急性心肌梗死经皮冠状动脉介入治疗术后心电图ST段回落与P选择素的关系  

Relationship between Serum P-selectin Levels and ST-segment Resolution in Cases with Acute Myocardial Infarction after Percutaneous Coronary Intervenion

作　　者：吴秀华 来晏[1] 陈飞[1] 刘学波 Wu Xiuhua;Lai Yan;Chen Fei;Liu Xuebo(Tongji Hospital Affiliated to Tongji University,Shanghai,200065;Shanghai Maritime University,Shanghai,201306,P.R.China)

机构地区：[1]同济大学附属同济医院心内科,上海200065 [2]上海海事大学,上海201306

出　　处：《老年医学与保健》2018年第4期404-407,共4页Geriatrics & Health Care

摘　　要：目的探讨ST段抬高心肌梗死(STEMI)患者急诊经皮冠脉介入治疗(PCI)成功再灌注治疗后ST段回落与血清P选择素(sP-selectin)的关系。方法连续入选57例急诊行PCI术STEMI患者,依据术后90min心电图单导联ST段抬高回落(STR)百分比分为2组:STR≥70%(回落完整)组、STR<70%(回落不完整)组;评估和比较年龄、心血管危险因素、胸痛到球囊开通时间、killip分级、CFTC帧数等;动态观察2组PCI术后24h、1周、4周sP-selectin、hs-CRP的变化;多因素回归分析STEMI患者ST段回落不良的危险因素。结果 STR≥70%有18例,STR<70%39例;STR<70%(回落不完整)组年龄偏大,胸痛到球囊开通血管时间延长,Killip分级较高,CFTC帧数较大;PCI术后sPslection、Hs-CRP动态变化呈下降趋势,24h、4周ST段回落完整组与不完整组有显著差异(P<0.05)。结论胸痛到球囊开通血管时间、前壁广泛心肌梗死、年龄是PCI术后心肌再灌注不良独立危险因素;血清P-选择素在临床危险分层评价、监测和随访中起着重要的作用。Objective To investigate the relationship of serum P-selectin with ST-segment resolution with ST-segment elevation myocardial infarction（STEMI） after successful reperfusion with emergency percutaneous coronary intervention（PCI）.Methods A total of 57 STEMI cases undergoing emergency PCI were consecutively included and were divided, according to ST-segment resolution（STR） 90 min after PCI, into 2 groups： STR≥70% group（n=18） and STR70% group（n=39）;the age, cardiovascular risk factors, symptom-onset-to-balloon intervals, Killip class and CFTC of all the cases in both groups were assessed and a comparison was made between the 2 groups; dynamic observation was made to the changes of serum P-selectin and hs-CRP at the time point of 24 hours, 1 week, 4 weeks after PCI; multiple regression analysis was applied in identifying the risk factors associated with poor ST-segment resolution. Results Cases in STR70% group were older with longer symptomonset-to-balloon time, higher Killip class and higher CTFC; the levels of serum P-selectin and hs-CRP after PCI kept dynamically decreasing and there existed an obvious difference in serum P-selectin and hs-CRP at the time point of 24 hours and 4 weeks after PCI between the 2 groups（P0.05）. Conclusions Symptom-onset-to-balloon time, infarct related artery（LAD） and age are the independent risk factors for poor myocardial reperfusion; the serum P-selectin plays an important role in risk stratification,monitoring and follow-up.

关 键 词：ST段抬高型心肌梗死 ST段回落 P选择素 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]