壁(14.0% vs.8.0%)及广泛前壁心肌梗死比例(50.9% vs.25.3%)更高，LVEF[(40.3±8.7) vs. (53.0±10.6), P<0.001]降低，CK-MB峰值[(174.37±114.73) U/L vs. (145.88±112.44) U/L, P=0.015]、脑钠肽前体[(2 293±1 165) pg/L vs.(1 872±662) pg/L, P=0.025]增高，使用主动脉球囊反搏(IABP)(22.8% vs.9.3%, P=0.032) 比例更高；多因素Logistic回归显示吸烟(OR=3.423，95%CI 1.694～8.735,P =0.019)与LVEF<40%相关(P<0.05)。结论吸烟可能使STEMI早发，心功能更差，合并的炎症反应更强。

【关键词】吸烟；急性ST段抬高型心肌梗死；临床特点

DOI:10.3969/g.issn.0253-9802.2015.02.012

收稿日期：(2014-11-06)

Clinical characteristics of smokers with acute ST-elevation myocardial infarctionZhangXiaojing.DepartmentofInternalMedicine，theSecondPeople’sHospitalofLechang，Lechang512229，China

Abstract【】ObjectiveTo investigate the clinical characteristics of smokers with acute ST-elevation myocardial infarction(STEMI). MethodsA retrospective study including 132 STEMI patients admitted to the Second People’s Hospital of Lechang was conducted. All patients were divided into two groups according to smoke history: smokers(n=57) and non-smokers(n=75). Baseline clinical data and laboratory examination parameters were statistically compared between both groups. The correlation between smoking and LVEF<40% was assessed by using multivariate logistic regression. ResultsCompared with non-smokers, the age of smokers was significantly younger (59.6±10.9 years vs. 64.9±8.9 years, P=0.007), the level of C response protein(CRP) was significantly higher (30.09 mg/L vs.21.14 mg/L,P=0.010), the percentage of anterior (14.0% vs. 8.0%) and extensive anterior MI (50.9% vs.25.3%) were apparently higher, LVEF was dramatically reduced (40.3±8.7 vs. 53.0±10.6, P<0.001), peak value of NT-proBNP (2 293±1 165 pg/L vs. 1 872±662 pg/L, P=0.025)and CK-MB(174.37±114.73 U/L vs. 145.88±112.44 U/L, P=0.015) were significantly elevated and the percentage of use of IABP was equally obviously higher (22.8% vs.9.3%, P=0.032). Multivariate logistic regression revealed that smoking was significantly correlated with the incidence of LVEF<40% (OR=3.423，95%CI 1.694-8.735, P=0.019). ConclusionsSmoking may lead to earlier onset of STEMI, worse cardiac function and more severe inflammatory responses.

【Key words】Smoking; Acute ST-elevation myocardial infarction; Clinical characteristics

根据中国心血管病2013年概要，我国15岁以上烟民有3.56亿，2010年戒烟率仅为16.9%[1]。吸烟增加冠状动脉粥样硬化性心脏病(冠心病)的风险，且吸烟者心肌梗死的相对风险增加2～5倍；在吸烟人群中，大约50%可避免的死亡与吸烟相关，约半数与心血管疾病相关[2]。此外，急性ST段抬高性心肌梗死(STEMI)是冠心病的主要类型和严重的心血管事件，临床预后不同，院内病死率高达6%～14%[3]。本文通过回顾性分析，旨在探讨STEMI吸烟患者的临床特点。

对象与方法

一、 研究对象

入选2010年8月至2013年3月在乐昌市第二人民医院就诊的急性STEMI患者132例，均符合ACC/AHA急性STEMI的诊断标准[4]。

二、方法

回顾性分析2组患者的基本资料、临床资料及实验室资料。吸烟组的标准定义为吸烟≥1年，且每日≥2支；既往吸烟患者，若戒烟10年，定义为非吸烟组。血脂四项、肾功能、CRP在患者入院第2日清晨抽取检测，同时测定总胆固醇，甘油三酯、LDL-C、HDL-C、血清肌酐及CRP。入院时测定肌钙蛋白I、脑钠肽前体、心功酶，每隔4 h测定心功酶，并确定CK-MB峰值。住院期间行心电图及UCG检查，根据心电图的ST段、Q波动态改变及UCG，确定心肌梗死部位及LVEF。……