摘要
目的分析老年急性心肌梗死（AMI）伴消化道出血患者的临床特点及预后。方法325例确诊为AMI的老年患者分为对照组（304例）、AMI后消化道出血组（14例）和消化道出血后AMI组（7例），分析老年AMI伴消化道出血患者的临床特点和1年心血管死亡和因再发心绞痛、非致死性AMI、心力衰竭和脑卒中而住院的复合终点结果。结果（1）AMI后消化道出血组的估测肾小球滤过率（eGFR）低于对照组，分别为（61．9±27．3）ml·min^-1·1．73m^-2与（77．3±27．9）ml·min^-1·1．73m^2，差异有统计学意义（P〈0．05），多因素回归分析结果显示，eGFR降低对老年AMI患者发生消化道出血的相对危险为0．980（95％CI为0．960～0．999，P（0．05）；（2）消化道出血后AMI组抗血小板、抗凝治疗的比例和AMI后消化道出血组阿司匹林使用的比例均低于对照组（P均〈0．05），消化道出血后AMI组的血红蛋白低于AMI后消化道出血组，分别为（74±14）g／L与（111±25）g／L，差异有统计学意义（P〈0．01），接受输血治疗的比例高于AMI后消化道出血组，分别为85．7％（6例）与28．6％（4例），差异有统计学意义（P〈O．05）；消化道出血后AMI组介入或溶栓治疗的比例显著低于对照组差异有统计学意义（P〈0．01）；（3）AMI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AMI、心力衰竭和脑卒中而住院的复合终点高于对照组，分别为42．9％（6／14）与17．8％（54／304），差异有统计学意义（P〈0．05）。结论eGFR降低是老年AMI患者发生消化道出血重要的预测因素。老年AMI患者伴发消化道出血常使抗血小板、抗凝和冠状动脉再通治疗困难，且多预后不良。
Objective To investigate the clinical characteristics and prognosis of acute myocardial infarction（AMI） patients with gastrointestinal bleeding （GIB） in the elderly. Methods Total 325 elderly patients with AMI were divided into AMI control group （n= 304, patients without gastrointestinal bleeding around the period of AMI）, GIB-post-AMI （n= 14, patients developing gastrointestinal bleeding after AMI） group and AMI-post-GIB （n= 7, patients with gastrointestinal bleeding subsequently suffered an AMI） group. The clinical characteristics and combined end points of cardiovascular death and hospitalization for recurrent angina pectoris, non-lethal AMI, heart failure and stroke were analysed. Results （1） Estimated glomerular filtration rate （eGFR） became lower in the patients with GIB-post-MI （61.9 ± 27.3） ml·min^-1·1.73m^2compared with AMI control patients （77.3±27.9） ml·min^-1·1.73m^2,P〈0.05. Multivariate regression analysis revealed that the relative risk from a decreased eGFR for developing gastrointestinal bleeding after AMI in elderly patients was 0. 980 （95%CI： 0. 960-0. 999, P〈0.05）. （2） There were significantly less patients adopting anti-platelet and anti-coagulant medications in AMI-post-GIB group and less patients applying aspirin in GIB-post-AMI group as compared with AMI control group, respectively （P〈0.05）. AMI- post-GIB patients had significantly lower hemoglobin （74± 14） g/L than GIB-post-AMI patients （111 ±25） g/L, P〈0.01. More MI-post-GIB patients （6 cases, 85.7%） versus GIB-post-AMI patients （4 cases, 28.6%）underwent blood transfusion（ P〈 0.05）. There were significantly less patients adopting PCI and thrombolytic therapy in AMI-post-GIB group as compared to AMI control patients （P〈0.01）. （3） The combined end points of cardiovascular death and hospitalization for recurrent angina pectoris, non-lethal MI, heart failure and stroke in GIB-post-MI group were significantly higher than in AMI control group [42.9% （6/14） vs. 17.8% （54/304）, P〈0.05]. Conclusions Reduced eGFR is an important predictor for elderly AMI patients developing gastrointestinal bleeding which makes it difficult to take anti-platelet and anti-coagulant medication and to receive revascularization treatment, usually with worse prognosis.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2011年第10期823-826,共4页
Chinese Journal of Geriatrics
关键词
心肌梗死
胃肠出血
预后
Myocardial infarction
Gastrointestinal hemorrhage
Prognosis
