上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (05): 573-582.doi: 10.3969/j.issn.1674-8115.2020.05.003

• 创新团队成果专栏 • 上一篇    下一篇

吸烟对急性ST段抬高型心肌梗死急性期心肌损伤及预后的影响

冯泽豪1*，张 清1*，柴烨子1，苏 璇1，孙宝航行1，刘启明1，严福华2，姜 萌1#，卜 军1#   

  1. 1. 上海交通大学医学院附属仁济医院心内科，上海 200127；2. 上海交通大学医学院附属瑞金医院放射科，上海 200025
  • 出版日期:2020-05-28 发布日期:2020-05-28
  • 通讯作者: 姜 萌，电子信箱：jiangmeng0919@163.com。卜 军，电子信箱：pujun310@hotmail.com。#为共同通信作者。
  • 作者简介:冯泽豪（1994—），男，硕士生；电子信箱：fengzehao2016@126.com。张 清（1966—），男，副主任医师，硕士；电子信箱：zhangqing1221@outlook.com。*为共同第一作者。
  • 基金资助:
    国家自然科学基金（81971570）；上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目（16CR3020A）；上海市教育委员会高峰高原学科建设计划（20172014）；上海市浦东新区卫生和计划生育委员会联合攻关项目（PW2018D-03）；上海交通大学“交大之星”计划医工交叉研究基金（YG2019ZDA13）；上海交通大学医学院高水平地方高校创新团队（SSMU-ZDCX20180200）。

Evaluation of effect of smoking on myocardial injury and prognosis in patients with acute ST-segment elevation myocardial infarction

FENG Ze-hao1*, ZHANG Qing1*, CHAI Ye-zi1, SU Xuan1, SUN Bao-hang-xing1, LIU Qi-ming1, YAN Fu-hua2, JIANG Meng1#, PU Jun1#   

  1. 1. Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 2. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2020-05-28 Published:2020-05-28
  • Supported by:
    National Natural Science Foundation of China (81971570); Shanghai ShenKang Hospital Development Center Three-year Action Plan: Promoting Clinical Skills and Innovation in Municipal Hospital (16CR3020A); Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20172014); Shanghai Pudong Health and Family Planning Commission Joint Research Project (PW2018D-03); Medical-Engineering Cross Research Foundation of Shanghai Jiao Tong University (YG2019ZDA13); Innovative Research Team of High-Level Local Universities in Shanghai (SSMU-ZDCX20180200).

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摘要： 目的·结合心脏磁共振技术探讨吸烟对ST段抬高型心肌梗死（ST-segment elevation myocardial infraction，STEMI）患者急性期心肌损伤的影响及长期预后。方法·筛选349名自2012年5月至2017年8月入组的STEMI患者并至少随访2年，随访的主要终点指标包括全因死亡、再发心肌梗死及卒中，次要终点指标为再发心力衰竭入院。根据患者入组前吸烟状态分为吸烟组及非吸烟组，结合是否出现心肌内出血（intramyocardial hemorrhage，IMH）进一步分析2组患者终点事件发生率的差异。结果·吸烟组共221人，占总样本的63.3%；吸烟组患者的平均发病年龄较非吸烟组提前4.66岁，但住院期间左心室血栓发生率及脑利钠肽水平均低于非吸烟组（P=0.023，P=0.000）。在影像学参数中，2组患者的左心室射血分数差异无统计学意义（P>0.05），但吸烟患者的收缩末期及舒张末期容积指数与非吸烟组患者差异有统计学意义（P=0.019，P=0.007）。吸烟与非吸烟患者的主要终点事件发生率差异无统计学意义（P>0.05），吸烟患者的心力衰竭再入院率低于非吸烟患者，但进一步校正基线差异后2组间心力衰竭发生率差异无统计学意义（P=0.167）。在有IMH的患者中，吸烟对主要终点起到保护作用（HR=0.266，P=0.008）。在无IMH的患者中，非吸烟者的全因死亡及再发心肌梗死预后优于吸烟者（P=0.024）。结论·在STEMI患者中吸烟对长期预后无保护作用；在合并IMH时吸烟对全因死亡、再发心肌梗死及卒中具有一定保护作用，但在无IMH的患者中，吸烟患者预后差于非吸烟者。

关键词: 吸烟者矛盾, 心肌内出血, 心脏磁共振, ST段抬高型心肌梗死

Abstract:

Objective · To investigate the influence of smoking on acute myocardial injury and long-term prognosis in the patients with ST-segment elevation myocardial infraction (STEMI) by cardiac magnetic resonance (CMR). Methods · Three hundred and forty-nine STEMI patients were retrospectively selected from a prospective cohort from May 2012 to August 2017, and were followed up for at least 2 years. The primary endpoint was a composite of all-cause death, reinfarction and stroke. The secondary endpoint was heart failure rehospitalization. The patients were divided into smoker group and non-smoker group according to the baseline status of smoking which was recorded at admission. The difference in the incidence of endpoint events was further analyzed in combination with the presence or absence of intramyocardial hemorrhage (IMH) between the two groups. Results · There were 221 patients in the smoker group, accounting for 63.3% of the total sample. The average age of onset in smokers were 4.66 years earlier than non-smokers. However, smokers showed a lower incidence of left ventricular thrombosis and lower levels of brain natriuretic peptide than non-smokers (P=0.023, P=0.000). There was no difference in the left ventricular ejection fraction between the two groups (P>0.05), but the smokers had a better end-systolic and end-diastolic volume index (P=0.019, P=0.007). Smokers and non-smokers had similar clinical outcomes of all-cause death, reinfarction and stroke (P>0.05). The incidence of heart failure rehospitalization in smokers was quite lower than that of the non-smokers, but this kind of protective effect disappeared after differences in baseline being adjusted (P=0.167). In the patients with IMH, smoking had a protective effect on primary endpoints (HR=0.266, P=0.008), but in the patients without IMH, smokers had a worse outcome of all-cause death and reinfarction than non-smokers (P=0.024). Conclusion · In patients with STEMI, smoking has no protective effect on long-term prognosis. When IMH appears in STEMI patients, smoking has a protective effect on all-cause death, reinfarction and stoke. However, in patients without IMH, smokers have a worse prognosis than non-smokers.

Key words: smoker's paradox, intramyocardial hemorrhage (IMH), cardiac magnetic resonance (CMR), ST-segment elevation myocardial infarction (STEMI)

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