标题：青年急性心肌梗死患者发生院内并发症的危险因素研究

      作者：罗艳兰，黄素兰，郭宁，葛良清    常德市第一人民医院心内科，湖南 常德 415000

      卷次： 2022年33卷5期

      【摘要】 目的 研究青年急性心肌梗死患者院内并发症发生情况及其独立危险因素。方法 根据纳排标准连续纳入2018年1月至2019年12月常德市第一人民医院心内科收治的122例青年急性心肌梗死患者，其中出现并发症30例(并发症组)，未出现并发症92例(无并发症组)。比较两组患者既往病史、检验指标和冠脉造影等指标；采用多因素Logistic回归分析青年急性心肌梗死患者发生院内并发症的危险因素，并建立发生院内并发症的回归方程；绘制受试者工作特征曲线(ROC)，评估回归方程评价青年急性心肌梗死患者发生院内并发症的效能。结果 两组患者的高血压病史、红细胞分布宽度、纤维蛋白原、B型脑钠肽前体、心脏射血分数、冠脉病变数目、冠脉病变范围、急性心肌梗死分型比较，差异均有统计学意义(P<0.05)；Logistic回归分析结果显示，红细胞分布宽度(OR=1.01，95%CI：1.001~1.019，P=0.036)、冠脉病变数(OR=2.519，95%CI：1.185~5.357，P=0.016)和纤维蛋白原(OR=14.984，95%CI：3.863~58.113，P<0.001)是青年AMI患者发生院内并发症的独立危险因素；ROC曲线分析结果显示，回归方程评估青年AMI患者发生院内并发症的Youden指数最大值为0.644，ROC曲线下面积(AUC)为0.873 (95%CI：794~0.952，P<0.001)，灵敏度为 0.769，特异度为 0.875。结论 红细胞分布宽度、冠脉病变数和纤维蛋白原是青年急性心肌梗死患者发生院内并发症的危险因素；建立的回归方程对青年急性心肌梗死患者是否发生院内并发症有较高的预测价值。
      【关键词】 青年；急性心肌梗死；院内并发症；危险因素
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2022）05—0554—05

Risk factors of nosocomial complications in young patients with acute myocardial infarction.
LUO Yan-lan,HUANG Su-lan, GUO Ning, GE Liang-qing. Cardiovascular Department, the First People's Hospital of Changde, Changde415000, Hunan, CHINA
【Abstract】 Objective To study the incidence and independent risk factors of nosocomial complications inyoung patients with acute myocardial infarction (AMI). Methods In this study, 122 young patients with AMI from Jan-uary 2018 to December 2019 were included according to the study's inclusion criteria. There were 30 patients with com-plications (complications group) and 92 patients without complications (non-complications group). The medical history,test index, and coronary angiography were compared between the two groups. Multivariate Logistic regression was usedto analyze the risk factors of nosocomial complications in young patients with AMI, and the regression equation of noso-comial complications was established. Receiver operator characteristic (ROC) curve was drawn to evaluate the efficacyof regression equation in evaluating the nosocomial complications in young patients with AMI. Results There werestatistically significant differences in history of history of hypertension, red blood cell distribution width (RDW), fi-brinogen, B-type brain natriuretic peptide precursor, heart ejection fraction, and number of coronary artery lesion,scope of coronary artery lesions, and type of acute myocardial infarction AMI between complications group and non-com-plications group (P<0.05). Logistic regression analysis showed that RDW (OR=1.01, 95%CI: 1.001-1.019, P=0.036),number of coronary artery lesions (OR=2.519, 95%CI: 1.185-5.357, P=0.016), and fibrinogen (OR=14.984, 95%CI:3.863-58.113, P<0.001) were risk factors for nosocomial complications in young patients with AMI. ROC curve analy-sis results showed that the maximum value of Youden index was 0.644, and the area under ROC curve (AUC) was 0.873(95%CI: 794~0.952, P<0.001). Sensitivity and specificity of the regression equation for the assessment of noscomialcomplications in young patients with AMI were 0.769 and 0.875, respectively. Conclusion RDW, number of coronaryartery lesions, and fibrinogen were the risk factors for nosocomial complications in young patients with AMI. The estab-lished regression equation has a high predictive value for the occurrence of nosocomial complications in young patientswith AMI.
      【Key words】 Young people; Acute myocardial infarction; Nosocomial complications; Risk factor