微血管梗阻对急性ST段抬高型心肌梗死患者预后的预测价值  

The prognostic value of microvascular obstruction in patients with acute ST-segment elevation myocardial infarction

作　　者：张师儒 李瑞雪 焦云娣[1] 武佳科 张男[1] 段玮丽 孙志军[1] 孙兆青[1] ZHANG Shi-ru;LI Rui-xue;JIAO Yun-di;WU Jia-ke;ZHANG Nan;DUAN Wei-li;SUN Zhi-jun;SUN Zhao-qing(Department of Cardiology,Shengjing Hospital,China Medical University,Shenyang 110022,China;Department of Epidemiology,School of Public Health,China Medical University,Shenyang 110022,China)

机构地区：[1]中国医科大学附属盛京医院心血管内科,辽宁省沈阳市110022 [2]中国医科大学公共卫生学院流行病学教研室,辽宁省沈阳市110022

出　　处：《中国心血管病研究》2021年第3期193-197,共5页Chinese Journal of Cardiovascular Research

基　　金：十三五重点专项-东北地区重大慢病防控科技综合示范研究(2018YFC1311600)。

摘　　要：目的探讨微血管阻塞(MVO)对行经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者预后的预测价值。方法采用前瞻性队列研究方法,纳入2017年2月至2018年11月在中国医科大学附属盛京医院行PCI的STEMI患者104例,所有患者均于术后1周内行心脏磁共振检查,根据是否存在MVO将STEMI患者分为MVO阳性组(48例)和MVO阴性组(56例)。对比两组患者的临床资料,随访术后2年临床终点事件,使用Cox回归模型分析MVO对急性STEMI患者预后的预测价值。结果MVO阳性组患者白细胞计数[11.1(8.9,13.5)×10^(9)L比9.3(7.7,11.1)×10^(9)L]、肌钙蛋白I水平[55.28(28.65,77.70)μg/L比15.21(2.35,28.60)μg/L]、脑钠肽水平[182.00(67.50,281.65)ng/L比85.45(46.22,181.95)ng/L]、左心室收缩末期容积[73.85(57.93,85.62)ml比59.24(46.31,75.58)ml]和梗死面积[16.70(11.31,22.30)%比10.41(7.71,15.61)%]均高于MVO阴性组患者(P<0.05),而左心室射血分数低于MVO阴性组患者[(45.5±10.56)%比(51.4±13.13)%,P<0.05]。Cox回归分析显示,MVO与STEMI患者PCI术后2年的主要心血管不良事件(P=0.029,HR=4.115,95%CI 1.153~14.685)风险独立相关。结论MVO是STEMI患者PCI术后2年主要心血管不良事件的独立预测因素。Objective To investigate the prognostic value of microvascular obstruction in patients with acute ST segment elevation myocardial infarction(SETMI)undergoing percutaneous coronary intervention.Methods This prospective study included 104 consecutive patients with acute STEMI undergoing PCI in Shengjing Hospital of China Medical University from February 2017 to November 2018.All patients underwent cardiac magnetic resonance within one week after operation.Patients were divided into MVO(+)group(n=48)and MVO(-)group(n=56),according to the presence of MVO.Clinical data and 2 years follow-up were recorded and compared.Cox regression model was used to analyze the prognostic value of MVO in the patients with acute STEMI.Results Compared with the patients in the MVO(-)group,patients in the MVO(+)group showed higher white blood cell count[11.1(8.9,13.5)×10^(9)L vs.9.3(7.7,11.1)×10^(9)L],troponin I level[55.28(28.65,77.70)μg/L vs.15.21(2.35,28.60)μg/L],brain natriuretic peptide level[182.00(67.50,281.65)ng/L vs.85.45(46.22,181.95)ng/L],left ventricular end-systolic volume[73.85(57.93,85.62)ml vs.59.24(46.31,75.58)ml]and infarct size[16.70(11.31,22.30)%vs.10.41(7.71,15.61)%](P<0.05)but lower left ventricular ejection fraction[(45.5±10.56)%vs.(51.4±13.13)%,P<0.05].Cox regression analysis showed that MVO was independently associated with the risk of major cardiovascular adverse events in patients with acute STEMI during2-year clinical follow-up after PCI(P=0.029,HR=4.115,95%CI 1.153-14.685).Conclusion MVO is an independent predictor of major cardiovascular adverse events in patients with acute STEMI during 2-year clinical follow-up after PCI.

关 键 词：微血管阻塞 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 心脏核磁共振 预后 

分 类 号：R541.4[医药卫生—心血管疾病]