急性心肌梗死后微血管阻塞的危险因素及其对左室重构的预测价值  

Risk Factors of Microvascular Obstruction After Acute Myocardial Infarctionand Its Predictive Value for Left Ventricular Remodeling

作　　者：王玮 邢军辉[1] 冯蕊涵 李凌[1] WANG Wei;XING Junhui;FENG Ruihan;LI Ling(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州450052

出　　处：《河南医学研究》2021年第2期203-207,共5页Henan Medical Research

摘　　要：目的探讨急性心肌梗死后微血管阻塞(MVO)的危险因素及其对左室重构的预测价值。方法选取2017年1月至2020年3月于郑州大学第一附属医院心血管内科首次确诊为急性心肌梗死的患者共计61例,所有患者均于梗死后1周内接受3.0 T心脏磁共振(CMR)检查,根据CMR检查结果,分为MVO组(25例)和非MVO组(36例)。比较两组患者的一般资料及实验室检查,包括心梗定位、Gensini评分、平均血小板体积(MPV)、心肌肌钙蛋白Ⅰ(cTnⅠ)、氨基末端脑钠肽前体(NT-proBNP)、尿素、肌酐、低密度脂蛋白胆固醇(LDL-C)及甘油三酯(TG)等,采用多因素logistic回归分析发生MVO的危险因素。进行超声心动图检查随访,以评估左室重构的发生情况。结果MVO组的MPV、Gensini评分及前壁心梗比例均高于非MVO组(P<0.05),MPV(OR=1.960,95%CI:1.050~3.650,P<0.05)及前壁心梗(OR=4.560,95%CI:1.300~16.050,P<0.05)为发生MVO的独立危险因素。MVO组患者在随访6~12个月时左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)均高于非MVO组(P<0.05),左心室射血分数(LVEF)低于非MVO组(P<0.05)。MVO组发生左室重构的比例高于非MVO组(44.00%比11.11%,P<0.05)。结论较大的MPV及前壁心梗是发生MVO的独立危险因素,MVO对急性心肌梗死后左室重构的发生有一定预测价值。Objective To investigate the risk factors of microvascular obstruction(MVO)after acute myocardial infarction(AMI)and its predictive value for left ventricular remodeling.Methods A total of 61 patients who were first diagnosed with acute myocardial infarction in the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from January 2017 to March 2020 were retrospectively analyzed.All patients underwent 3.0 T cardiac magnetic resonance(CMR)within 1 week after infarction.According to the results of CMR examination,the patients were divided into MVO group(25 cases)and non-MVO group(36 cases).General data and laboratory tests,including myocardial infarction localization,Gensini score,mean platelet volume(MPV),cardiac troponinⅠ(cTnⅠ),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),urea,creatinine,low-density lipoprotein cholesterol(LDL-C)and triglyceride(TG)were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors for microvascular obstruction.Echocardiographic follow-up was performed to assess the occurrence of left ventricular remodeling.Results MPV,Gensini score and the proportion of anterior myocardial infarction in the MVO group were higher than those in the non-MVO group(P<0.05),MPV(OR=1.960,95%CI:1.050-3.650,P<0.05)and anterior myocardial infarction(OR=4.560,95%CI:1.300-16.050,P<0.05)were independent risk factors for microvascular obstruction.The left ventricular end diastolic volume(LVEDV)and left ventricular end systolic volume(LVESV)in the MVO group were higher than those in the non-MVO group,and the left ventricular ejection fraction(LVEF)in the MVO group was lower than that in the non-MVO group at 6-12 months follow-up(P<0.05).The incidence of left ventricular remodeling in the MVO group was higher than that in the non-MVO group(44.00%versus 11.11%,P<0.05).Conclusion Larger MPV and anterior myocardial infarction are independent risk factors for MVO,and MVO has certain predictive value for the occurrence of left ve

关 键 词：微血管阻塞 平均血小板体积 急性心肌梗死 左室重构 

分 类 号：R542.22[医药卫生—心血管疾病]