[1]户富栋,陈　熙,申泱泱,等.急性心肌梗死患者血钙水平与心功能及出院后90 d内非计划性再住院的关系[J].新乡医学院学报,2020,37(5):456-461.[doi:10.7683/xxyxyxb.2020.05.014]
　HU Fudong,CHEN Xi,SHEN Yangyang,et al.Relationship between serum calcium level and cardiac function and unplanned rehospitalization in 90 days after discharge in patients with acute myocardial infarction[J].Journal of Xinxiang Medical University,2020,37(5):456-461.[doi:10.7683/xxyxyxb.2020.05.014]
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急性心肌梗死患者血钙水平与心功能及出院后90 d内非计划性再住院的关系
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年5
页码:
456-461
栏目:
临床研究
出版日期:
2020-05-05

文章信息/Info

Title:
Relationship between serum calcium level and cardiac function and unplanned rehospitalization in 90 days after discharge in patients with acute myocardial infarction
作者:
户富栋; 陈　熙; 申泱泱; 付　新; 胡彩娜; 姜正明
（郑州大学第一附属医院心内科，河南　郑州　450052）
Author(s):
HU Fudong; CHEN Xi; SHEN Yangyang; FU Xin; HU Caina; JIANG Zhengming
(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)
关键词:
血钙; 急性心肌梗死; 心功能; 再住院
Keywords:
serum calcium; acute myocardial infarction; cardiac function; readmission
分类号:
R541.4
DOI:
10.7683/xxyxyxb.2020.05.014
文献标志码:
A
摘要:
目的　探讨急性心肌梗死（AMI）患者入院血钙水平与其心脏功能的关系及对其出院后90 d内非计划性再住院情况的影响。方法　选择2017年1月至2018年12月郑州大学第一附属医院收治的298例＞18岁的疑似冠状动脉性心脏病（CAD）患者为观察对象，患者均有心肌缺血症状或缺血性心电图表现。根据冠状动脉造影检查结果分为AMI组（n=129）、CAD组（n=102）和对照组（冠状动脉未见狭窄性病变且血流正常）（n=67），并根据血钙水平将AMI患者分为低钙血症组（血钙 ＜2.20 mmol·L-1，n=64）和正常血钙组（血钙2.20~2.75 mmol·L-1，n=65）。记录患者性别、年龄、高血压病、2型糖尿病、高脂血症、吸烟者比例等病史资料及心电图、X线胸片检查结果，观察患者入院第2 天血清N末端B型利钠肽原（NT-proBNP）、血钙、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、空腹血糖、心肌酶、肌钙蛋白水平；采用彩色多普勒超声诊断仪检测患者的左心室射血分数（LVEF）和心腔大小；分析血钙水平对AMI患者出院后90 d内非计划性再住院率的影响。结果　3组患者的年龄、性别、高血压病患病率、2型糖尿病患病率、吸烟者比例、TC、LDL-C、收缩压、舒张压、空腹血糖、LVEF、NT-proBNP和血钙水平比较差异均有统计学意义（P＜0.05），3组患者的高脂血症史和TG水平比较差异无统计学意义（P＞0.05）。与对照组比较，CAD组患者的年龄、高血压病患病率、2型糖尿病患病率、TC、LDL-C、空腹血糖和NT-proBNP水平显著增加，血钙和LVEF水平显著下降（P＜0.05）；与对照组比较，AMI组患者的年龄、男性比例、吸烟者比例及高血压患病率、2型糖尿病患病率、TC、LDL-C、空腹血糖和NT-proBNP水平显著增高，而女性患者比例、血钙和LVEF水平显著下降（P＜0.05）。与CAD组比较，AMI组患者LDL-C、空腹血糖和NT-proBNP水平显著增高，血钙、LVEF、收缩压和舒张压水平显著下降（P＜0.05）。血钙水平与AMI患者血清NT-proBNP水平呈负相关（r=-0.533,P＜0.05），与LVEF呈正相关（r=0.225,P＜0.05）。低钙血症组患者冠状动脉病变支数、心功能Killip分级和NT-proBNP水平显著高于正常血钙组（P＜0.05）；低钙血症组患者年龄、男性患者比例、高脂血症史、高血压病患病率、2型糖尿病患病率、吸烟者比例、TC、LDL-C、TG、收缩压、舒张压、空腹血糖、LVEF、严重心律失常患病率、梗死相关血管、PCI和急诊PCI率、支架植入数与正常血钙组比较差异均无统计学意义（P＞0.05）。低钙血症组患者死亡1例（入院第3 天心脏破裂），出院后90 d内非计划性再住院13例（20.6%），其中心力衰竭 12例，再发AMI 1例；正常血钙组患者住院和随访期间未见任何死亡事件，出院后90 d内非计划性再住院5例（7.7%），均为心力衰竭。低钙血症组患者出院后 90 d内非计划性再住院率显著高于正常血钙组（χ2=4.419，P＜0.05）。结论　AMI患者的血钙水平降低，其血钙水平越低，患者心功能障碍越严重，且出院后90 d内非计划性再住院率越高。
Abstract:
Objective　To investigate the relationship between the blood calcium level and cardiac function in patients with acute myocardial infarction (AMI) and its effect on their unplanned rehospitalization in 90 days after discharge.Methods　A total of 298 suspected coronary artery disease(CAD)patients (＞18 years old) in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018 were selected as study subjects.All patients had myocardial ischemia symptoms or the manifestations of ischemic electrocardiogram(ECG).According to the results of coronary angiography,the patients were divided into AMI group(n=129),CAD group(n=102)and control group(without coronary stenotic changes and the coronary blood flow was normal)(n=67),and the patients with AMI were further divided into hypocalcemia group(serum calcium ＜2.20 mmol·L-1,n=64)and normal serum calcium group(serum calcium 2.20-2.75 mmol·L-1,n=65) according to the serum calcium levels after admission.The data of medical history such as sex,age,hypertension,type 2 diabetes mellitus(T2DM),hyperlipemia,smoking rate and other medical history data as well as the results of electrocardiogram and X-ray examination were recorded.The levels of serum N-terminal pro-B-type natriuretic peptide(NT-proBNP),calcium,total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),triacylglycerol(TG),fasting blood glucose,cardiac enzymes and troponin were tested and observed especially on the second day after admission.The left ventricular ejection fractions(LVEF) and the sizes of cardiac chambers were examined by color doppler ultrasonic diagnosis apparatus,and the effect of hypocalcemia on unplanned rehospitalization in 90 days after discharge was analyzed in patients with AMI.Results　There was statistically significant difference in the age,sex,hypertension prevalence rate,T2DM prevalence rate,smoking rate,TC,LDL-C,systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),LVEF,NT-proBNP and serum calcium levels among the three groups (P＜0.05),but there was no significant difference in the hyperlipidemia history and TG levels among the three groups(P＞0.05).Compared with the control group,the age,hypertension prevalence rate,T2DM prevalence rate,TC,LDL-C,FBG land NT-proBNP levels in the CAD group were significantly higher,but serum calcium and LVEF in the CAD group were significantly lower(P＜0.05),the age,the proportion of male patients,smoking rate,hypertension prevalence rate,T2DM prevalence rate,TC,LDL-C,FBG and NT-proBNP levels in the AMI group were higher,but the proportion of female patients,serum calcium levels and LVEF in the AMI group were lower(P＜0.05).Compared with the CAD group,the levels of LDL-C,FBG and NT-proBNP in the AMI group were higher,but the serum calcium,LVEF,SBP and DBP levels in the AMI group were lower(P<0.05).In patients with AMI,the serum calcium level was negatively correlated with serum NT-proBNP level(r=-0.533,P<0.05),and positively correlated with LVEF (r=0.225,P<0.05).The number of diseased coronary vessels,cardiac function Killip classes and NT-proBNP levels in the hypocalcemia group were significantly higher than those in the normal serum calcium group(P＜0.05),but there was no significant difference in the age,sex,hyperlipidemia history,hypertension prevalence rate,T2DM prevalence rate,smoking rate,TC,LDL-C,TG,SBP,DBP,FBG and LVEF,severe arrhythmia prevalence rate,infarct-related artery,emergency or total percutaneous coronary intervention(PCI) rate and the number of implanted stents between the hypocalcemia group and the normal serum calcium group(P＞0.05).In the hypocalcemia group,one patient died by myocardial rupture on the third day after admission,and 13 patients(20.6%) had unplanned readmission in 90 days after discharge which included in 12 patients with heart failure and 1 patients with recurring AMI.In the normal serum calcium group,there was no any death during hospitalization and follow-up,and 5 patients(7.7%)had unplanned readmission in 90 days after discharge because of heart failure.The rate of unplanned readmission in 90 days after discharge in the hypocalcemia group was higher than that in the normal serum calcium group(χ2　=4.419，P＜0.05).Conclusion　Serum calcium level is lower in patients with AMI.The lower the blood calcium level in AMI patients,the more serious the cardiac dysfunction,and the higher the rate of unplanned rehospitalization 90 days after discharge.

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更新日期/Last Update: 2020-05-05