急性ST段抬高型心肌梗死冠状动脉自发再通影响因素  

Determinants of spontaneous coronary recanalization in ST-segment elevation myocardial infarction

作　　者：李小明[1] 王云飞[1] 薛淞[1] 华琦[1] 刘志[1] 李博宇[1] 胡少东[1] 李静[1] 

机构地区：[1]首都医科大学宣武医院心脏科,北京100053

出　　处：《中华保健医学杂志》2014年第3期190-193,共4页Chinese Journal of Health Care and Medicine

基　　金：首都医科大学基础临床合作课题(13JL34);首都医学发展基金(2009-1054);北京市高层次卫生人才项目(2013-198)

摘　　要：目的 探讨急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）冠状动脉自发再通（spontaneous recanalization,SR）的影响因素。方法 连续观察首都医科大学宣武医院2009年1月-2010年8月行急诊冠状动脉造影的STEMI患者,根据心肌梗死溶栓临床试验（thrombolysis in myocardial infarction,TIMI）血流分为自发再通组（急诊造影血流TIMI 2-3级）和非自发再通组（急诊造影血流TIMI 0-1级）,分析其临床及造影特点,并探究SR的影响因素。结果 共入选208例患者,其中53例（25.5%）为SR。SR组与非SR组在年龄（59±13岁vs 62±12岁,P=0.449）、性别（P=0.125）等方面比较,差异无统计学意义,而尿酸（305±97μmol/L vs 344±105μmol/L,P=0.003）和血糖（6.54±3.09 mmol/L vs 7.98±3.90 mmol/L,P=0.005）水平SR组较非SR组明显较低。多因素分析显示,尿酸（OR=1.007,95%CI 1.002-1.012,P=0.015）、血糖（OR=1.203,95%CI 1.034-1.400,P=0.003）是SR的独立预测因素;SR组的病变更倾向于梗死相关血管（infarction related artery,IRA）远端（OR=0.140,95%CI 0.041-0.477,P=0.001）;前降支更容易自发再通（OR=0.200,95%CI 0.081-0.496,P=0.001）。结论 SR在STEMI患者中较为常见,生化指标和病变部位与SR密切相关。Objective To investigate the determinants of spontaneous coronary recanalization （SR） in ST-segment elevation myocardial infarction （STEMI）. Methods Consecutive STEMI patients who received emergency coronary angiography from January 2009 to August 2010 in our medical center were included in this study. All patients were divided into SR group （TIMI2 - 3 grade） and non-SR group （TIMI 0 - 2 grade） according to the results of the emergency coronary angiography. Clinical and angiographic features were analyzed to explore the determinants of SR. Results A total of 53 （25.5%） patients met the criteria of SR. The blood level of uric acid （305 ±97 μmol/L vs 344 ±105 μmol/L,P = 0.003） and glucose （6.54 ±3.09 mmol/L vs 7.98 ±3.90 mmol/L,P = 0.005） levels were statistically different between SR group and non-SR group. Muhiple factors analysis showed that blood glucose （OR = 1.203,95% CI 1.034 - 1.400,P = 0.003） and uric acid （OR = 1.007,95% CI 1.002 - 1.012,P = 0.015） were independent predictors for SR. The culprit lesions were more distal in SR group than those in the non SR group （OR = 0.140,95% CI 0.041 - 0.477,P = 0.001）. Left anterior descending branch recanalization occurred more often （OR = 0.200,95% CI 0.081 - 0.496,P = 0.001）. Conclusion SR is not uncommon in STEMI patients. Biochemical indexes and lesion features are closely associated with SR.

关 键 词：急性ST段抬高型心肌梗死 梗死相关动脉 自发再通 冠状动脉造影 

分 类 号：R543.3[医药卫生—心血管疾病]