血清乳酸在急性心肌梗死中的临床意义：一项心脏磁共振成像研究

Clinical Significance of Serum Lactate in Acute Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study.

作者信息

Park Ik Hyun, Cho Hyun Kyu, Oh Ju Hyeon, Chun Woo Jung, Park Yong Hwan, Lee Mirae, Kim Min Sun, Choi Ki Hong, Kim Jihoon, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Lee Sang-Chol, Gwon Hyeon-Cheol, Choe Yeon Hyeon, Jang Woo Jin

机构信息

Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea.

Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

出版信息

J Clin Med. 2021 Nov 13;10(22):5278. doi: 10.3390/jcm10225278.

Little is known about causality and the pathological mechanism underlying the association of serum lactate with myocardial injury in patients with acute myocardial infarction (AMI). We evaluated data from 360 AMI patients undergoing percutaneous coronary intervention (PCI) using cardiovascular magnetic resonance imaging (CMR). Of these, 119 patients had serum lactate levels > 2.5 mmol/L on admission (high serum lactate group), whereas 241 patients had serum lactate levels ≤ 2.5 mmol/L (low serum lactate group). We compared the myocardial infarct size assessed by CMR between the two groups and performed inverse probability of treatment weighting (IPTW). In CMR analysis, myocardial infarct size was significantly greater in the high serum lactate group than in the low serum lactate group (22.0 ± 11.4% in the high serum lactate group vs. 18.9 ± 10.5% in the low serum lactate group; = 0.011). The result was consistent after IPTW adjustment (21.5 ± 11.1% vs. 19.2 ± 10.4%; = 0.044). In multivariate analysis, high serum lactate was associated with larger myocardial infarct (odds ratio 1.59; 95% confidence interval 1.00-2.51; = 0.048). High serum lactate could predict advanced myocardial injury in AMI patients undergoing PCI.

关于急性心肌梗死（AMI）患者血清乳酸与心肌损伤之间关联的因果关系及病理机制，目前所知甚少。我们使用心血管磁共振成像（CMR）评估了360例接受经皮冠状动脉介入治疗（PCI）的AMI患者的数据。其中，119例患者入院时血清乳酸水平>2.5 mmol/L（高血清乳酸组），而241例患者血清乳酸水平≤2.5 mmol/L（低血清乳酸组）。我们比较了两组通过CMR评估的心肌梗死面积，并进行了治疗权重逆概率（IPTW）分析。在CMR分析中，高血清乳酸组的心肌梗死面积显著大于低血清乳酸组（高血清乳酸组为22.0±11.4%，低血清乳酸组为18.9±10.5%；P = 0.011）。IPTW调整后结果一致（21.5±11.1%对19.2±10.4%；P = 0.044）。在多变量分析中，高血清乳酸与更大的心肌梗死相关（比值比1.59；95%置信区间1.00 - 2.51；P = 0.048）。高血清乳酸可预测接受PCI的AMI患者的严重心肌损伤。