脂蛋白a与急性前壁心肌梗死后左心室血栓的关系研究  

Study on the relationship between Lp(a)and left ventricular thrombosis after acute anterior wall myocardial infarction

作　　者：王询 傅向华[2] 王泽静[3] 肖康[3] WANG Xun;FU Xiang-hua;WANG Ze-jing;XIAO Kang(Department of Cardiology Medicine, First Hospital of Qinhuangdao, Hebei Province, Qinhuangdao 066000, China;Department of Cardiology Medicine, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;Department of CT, First Hospital of Qinhuangdao, Hebei Province, Qinhuangdao 066000, China)

机构地区：[1]河北省秦皇岛市第一医院心内科,河北秦皇岛066000 [2]河北医科大学第二医院心血管内科,河北石家庄050000 [3]河北省秦皇岛市第一医院CT室,河北秦皇岛066000

出　　处：《河北医科大学学报》2020年第7期754-757,792,共5页Journal of Hebei Medical University

摘　　要：目的观察脂蛋白a[lipoprotein a,Lp(a)]与急性前壁心肌梗死后左心室血栓的关系。方法入选因首次急性前壁心肌梗死比较并行急诊冠状动脉介入治疗的患者,根据心脏彩色超声检查左心室有无血栓分为无血栓组和有血栓组,两组患者的性别、年龄、Lp(a)、左心室舒张内径、左心室射血分数等结果,进行分析比较。结果总共入选284例患者,年龄38~89岁,平均(71.7±7.4)岁,其中有19例(6.69%)出现左心室血栓。血栓组的Lp(a)、发病到血管再通时间、肌酸激酶同工酶峰值高于无血栓组(P<0.01),血栓组的左心室射血分数和术后TIMI(thrombolysis in myocardial infarction)3级血流的比例低于无血栓组(P均<0.01)。以有无左心室血栓为因变量进行二元Logistic多因素回归分析显示,Lp(a)、肌酸激酶同工酶峰值、发病到血管再通时间、左心室射血分数降低、术后未达TIMI3级血流是左心室血栓形成的危险因素。结论Lp(a)升高(≥300 mg/L)是急性前壁心肌梗死后形成左心室血栓的危险因素。Objective To observe the relationship between lipoprotein a[Lp(a)]and left ventricular thrombosis after acute anterior wall myocardial infarction.Methods The patients who were admitted to our hospital for the first acute anterior wall myocardial infarction and underwent emergency coronary interventional therapy were divided into non-thrombotic group and thrombotic group according to the transthoracic echocardiographic examination.Gender,age,Lp(a),left ventricular diastolic diameter and left ventricular ejection fraction(LVEF)were analyzed and compared between the two groups.Results A total of 284 patients,aged 38-89 years,with an average age of(71.7±7.4)years,were enrolled,and 19 cases(6.69%)of them developed left ventricular thrombosis.Patients with left ventricular thrombus had higher Lp(a)longer time from attack to reperfusion,higher peak creatine kinase level,lower ejection fraction,lower frequency of TIMI 3 flow post PCI than patients without left ventricular thrombus(all P<0.01).Multivariable logistic regression models estimated that the Lp(a),peak creatine kinase level,time from attack to reperfusion,impaired LVEF,abnormal TIMI-flow post PCI were positive predictor of left ventricular thrombus.Conclusion Elevated serum level of Lp(a)(≥300 mg/L)is an independent risk factor for left ventricular thrombosis after acute anterior wall myocardial infarction.

关 键 词：前壁心肌梗死 脂蛋白(A) 血栓形成 

分 类 号：R542.22[医药卫生—心血管疾病]