冠状动脉非阻塞性急性ST段抬高型心肌梗死的临床特征和预测因素  

Independent predictors and clinical characteristics on STEMI with non-obstructive coronary arteries

作　　者：王金鑫[1] 段鹏 朱庆磊[1] WANG Jin-xin;DUAN Peng;ZHU Qing-lei(Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院心内科,北京市100853 [2]解放军371医院心内科

出　　处：《中国心血管病研究》2018年第4期307-310,共4页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金资助项目(项目编号:81570349)

摘　　要：目的探讨冠状动脉非阻塞性急性ST段抬高型心肌梗死（STEMI）的临床特征和预测因素。方法回顾性分析我院心梗绿色通道收治的直接行PCI的STEMI患者154例，根据冠状动脉造影显示狭窄是否超过50％分为冠状动脉非阻塞性STEMI组17例和冠状动脉阻塞性STEMI组137例。收集、统计两组患者临床资料，对可能的预测因素进行两组间单因素分析和多因素Logistic回归分析，绘制受试者工作特征曲线（ROC曲线），评价联合预测因子对冠状动脉非阻塞性STEMI的预测价值。结果在STEMI患者中冠状动脉非阻塞与阻塞相比，白细胞计数较低，血浆纤维蛋白原较低。白细胞计数（OR=O．472，95％CI0．321-0．695，P〈0．01）和血浆纤维蛋白原（OR=0．200，95％CI0．054~0．747，P=0．017）是冠状动脉非阻塞性STEMI的独立预测因素。ROC曲线分析显示，两个因素联合预测冠状动脉非阻塞性STEMI的ROC曲线下面积为0．927（P〈0．01），敏感度为93．3％，特异度为87．1％。结论白细胞计数和血浆纤维蛋白原是冠状动脉非阻塞性STEMI的独立预测因素。两个因素对冠状动脉非阻塞性STEMI的联合预测价值较高，或可帮助判断STEMI患者冠状动脉为阻塞性或非阻塞性，以选择下一步诊疗方案。Objective To study the independent predictors and clinical characteristics on ST elevation myocardial infarction（STEMI） with non-obstructive coronary arteries. Methods 154 patients with STEMI undergoing primary percutaneous coronary intervention （PCI） in our hospital were summarized and analyzed, and the pa- tients were divided into two groups according to whether the conventional cut-off of〈50% stenosis by the anglo- graphic criteria： STEMI with non-obstructive coronary arteries group （n= 17） and STEMI with obstructive coronary arteries group （n=137）. The relevant factors were analyzed by t-test between two groups and multiple factors logis- tic regression analysis. The receiver operating characteristic （ROC） curve was plotted to assess the predictive value of the relevant factors on STEMI with non-obstructive coronary arteries. Results The two groups were differences in white blood cell count and fibrinogen. White blood cell count （OR=0.472, 95%CI 0.321-0.695, P〈0.01） and fibrinogen （OR=0.200, 95%CI 0.054-0.747, /~=0.017 ） were the independent predictors on STEMI with non-ob- structive coronary arteries. It was shown by ROC curve analysis that the area under the curve of the two factors to- gether was 0.927 （P〈0,01） with the sensitivity of 93.3% and the specificity of 87.1%. Conclusion White blood cell count and fibrinogen are the independent predictors on STEMI with non-obstructive coronary arteries and the two factors together have a higher predictive value, which may help determine the STEMI patients with coronary artery obstructive or non-obstructive, so as to choose the next step in the treatment program.

关 键 词：ST段抬高型心肌梗死 冠状动脉非阻塞 预测因素 冠状动脉造影术 

分 类 号：R542.22[医药卫生—心血管疾病]