急性ST段抬高型心肌梗死直接PCI术后心肌内出血的危险因素分析  

Related factors of intramyocardial hemorrhage in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作　　者：姜子超 刘康 凌维维 阿鑫 吴丹 钱赓[2] Jiang Zi-Chao;Liu Kang;Ling Wei-Wei;A Xin;Wu Dan;Qian Geng(Chinese PLA Medical School,Beijing 100853,China;Department of Cardiology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心心血管内科,北京100853

出　　处：《解放军医学杂志》2022年第2期171-177,共7页Medical Journal of Chinese People's Liberation Army

基　　金：中华心血管病发展专项基金(Z-2019-42-1908-2)。

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)直接PCI术后心肌内出血(IMH)的影响因素。方法收集2014年2月-2019年3月在解放军总医院第一医学中心急诊行直接PCI治疗,且于术后3~7d行心脏磁共振检查的204例急性STEMI患者的临床资料进行回顾性分析。根据是否存在IMH分为IMH阳性组(n=87)与IMH阴性组(n=117),分析两组患者临床特征的差异,并采用logistic回归分析IMH发生的影响因素。结果与IMH阴性组比较,IMH阳性组缺血总时间、入院血糖、入院心率、血红蛋白下降值、肌酸激酶同工酶(CK-MB)峰值、肌钙蛋白T(TnT)峰值、低密度脂蛋白胆固醇、梗死程度等明显增高,左室射血分数(LVEF)明显降低,糖尿病史、高脂血症史、术前TIMI血流<3级、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂的患者比例高,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,糖尿病史(P=0.003,OR=7.782,95%CI2.009~30.846)、缺血总时间(P<0.001,OR=1.011,95%CI1.007~1.014)、入院血糖(P<0.001,OR=1.428,95%CI1.182~1.725)、入院心率(P=0.006,OR=1.041,95%CI1.012~1.071)、血红蛋白下降值(P<0.001,OR=1.117,95%CI1.059~1.178)、CK-MB峰值(P=0.007,OR=1.006,95%CI1.002~1.010)、前壁梗死(P=0.012,OR=3.359,95%CI1.307~8.633)、使用GPⅡb/Ⅲa受体拮抗剂(P=0.022,OR=3.362,95%CI1.195~9.460)是急性STEMI患者直接PCI术后发生IMH的独立危险因素。结论糖尿病史、缺血总时间、入院血糖、入院心率、血红蛋白下降值、CK-MB峰值、前壁梗死、使用GPⅡb/Ⅲa受体拮抗剂等为急性STEMI直接PCI术后IMH的独立危险因素,可实施适当的策略予以干预。Objective To evaluate the predictors of the occurrence of intramyocardial hemorrhage (IMH) in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention.Methods A total of two hundred and four patients,admitted in the First Medical Center of Chinese PLA General Hospital from February,2014to March,2019,diagnosed as STEMI undergoing emergency PCI treatment within the first 12 h of evolution,were screened for our retrospective analysis.IMH lesions were visualized by T;-weighted sequences on cardiac magnetic resonance (CMR) between days 3 to 7 after PCI.Based on the existence of IMH,all patients were classified into the non-IMH group (n=117) and the IMH group (n=87).We investigate the clinical features between the two groups.Factors influencing were analyzed by logistic regression analysis.Results Compared with the non-IMH group,the ischemia time,admission glucose,admission heart rate,hemoglobin(Hb) reduction,creatine kinase isoenzymes (CK-MB) peak value,troponin T (Tn T) peak value,low-density lipoprotein cholesterol,infarct size were significantly higher and the left ventricular ejection fraction (LVEF) was significantly lower in IMH group(P<0.05).Besides,in the IMH group,the proportion of patients with diabetes mellitus history,hyperlipemia history,preprocedural thrombolysis in myocardial infarction (TIMI) flow grades<3,anterior infarction,periprocedural glycoproteinⅡb/Ⅲa inhibitor treatment was significantly higher (P<0.05).Logistic regression model presented that diabetes mellitus history (P=0.003,OR=7.782,95%CI 2.009-30.846),ischemia time (P<0.001,OR=1.011,95%CI 1.007-1.014),admission glucose (P<0.001,OR=1.428,95%CI1.182-1.725),admission heart rate (P=0.006,OR=1.041,95%CI 1.012-1.071),Hb reduction (P<0.001,OR=1.117,95%CI 1.059-1.178),CK-MB peak value (P=0.007,OR=1.006,95%CI 1.002-1.010),anterior infarction (P=0.042,OR=2.626,95%CI 1.037-6.652) and periprocedural glycoproteinⅡb/Ⅲa inhibitor treatment (P=0.022,OR=3.362,95%CI 1.195-9.460) were ind

关 键 词：心肌内出血 心肌梗死 经皮冠状动脉介入治疗 心脏磁共振 

分 类 号：R542.22[医药卫生—心血管疾病]