血清同型半胱氨酸、血浆纤维蛋白原、D-二聚体与急性STEMI患者急诊PCI术后无复流的相关性分析  

Correlation analysis between serum homocysteine,plasma fibrinogen,D-dimer and no-reflow phenomenon after emergency PCI in patients with acute STEMI

作　　者：张鸿雁 黄钟[1] 陈鑫[1] 张天[1] 李桂花[1] ZHANG Hongyan;HUANG Zhong;CHEN Xin;ZHANG Tian;LI Guihua(Emergency Department,The First Affiliated Hospital of Shihezi University School of Medicine,Xinjiang 832000,China)

机构地区：[1]石河子大学医学院第一附属医院急诊科,新疆石河子832000

出　　处：《中华灾害救援医学》2021年第2期781-786,共6页Chinese Journal of Disaster Medicine

摘　　要：目的探讨血清同型半胱氨酸(Homocysteine,Hcy)、血浆纤维蛋白原(Fibrinogen,Fib)、D-二聚体(D-dimer,D-D)水平的高低与急性ST段抬高型心肌梗死(Acute ST-Segment Elevation Myocardial Infarction,STEMI)患者急诊行经皮冠状动脉介入(Percutaneous Coronary Intervention,PCI)治疗术后出现无复流现象的相关性。方法回顾性分析2016-12至2019-06间于新疆石河子大学医学院第一附属医院明确诊断为STEMI并急诊行PCI治疗的患者398例。依据患者PCI术后是否发生无复流分为无复流组(n=71)和正常血流组(n=327)。采用Logistic回归分析研究STEMI患者PCI术后出现无复流现象的影响因素;运用接受者操作特征曲线(Receiver Operating Characteristic curve,ROC)分析评估两组患者PCI术后发生无复流的预测效能。结果 (1)两组患者入院时Killip分级≥2级、心肌梗死溶栓治疗评分体系(Thrombolytic Therapy Score System for Myocardial Infarction,TIMI)评分、全球急性冠脉综合征注册评分(Global Registration Score for Acute Coronary Syndrome,GRACE)、D-D、肌酸激脢同工酶(Creatine Kinase Isoenzyme,CK-MB)峰值、肌钙蛋白T(Troponin T,cTnT)峰值、血清肌酐(Serum Creatinine,Scr)、高密度脂蛋白胆固醇(High Density Lipoprotein Cholesterol,HDL-C)、Hcy、Fib、左心室射血分数(Left Ventricular Ejection Fraction,LVEF)、首次医疗接触(First Medical Contact,FMC)比较,差异均有统计学意义(P<0.05)。(2)多因素Logistic回归分析提示TIMI评分、GRACE评分、Hcy、Fib、D-D是STEMI患者PCI术后是否发生无复流的独立影响因素。(3)ROC曲线分析显示:Hcy+Fib+D-D联合分析STEMI患者PCI术后发生无复流的预测价值优于Hcy、Fib、D-D、Hcy+Fib及Hcy+D-D、Fib+D-D组。结论 STEMI患者急诊行PCI治疗前所测Hcy、Fib、D-D指标的升高是其术后出现无复流现象的独立危险因素,Hcy+Fib+D-D联合可以作为评估无复流高危患者的检测指标。Objective To investigate the correlation between the levels of serum homocysteine(Hcy),plasma fibrinogen(Fib),D-dimer(D-D)and the no-reflow phenomenon after emergency percutaneous coronary intervention(PCI)in patients with acute STsegment elevation myocardial infarction(STEMI).Methods Retrospective analysis of 398 patients diagnosed as STEMI and received PCI in the First Affiliated Hospital of Shihezi University School of Medicine from December 2016 to June 2019.According to the occurrence of no-reflow after PCI,the patients were divided into two groups:no-reflow group(n=71)and normal flow group(n=327).Logistic regression analysis was used to study the influencing factors of no-reflow phenomenon in STEMI patients after PCI.ROC curve analysis was used to evaluate the predictive efficacy of no-reflow in the two groups after PCI.Results(1)Significant differences(P<0.05)were found between the two groups at admission in Killip grade≥2,thrombolytic therapy score system for myocardial infarction(TIMI)score,global registration score for acute coronary syndrome(GRACE),D-D,Creatine kinase isoenzyme(CK-MB)peak,troponin T(cTnT)peak,serum creatinine(Scr),high density lipoprotein cholesterol(HDL-C),Hcy,Fib,left ventricular ejection fraction(LVEF)and first medical contact(FMC).(2)Multivariate Logistic regression analysis showed that TIMI score,GRACE score,Hcy,Fib and D-D were independent influencing factors of no-reflow phenomenon in patients with STEMI after PCI.(3)ROC curve analysis showed that the predictive value of Hcy+Fib+D-D was better than that of Hcy,Fib,D-D,Hcy+Fib,Hcy+D-D and Fib+D-D group in analyzing no-reflow after PCI in STEMI patients.Conclusion Each of the increase of Hcy,Fib and D-D measured before emergency PCI treatment in STEMI patients is an independent risk factor for no-reflow after operation.The combination of Hcy+Fib+D-D can be used as an index to evaluate the high-risk patients with no-reflow.

关 键 词：急性ST段抬高型心肌梗死 同型半胱氨酸 纤维蛋白原 D-二聚体 无复流 

分 类 号：R542.22[医药卫生—心血管疾病]