降钙素原与急性心肌梗死患者直接支架术后无复流的关系  

Relation of procalcitonin and no-reflow phenomenon in patients with acute myocardial infarction after emergency percutaneous coronary intervention

作　　者：李亚 刘永兴 彭万忠 徐泽升 刘娟 刘均英 

机构地区：[1]河北沧州中心医院心血管内科,河北沧州061001

出　　处：《岭南心血管病杂志》2017年第4期369-372,380,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨急性心肌梗死患者入院后即刻降钙素原与直接经皮冠状动脉介入(percutaneous coronaryintevention,PCI)治疗中发生无复流的关系。方法选择急性ST段抬高型心肌梗死12 h内行直接PCI治疗的患者172例。根据支架术后靶血管血流情况分两组:无复流组为心肌梗死溶栓试验(thrombolysis in myocardialinfarction,TIMI)血流0、1、2级36例;血流正常组TIMI血流3级116例。比较两组一般临床资料和PCI治疗资料。采用多元回归分析评价降钙素原与直接PCI治疗后无复流现象的相关性。结果无复流组患者入院时Killip分级Ⅱ~Ⅲ级患者比例高于血流正常组,差异有统计学意义[64.3%(36/56)vs.39.7%(46/116),P<0.05]。无复流组入院时降钙素原、超敏C反应蛋白、肌钙蛋白、脑钠肽浓度均高于血流正常组,差异有统计学意义(P<0.05)。无复流组胸痛至再灌注时间比血流正常组长,差异有统计学意义[(7.3±2.4)h vs.(5.4±2.9)h,P=0.011]。无复流组住院期间主要心血管事件发生率高于血流正常组,差异有统计学意义(P<0.05)。受试者工作特征(receiver operator characteristic,ROC)曲线分析结果显示,降钙素原预测无复流的最佳切点值为0.15 ng/m L,预测无复流的敏感度为73%,特异度为70%。多元Logistic回归分析结果显示,入院时患者年龄、超敏C反应蛋白浓度、脑钠肽浓度、Killip分级、降钙素原浓度、胸痛至再灌注时间、植入支架总长度是急性心肌梗死直接PCI治疗中发生无复流的独立危险因素。降钙素原浓度与入院时Killip分级、胸痛至再灌注时间、植入支架总长度明显相关。结论降钙素原是急性ST段抬高型心肌梗死直接PCI治疗后无复流现象的独立预测因素,对发生无复流患者危险分层有临床指导意义。Objectives To explore the association of the serum concentration of procalcitonin and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention （PCI）. Methods Totally 172 patients treated with emergency PCI were divided into two groups based on thrombolysis in myocardial infarction（TIMI）flow grade. No-reflow group was defined as TIMI flow grade 0,1,2. Normal-reflow group was defined as TIMI flow grade 3. Clinical data and PCI treatment data were compared between the two groups. Association of serum concentration of procalcitonin with TIMI flow grade after PCI was evaluated by multivariate Logis tic regression. Results Percentage of patients with Killip Ⅱ and Ⅲ grade was significantly higher in no-flow group than in normal flow group [64.3%（36/56） vs. 39.7%（46/116）,P〈0.05]. Serum concentrations of procalcitonin ,brain natriuretic peptide（BNP）,high sensitivity C-reactive protein（hs-CRP）in no-flow group were significantly higher than those in normal flow group（P〈0.05）. Duration from angina to PCI in no-flow group was much higher than that in normal flow group[（7.3±2.4）h vs.（5.4±2.9）h,P=0.011]. Incidence of major adverse cardiac events of no-flow group was much higher than that of normal flow group（P〈0.05）. In receiver operating characteristics curve（ROC）analysis, the cut-off value of serum concentration of procalcitonin was 0.15 ng/mL for the prediction of no-reflow （sensitivity： 73%,specificity：70%）. At multivariate analysis ,high procalcitonin ,ages ,C reactive protein ,BNP ,duration from angina to PCI,Killip grade and total stent length were independ predictors of no-reflow after emergency PCI. Serum concentration of procalcitonin significantly related with Killip grade ,duration from angina to PCI and total stent length. Conclusions Serum concentration of procalcitonin on admission is an independent predictor of no-reflow after emergency PCI in patients with acute ST-seg

关 键 词：心肌梗死 降钙素原 无复流现象 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]