青年急性心肌梗死患者非工作时间发病与梗死面积的关系

职业与健康 ›› 2023, Vol. 39 ›› Issue (21): 2911-2916.

青年急性心肌梗死患者非工作时间发病与梗死面积的关系

马静^1,2, 崔岩³, 邹众赫³, 肖健勇⁴, 刘寅⁴, 高静^1,2,3

1.天津市心血管病研究所,天津 300222;
2.天津市心血管急危重症重点实验室,天津 300222;
3.天津医科大学胸科临床学院,天津 300222;
4.天津市胸科医院心内科,天津 300222

收稿日期:2023-03-14 修回日期:2023-04-17 出版日期:2023-11-01 发布日期:2026-03-26
通信作者: 高静,主任医师,E-mail：gaojing2088@163.com
作者简介:马静,女,助理研究员,主要从事心血管危害因素及防治的流行病学研究工作。
基金资助:
天津市卫生健康科技人才培育项目（KJ20162）; 天津市重点研发计划科技支撑重点项目（20YFZCSY00820）; 天津市卫生健康科技项目重点学科专项（TJWJ2022XK032）

Relationship between off-hour onset and infarct size of young patients with acute myocardial infarction

MA Jing^1,2, CUI Yan³, ZOU Zhonghe³, XIAO Jianyong⁴, LIU Yin⁴, GAO Jing^1,2,3

1. Tianjin Cardiovascular Institute,Tianjin 300222,China;
2. Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care,Tianjin Municipal Science and Technology Bureau,Tianjin 300222,China;
3. Clinical School of Thoracic,Tianjin Medical University,Tianjin 300222,China;
4. Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China

Received:2023-03-14 Revised:2023-04-17 Online:2023-11-01 Published:2026-03-26
Contact: GAO Jing,Chief physician,E-mail：gaojing2088@163.com

摘要/Abstract

摘要： 目的在ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）≤45岁青年患者中,探讨非工作时间发病是否会造成梗死面积的差异。方法连续纳入2015年1月—2019年12月于天津市胸科医院就诊的青年STEMI患者217例,根据症状出现时间将患者分为正常工作时间（工作日08：00~16：59）和非工作时间（工作日17：00—次日07：59和周末）;进一步按6 h间隔分为4个发病时间组即00：00~05：59,06：00~11：59,12：00~17：59和18：00~23：59。用非线性回归模型评估梗死面积（峰值肌酸激酶替代）随24 h发病时间的变化,多变量线性回归模型分析不同发病时间和梗死面积的关联性。结果非工作时间发病组的射血分数低于正常工作时间发病组,峰值肌酸激酶（creatine kinase,CK）水平高于正常工作时间发病组（P<0.05）,00：00~05：59发病组的中位峰值CK水平高于其他3组的趋势。周期正弦回归分析结果显示,青年STEMI患者梗死面积随24 h发病时间显示昼夜节律变化,最大梗死面积出现在凌晨2点。多变量线性回归模型显示,调整混杂因素后非工作时间发病的青年STEMI患者相对于工作时间发病的患者峰值CK平均增加708.07 U/L;00：00~05：59发病的青年STEMI患者相对于06：00~23：59发病的患者峰值CK平均增加864.08 U/L。结论本研究在中国青年STEMI患者中梗死面积随24 h发病时间的昼夜变化,在非工作时间和00：00~05：59发病的青年STEMI患者可能有更严重的心肌损伤。

关键词: 青年, 急性心肌梗死, 非工作时间, 发病时间, 梗死面积

Abstract: Objective To determine the impact of time of symptom onset during off-hour on infarct size in young patients（≤45 years old） with ST-segment elevation myocardial infarction（STEMI）. Methods A total of 217 young patients with STEMI who admitted in Tianjin Chest Hospital from January 2015 to December 2019 were continuously included. The on-hour group included patient with symptom onset time between 08：00-16：59 on weekdays,the rest were catalogued as off-hour group. The patients were further divided into four groups based on 6-hour intervals（00：00-05：59,06：00-11：59,12：00-17：59 and 18：00-23：59）. The non-linear regression model was used to assess the dependence of infarct size（peak creatine kinase,peak CK） on 24-hour time of symptom onset. The multivariate linear regression model was used to analyze the association between time of symptom onset and infarct size. Results The ejection fraction of the patients in off-hour group was lower than that in on-hour group,and the peak CK was higher than that in on-hour group（P<0.05）. The median peak CK of the 00：00-05：59 onset group tended to be higher than those of other groups. The periodic sinusoidal regression analysis showed circadian rhythm in infarct size with 24-hour onset time,and the maximum infarct size occurred at 2：00 am. The multivariate linear regression model showed that after adjusting for confounders,there was an average increase in peak CK of 708.07 U/L in patients with off-hour onset compared with patients with on-hour onset,while there was an average increase in peak CK of 864.08 U/L in patients with onset time between 00：00 and 05：59 compared with patients with onset time between 06：00 and 23：59. Conclusion This study reports that the myocardial infarct size after STEMI have a circadian dependence on time of symptom onset in Chinese young patients,and the young patientswith STEMI onset during off-hour and 00：00-05：59 may have a greater myocardial injury.

Key words: Young people, Acute myocardial infarction, Off-hour, Time of symptom onset, Infarction size

中图分类号:

R181.3

马静, 崔岩, 邹众赫, 肖健勇, 刘寅, 高静. 青年急性心肌梗死患者非工作时间发病与梗死面积的关系. [J]职业与健康, 2023, 39(21): 2911-2916.

MA Jing, CUI Yan, ZOU Zhonghe, XIAO Jianyong, LIU Yin, GAO Jing. Relationship between off-hour onset and infarct size of young patients with acute myocardial infarction. [J]OCCUPATION AND HEALTH, 2023, 39(21): 2911-2916.

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