糖调节受损与ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术中慢血流或无复流的关系  

Relationship of impaired glucose regulation with slow flow or no reflow during percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

作　　者：苗睿 张曼 王学智[1] 郝亚逢[1] 林莉[1] 权慧娟 MIAO Rui;ZHANG Man;WANG Xuezhi;HAO Yafeng;LIN Li;QUAN Huijuan(the Second Department of Cardiology,Handan City First Hospital of Hebei Province,Handan,Hebei,056000)

机构地区：[1]河北省邯郸市第一医院心内二科,河北邯郸056000

出　　处：《实用临床医药杂志》2024年第9期40-44,51,共6页Journal of Clinical Medicine in Practice

基　　金：河北省邯郸市科学技术研究与发展计划项目(22422083055ZC)。

摘　　要：目的 探讨糖调节受损(IGR)与ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术中慢血流或无复流(SF/NRF)的关系。方法 回顾性收集本院2021年10月—2022年10月收治的80例有SF/NRF的STEMI患者及84例无SF/NRF的STEMI患者的临床资料,包括空腹血糖、总胆固醇(TC)、甘油三酯(TG)、心肌肌钙蛋白Ⅰ(cTnⅠ)、纤维蛋白原、左心室射血分数(LVEF)、D-二聚体、尿酸、同型半胱氨酸、中性粒细胞绝对值与淋巴细胞绝对值比值(NLR)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)以及餐后2 h血糖水平。采用Logistic回归模型分析影响STEMI患者PCI术中SF/NRF发生的影响因素;采用受试者工作特征(ROC)曲线分析空腹血糖、餐后2 h血糖水平对STEMI患者PCI术中SF/NRF的诊断价值。结果 与非SF/NRF组相比,SF/NRF组cTnⅠ、纤维蛋白原、HDL-C水平升高,收缩压(SBP)、舒张压(DBP)、NLR水平降低,差异有统计学意义(P<0.05)。与非SF/NRF组相比,SF/NRF组支架直径、支架长度、胸痛至导管室时间更长,差异有统计学意义(P<0.05)。SF/NRF组空腹血糖、餐后2 h血糖水平高于非SF/NRF组,差异有统计学意义(P<0.05)。Logistic回归分析显示,空腹血糖、餐后2 h血糖水平是STEMI患者PCI术中SF/NRF发生的影响因素,且二者联合诊断STEMI患者PCI术中SF/NRF的曲线下面积(AUC)高于空腹血糖、餐后2 h血糖水平单独诊断的AUC(Z=3.272、4.369,P均<0.001)。结论 IGR与STEMI患者PCI术中SF/NRF有关,空腹血糖、餐后2 h血糖水平是STEMI患者SF/NRF发生的影响因素。Objective To investigate the relationship between impaired glucose regulation(IGR)and slow flow or no reflow(SF/NRF)during percutaneous coronary intervention(PCI)in patients with ST segment elevation myocardial infarction(STEMI).Methods Clinical materials of 80 STEMI patients with SF/NRF and 84 STEMI patients without SF/NRF in the hospital from October 2021 to October 2022 were retrospectively collected,including blood glucose,total cholesterol(TC),triglyceride(TG),cardiac troponinⅠ(cTnⅠ),fibrinogen,left ventricular ejection fraction(LVEF),D-dimer,uric acid,homocysteine,the ratio of absolute value of neutrophils to absolute value of lymphocytes(NLR),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and 2 h postprandial blood glucose level.Logistic regression model was used to analyze the influencing factors of SF/NRF in STEMI patients with PCI;the receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of fasting blood glucose and 2 h postprandial blood glucose levels for SF/NRF in STEMI patients with PCI.Results Compared with non-SF/NRF group,the levels of cTnⅠ,fibrinogen and HDL-C in SF/NRF group were significantly higher,while the levels of systolic blood pressure(SBP),diastolic blood pressure(DBP)and NLR were significantly lower(P<0.05).Compared with non-SF/NRF group,the stent diameter,stent length and the time from chest pain to catheter room in SF/NRF group were significantly longer(P<0.05).The levels of fasting blood glucose and 2 h postprandial blood glucose in SF/NRF group were significantly higher than those in non-SF/NRF group(P<0.05).Logistic regression analysis showed that fasting blood glucose and 2 h postprandial blood glucose were the influencing factors of SF/NRF in STEMI patients with PCI,and the area under the curve(AUC)of the combination of the two indicators for diagnosis of SF/NRF in STEMI patients during PCI was significantly higher than that by fasting blood glucose and 2 h postprandial blood glucose alone(Z=3.272,4.369

关 键 词：糖调节受损 ST段抬高型心肌梗死 慢血流或无复流 空腹血糖 餐后2小时血糖 

分 类 号：R542.22[医药卫生—心血管疾病] R459.7[医药卫生—内科学] R714.14[医药卫生—临床医学]