冠状动脉微循环阻力对STEMI介入术后左心室重塑的影响  

Effect of coronary microcirculation resistance on left ventricular remodeling after STEMI intervention

作　　者：陈泽[1] 李佳维 CHEN Ze;LI Jiawei(Department of Cardiovascular Medicine,Suzhou Jiulong Hospital,Shanghai Jiao Tong University School of Medicine,Jiangsu Province,Suzhou215000,China)

机构地区：[1]上海交通大学医学院附属苏州九龙医院心血管内科,江苏苏州215000

出　　处：《中国医药导报》2021年第11期58-61,共4页China Medical Herald

基　　金：国家自然科学基金青年科学基金项目(81800311)。

摘　　要：目的探讨冠状动脉微循环阻力指数(IMR)对急性ST段抬高型心肌梗死(STEMI)介入术后左心室重塑的影响。方法纳入2018年7月—2019年12月上海交通大学医学院附属苏州九龙医院收治的83例STEMI患者,入院后均施行直接经皮冠状动脉支架置入术(PCI),术中测量PCI治疗后IMR,将患者分为高IMR组(38例,IMR≥25 U)和正常IMR组(45例,IMR<25 U)。患者术后6个月均常规随访心脏彩色超声,比较两组心功能变化及左心室重塑情况,评价IMR与左心室重塑的关系及对其预测价值。结果与在院比较,术后6个月高IMR组LVEF降低,LVEDV升高,差异均有统计学意义(均P<0.05)。术后6个月,高IMR组左心室射血分数(LVEF)低于IMR正常组,左心室舒张末期容积(LVEDV)、左心室重塑发生率高于正常IMR组,差异均有统计学意义(均P<0.05)。Pearson相关性分析发现IMR与LVEF之间为负相关(r=-0.357),与LVEDV(r=0.608)为正相关(均P<0.05);多因素logistic回归分析发现IMR是STEMI患者介入术后左心室重塑的危险因素(OR=1.87,95%CI:1.07-3.25,P<0.05)。受试者工作特征曲线提示IMR预测STEMI患者介入术后6个月发生左心室重塑的曲线下面积为0.84(95%CI:0.76-0.93),最佳诊断界值为32.64 U,灵敏度及特异度分别为69%、78%。结论IMR影响STEMI介入术后心功能及左心室容积,同时其是STEMI发生左心室重塑的危险因素。Objective To investigate the effect of coronary index of microcirculatory resistance(IMR)on left ventricular remodeling after ST-segment elevation myocardial infarction(STEMI)intervention.Methods A total of 83 STEMI patients admitted to Suzhou Jiulong Hospital,Shanghai Jiao Tong University School of Medicine from July 2018 to December 2019 were enrolled and all underwent direct percutaneous coronary stent implantation(PCI)after admission.IMR after PCI treatment was measured intraoperatively,and the patients were divided into high IMR group(38 cases,IMR≥25 U)and normal IMR group(45 cases,IMR<25 U).All patients were routinely followed up with color ultrasound six months after surgery,and the changes of heart function and the condition of left ventricular remodeling were compared between the two groups,and the relationship between IMR and left ventricular remodeling and its predictive value were evaluated.Results Compared with the hospital,six months after surgery,LVEF was decreased and LVEDV was increased in the high IMR group,and the differences were statistically significant(all P<0.05).Six months after surgery,the left ventricular ejection fraction(LVEF)of the high IMR group was lower than that of the normal IMR group,and the left ventricular end-diastolic volume(LVEDV)and the incidence of left ventricular remodeling were higher than that of the normal IMR group,and the differences were statistically significant(all P<0.05).Pearson correlation analysis showed that IMR was negatively correlated with LVEF(r=-0.357)and positively correlated with LVEDV(r=0.608)(all P<0.05).Multiple logistic regression analysis showed that IMR was an risk factor for left ventricular remodeling after intervention in patients with STEMI(OR=1.87,95%CI:1.07-3.25,P<0.05).Receiver operating characteristic curve indicated that the area under curve of IMR predicting left ventricular remodeling six months after intervention in STEMI patients was 0.84(95%CI:0.76-0.93),the best diagnostic threshold was 32.64 U,and the sensitivity and specific

关 键 词：急性ST段抬高型心肌梗死 冠状动脉微循环阻力指数 介入 心功能 左心室重塑 

分 类 号：R542.2[医药卫生—心血管疾病]