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目的:探讨血电解质钠、钾、钙及白蛋白浓度与冠状动脉病变严重程度的关系。方法:回顾性分析358例冠心病介入诊疗者资料,其中冠心病者(冠心病组)286例,含急性心肌梗死(AMI)者51例,陈旧性心肌梗死(OMI)者56例,无心肌梗死(MI)冠心病者179例;冠状动脉造影(CAG)示无粥样硬化改变者(对照组)72例。采用Gensini积分系统评定冠状动脉病变严重性。结果:冠心病组中,平均冠状动脉病变Gensini积分AMI亚组[39(27~72)]最高,OMI亚组[36(22~57)]次之,无MI冠心病亚组[28(15~42)]最低(P<0.01);冠心病组患者平均血钙[AMI:(2.13±0.29)mmol/L,OMI:(2.34±0.22)mmol/L,无MI冠心病:(2.36±0.22)mmol/L]和白蛋白[AMI:(38.5±5.1)g/L,OMI:(41.3±3.9)g/L,无MI冠心病:(41.6±3.6)g/L]均明显低于对照组[血钙:(2.42±0.15)mmol/L,白蛋白:(42.8±4.0)g/L],均P<0.05,其中AMI亚组平均血钙和白蛋白还均明显低于其他冠心病亚组(均P<0.05);AMI亚组平均血钠、钾与其他亚组比较(除血钾与OMI亚组比较)也均明显较低(均P<0.05)。血钙和白蛋白与冠状动脉病变Gensini积分呈显著负相关,血钙r=-0.175(P=0.003),白蛋白r=-0.200(P=0.001),而血钠、钾与Gensini积分无明显相关性(均P>0.05);logistic回归分析示,经年龄、性别、糖尿病等传统危险因素调整后,低钙血症仍为冠心病危险因素(OR=2.618,95%CI=1.025~6.690,P=0.044)。结论:AMI可能会使血钠、钾、钙和白蛋白水平降低,血钙和白蛋白浓度与冠状动脉病变严重程度显著负相关,且低钙血症可能为冠心病的独立危险因素。
Objective: To investigate the relationship between the concentration of sodium, potassium, calcium and albumin in blood electrolytes and the severity of coronary artery disease. Methods: The data of 358 CHD patients were retrospectively analyzed. Among them, 286 were coronary heart disease patients (CHD), 51 were AMI patients, 56 were myocardial infarction (AMI), 56 were myocardial infarction 179 cases of coronary heart disease (MI); coronary angiography (CAG) showed no change of atherosclerosis (control group) 72 cases. The severity of coronary artery disease was assessed using the Gensini score system. Results: Coronary heart disease group had the highest Gensini score of AMI subgroup [39 (27-72)], and subgroup OMI (36 (22-57) (2.13 ± 0.29) mmol / L, (2.34 ± 0.22) mmol / L, and MI-free CHD: 2.36 ± 0.22 ) and albumin (AMI: (38.5 ± 5.1) g / L, OMI: (41.3 ± 3.9) g / L and MI-free CHD: (41.6 ± 3.6) g / L] (2.42 ± 0.15) mmol / L and albumin (42.8 ± 4.0) g / L, respectively, P <0.05, and mean serum calcium and albumin in AMI subgroup were also significantly lower than those in other coronary heart disease (All P <0.05). Mean serum sodium and potassium in AMI subgroups were also significantly lower than those in other subgroups (except for serum potassium and OMI subgroups) (all P <0.05). There was a significant negative correlation between serum calcium and albumin and coronary artery lesion Gensini score (r = -0.175, P = 0.003) and albumin r = -0.200 (P = 0.001) Logistic regression analysis showed that hypocalcemia was still a risk factor for coronary heart disease after adjustment for traditional risk factors such as age, sex and diabetes (OR = 2.618, 95% CI = 1.025-6.690, P < P = 0.044). Conclusions: AMI may reduce the levels of serum sodium, potassium, calcium and albumin, and the serum calcium and albumin concentrations have a significant negative correlation with the severity of coronary artery disease. Hypocalcemia may be an independent risk factor for coronary heart disease.