急性ST段抬高型心肌梗死不同缺血时间冠状动脉内血栓的病理分析  

Pathological analysis of coronary artery thrombus in different ischemic time in patients with ST segment elevation acute myocardial infarction

作　　者：饶萌萌 赵蓓[2] 刘佩林[2] 冯雪瑶[2] 时全星[2] 张中[2] 宋洪勇[2] 刘莉[2] 赵京涛[2] 魏腾飞[1] 周莉[2] 王守力[1,2] RAO Meng-meng ZHAO Bei LIU Pei-lin FENG Xue-yao SHIQ.uan-xing ZHANG Zhong SONG Hong-yong LIU Li ZHAO Jing-tao WEI Teng-fei ZHOU Li WANG Shou-li(306 PLA Clinical College, Anhui Medical University, Beijing 100101, China)

机构地区：[1]安徽医科大学解放军306临床学院,北京100101 [2]解放军306医院心内科,北京100101

出　　处：《解放军医学杂志》2017年第2期149-153,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨不同缺血时间对急性ST段抬高型心肌梗死(STEMI)患者冠状动脉血栓病理类型的影响。方法连续入选2012年9月-2016年4月行急诊PCI及冠状动脉血栓抽吸术的STEMI患者82例,按照缺血时间分为≤4h组(n=36)、4~7h组(n=30)、>7h组(n=16),比较3组间血栓类型(红色血栓、白色血栓、混合血栓)百分率的差异。结果≤4h组白血栓、红血栓、混合血栓的百分率分别为:61.1%(22/36)、8.3%(3/36)、30.6%(11/36),组内比较差异有统计学意义(P=0.019);4~7h组分别为23.3%(7/30)、10.0%(3/30)、66.7%(20/30),组内比较差异有统计学意义(P=0.012);>7h组分别为43.8%(7/16)、12.5%(2/16)、43.8%(7/16),组内比较差异无统计学意义(P=0.913)。白血栓在≤4h、4~7h、>7h组分别占61.1%(22/36)、19.4%(7/36)、19.4%(7/36),差异有统计学意义(P=0.009);混合血栓在≤4h、4~7h、>7h组分别占28.9%(11/38)、52.6%(20/38)、18.4%(7/38),差异有统计学意义(P=0.013);红血栓在≤4h、4~7h、>7h组分别占37.5%(3/8)、37.5%(3/8)、25.0%(2/8),差异无统计学意义(P=0.895)。结论不同缺血时间的STEMI患者其血栓主要构成类型不同,同种血栓在不同缺血时间的分布不同,缺血时间可能成为冠状动脉血栓类型的预测因素。Objective To investigate the relationship between ischemic time and thrombus types in patients with STsegment elevation myocardial infarction（STEMI）. Methods Eighty-two STEMI patients undergone emergency percutaneous coronary intervention（PCI） and coronary thrombus aspiration（CTA） from Sep. 2012 to Apr. 2016 were included and divided into 3 groups according to the ischemic time： ≤4 hours（n=36）, 4-7 hours（n=30） and 〉7 hours（n=16）. Visible aspirated thrombi were collected and separated into erythrocyte-rich type, platelet/fibrin-rich type and combined type thrombi by HE dying. The percentage difference of the 3 types thrombi was compared among the 3 groups. Results The percentage of platelet/fibrinrich type, erythrocyte-rich type and combined type thrombi in the 3 groups were as follows： in ≤4h group： 61.1%（22/36）, 8.3%（3/36） and 30.6%（11/36）, P=0.019; in 4-7h group： 23.3%（7/30）, 10.0%（3/30） and 66.7%（20/30）, P=0.012; and in 7h group： 43.8%（7/16）, 12.5%（2/16） and 43.8%（7/16）, P=0.913. For platelet/fibrin-rich type thrombi, the percentages in 3 periods were 61.1%（22/36）, 19.4%（7/36） and 19.4%（7/36）, P=0.009; For combined type thrombi, the percentages in 3 periods were 28.9%（11/38）, 52.6%（20/38） and 18.4%（7/38）, P=0.013; For erythrocyte-rich type thrombi, the percentages in 3 periods were 37.5%（3/8）, 37.5%（3/8） and 25.0%（2/8）, P=0.895. Conclusions The types of intracoronary aspirated thrombi differ from various periods. Ischemia time may be an important predicted factor.

关 键 词：心肌梗死 缺血时间 血栓形成 抽吸 血栓病理类型 

分 类 号：R543.31[医药卫生—心血管疾病]