以血糖值及白血球數預測罹患急性心肌梗塞後產生致命性心律不整的機率

Initial serum glucose level and white blood cell predict ventricular arrhythmia after first acute myocardial infarction

陳健驊(Jiann-Hwa Chen)

指導教授 ： 邱文達

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00104

摘要

目的：此研究的目的是主要是分析在急診室第一次罹患急性心肌梗塞
的年輕病患產生致命性心律不整的原因，並找尋預測的因子。
方法：這是一個十年期回溯性的世代研究。收案對象都是年齡大於
18歲且小於45 歲且第一次發作急性心肌梗塞的年輕人。收案時間是從1998年1月1日至2007年12月31日且收案的地點是三家大學教學醫院的急診室。
結果：總共有500位符合收案標準的病患進入此研究 （其中包含472
位男性及28位女性）。在這些病患中，在第一次發作急性心肌梗塞後產生致命性心律不整的機率是8% (n = 40）。病患被分為兩組：一組為罹患急性心肌梗塞後有產生致命性心律不整的病患 (n = 40），另一組為罹患急性心肌梗塞沒有產生致命性心律不整的病患 （n = 460）。在單一變項分析中 (univariable analyses)，發現急性前外側壁ST結段上升的心肌梗塞 （65% vs 47.8%；p = 0.04），白血球數目上昇 （16.4 ± 3.4 vs 11.5 ± 3.1 x 103 / mm3 ；p ＜ 0.01），以及起初的血糖值 （202.6 ± 90.9 vs 151.9 ± 64.7 mg/dL； p ＜ 0.01）在罹患急性心肌梗塞後有產生致命性心律不整的這組病患中有明顯的上昇。在多項式邏輯回歸模式 (multiple logistic regression model) 中證實白血球及起初的血糖值是第一次罹患急性心肌梗塞的年輕病患是否會產生致命性心律不整的獨立預測因子。在接受者測試曲線所畫出的圖形中 (receiver operation curve)，計算圖形底下的面積得到白血球及血糖值預測急性心肌梗塞後產生致命性心律不整的機率，分別為0.869 及 0.756。
結論：起初的血糖值及白血球兩者對於年輕人罹患急性心肌梗塞後是
否會發生致命性心律不整是有意義的預測指標。

關鍵字

心律不整 ； 急性心肌梗塞 ； 急診室 ； 年輕人

並列摘要

Objective：To analyze the factors that predispose the occurrence of ventricular arrhythmia (VA) in young patients with a first acute myocardial infarction (AMI) in the emergency department (ED) and to establish predictive implications.
Methods：This is a 10-year retrospective cohort study. Patients who wereolder than 18 years and younger than 45 years with a first attack of AMI were recruited from the ED of three universityteaching hospitals from January 1, 1998, to December 31,2007.
Results：Five hundred young patients (472 men and 28 women) who met the inclusion criteria were enrolled. Within these patients, theincidence of life-threatening VA with first attack of AMI was 8% (n=40). They were categorized into 2 groups: VA attack (n =40) and non-VA attack (n = 460). In univariable analyses, acute anterolateral ST-segment elevation myocardial infarction (65% vs 47.8%, p=0.04), elevate white blood cell (WBC) count (16.4±3.4 vs 11.5±3.1 x 103 per mm3, p<0.01), and initial serum glucose level (202.6±90.9 vs 151.9±64.7 mg/dL, p<0.01) were significantly increased in VA group. Multiple logistic regression model identified WBC count, and initial serum glucose level as the significant independent variables in the prediction of VA attack for young patients with first attack of AMI. The receiver operating characteristic area for WBC count and serum glucose level in predicting the risk of VA occurred
after AMI was 0.869 and 0.756, respectively.
Conclusion：Initial serum glucose level and WBC may be used as valuable predictors for VA attack in young patients with
first AMI.

並列關鍵字

ventricular arrhythmia ； acute myocardial infarction

參考文獻

1.Choudhury L, Marsh JD. Myocardial infarction in young patients.Am J Med 1999; 107:254-61.

2.Chen JH, Huang HH, Yen DH, et al. Different clinical presentations in Chinese people with acute myocardial infarction in the emergency department. J Chin Med Assoc. 2006;69:517-22.

3.Hong MK, Cho SY, Hong BK, et al. Acute myocardial infarction in young adults. Yonsei Med J 1994;35:184-9.

4.Doughty M, Mehta R, Bruckman D, et al. Acute myocardial infarction in the young: The University of Michigan experience. Am Heart J 2002; 143: 56-62.

5.Henkel DM, Witt BJ, Gersh BJ, et al. Ventricular arrhythmias after acute myocardial infarction: A 20-year community study. Am Heart J. 2006;151:806-12.