性别对急性ST段抬高型心肌梗死患者发生微循环阻塞影响研究  

Effect of gender on microvascular obstruction in patients with acute ST segment elevation myocardial infarction

作　　者：高光仁 冯连荣 李毅 王佳傲 张倩玉 张军[1] GAO Guang-ren;FENG Lian-rong;LI Yi;WANG Jia-ao;ZHANG Qian-yu;ZHANG Jun(Department of Cardiology,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Neurology,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]沧州市中心医院心内科,河北沧州061000 [2]沧州市中心医院神经内科,河北沧州061000 [3]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2023年第11期1133-1137,共5页Clinical Journal of Medical Officers

基　　金：2021年度河北省医学科学研究课题计划(20210479);河北省医学科学研究课题计划(20200322)。

摘　　要：目的探讨性别对急性ST段抬高型心肌梗死(STEMI)患者发生微循环阻塞(MVO)的影响。方法回顾性分析自2018年10月至2021年10月沧州市中心医院收治的283例急性STEMI患者的临床资料。患者住院期间均行冠状动脉造影并行经皮冠状动脉介入治疗(PCI),发病3~15 d内行心脏磁共振。根据有无MVO将患者分入有MVO组和无MVO组。比较两组患者的基线资料,有MVO组的性别比例、不同性别的MVO体积占左室总体积的百分比[MVO(%LV)]和MVO体积绝对值(ml)[MVO(ml)];分析急性STEMI患者发生MVO的影响因素,性别对有MVO组不同亚组的影响。结果有MVO组患者的白细胞计数、肌酸激酶、肌酸激酶同工酶、中性粒细胞计数、中性粒细胞/淋巴细胞比值及男性、前壁梗死、急诊PCI、起始心肌梗死溶栓试验(TIMI)血流0/1级比例均高于无MVO组,左室射血分数低于无MVO组,差异有统计学意义(P<0.05)。单因素Logistics回归分析显示,男性、急诊PCI、起始TIMI血流0/1级、白细胞计数、肌酸激酶、肌酸激酶同工酶、中性粒细胞/淋巴细胞比值、中性粒细胞计数均为急性STEMI患者发生MVO的危险因素,而左室射血分数为保护因素(P<0.05);在校正了起始TIMI血流0/1级、中性粒细胞计数、左室射血分数后,多因素Logistics回归分析显示,男性为急性STEMI患者发生MVO的独立危险因素(P<0.05)。在年龄<60岁组和年龄≥60岁亚组中,男性均为急性STEMI患者发生MVO的危险因素(P<0.05);在伴高血压、未伴糖尿病、未吸烟、非前壁梗死、急诊PCI、起始TIMI血流0/1级、术后TIMI血流2/3级亚组中,男性为急性STEMI患者发生MVO的危险因素(P<0.05)。在有MVO组中,男性比例高于女性,差异有统计学意义(P<0.05);男性和女性MVO(%LV)、MVO(ml)比较,差异无统计学意义(P>0.05),男性仅有高于女性的趋势。结论男性是急性STEMI患者发生MVO的独立危险因素。Objective To investigate the effect of gender on microvascular obstruction(MVO)in patients with acute ST segment elevation myocardial infarction(STEMI).Methods The clinical data of 283 patients with acute STEMI admited to Cangzhou Central Hospital from October 2018 to October 2021 were retrospectively analyzed.All patients underwent coronary angiography and percutaneous coronary intervention(PCI)during hospitalization,and cardiac magnetic resonance within 3 to 15 days after onset.Patients were divided into with MVO group and without MVO group according to the presence or absence of MVO.Baseline data were compared between the two groups.The sex ratio,percentage of MVO volume in the total left ventricular volume[MVO(%LV)] and absolute value of MVO volume(ml)[MVO(ml)] of different genders in with MVO group were compared.To analyze the influencing factors of MVO occurrence in acute STEMI patients and the effect of gender on dfferent subgroups with MVO.Results The leukocyte count,creatine kinase,creatine kinase isoenzyme,neutrophil count,neutrophil/lymphocyte ratio,male,anterior wall infarction,emergency PCI and initial thrombolysis in myocardial infarction(TIMI)blood flow level O/1 in with MVO group were higher than those in without MVO group,and left ventricular ejection fraction was lower than those in without MVO group,the difference was statistically significant(P<0.05).Univariate Logistics regression analysis showed that,male,emergency PCI,initial TIMI blood flow level O/1,leukocyte count,creatine kinase,creatine kinase isoenzyme,neutrophil count and neutrophil/lymphocyte ratio were all risk factors for MVO in acute STEMI patients,while left ventricular ejection fraction was a protective factor(P<0.05).After adjusting for initial TIMI blood flow level 0/1,neutrophil count and left ventricular ejection fraction,multifactor Logistics regression analysis showed that,male was independent risk factors for MVO in acute STEMI patients(P<0.05).In the age group<60 years old and the age≥60 years old subgroup,male was in

关 键 词：急性ST段抬高型心肌梗死 微循环阻塞 性别 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]