ST段抬高型心肌梗死患者直接PCI术后发生微血管阻塞的危险因素及其预测价值分析  

Risk factors and predictive value of microvascular obstruction in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作　　者：李晓冉 谭建 王佳丽 Li Xiaoran;Tan Jian;Wang Jiali(Center for Cardiovascular Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;不详)

机构地区：[1]首都医科大学附属北京友谊医院心血管中心,北京100050 [2]北京市疾病预防控制中心,北京市预防医学科学院,北京100027

出　　处：《中国循证心血管医学杂志》2024年第8期1000-1003,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨ST段抬高型心肌梗死(STEMI)患者接受直接经皮冠状动脉介入治疗(pPCI)术后发生微血管阻塞(MVO)的危险因素。方法 本研究入选2019年10月至2021年6月间于北京友谊医院心内科住院的STEMI并行pPCI患者149例作为研究对象,患者pPCI术后1周内接受心脏核磁共振(CMR)检查,根据患者术后是否发生MVO分为MVO组(n=77)及非MVO组(n=72),比较两组患者一般资料及实验室检查,包括心肌梗死定位、心肌肌钙蛋白T(cTnT)、N末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、尿素、肌酐、促甲状腺激素(TSH)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)等,采用多因素Logistic回归分析发生MVO的危险因素。结果 cTnT峰值、hs-CRP水平MVO组高于非MVO组,差异有统计学意义(P<0.05),ROC分析显示对于STEMI患者发生MVO的预测价值,cTnT峰值及hs-CRP的ROC曲线下面积分别为0.794、0.674(P<0.05)。结论 cTnT峰值及hs-CRP是STEMI患者发生MVO的独立危险因素,对MVO的发生具有一定预测价值。Objective To discuss the risk factors for microvascular obstruction(MVO)in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(pPCI).Methods STEMI patients undergone pPCI(n=149)were chosen from Department of Cardiology in Beijing Friendship Hospital from Oct.2019 to June 2021.The patients were received examination of cardiac magnetic resonance(CMR)within 1 week after pPCI,and divided into MVO group(n=77)and non-MVO group(n=72)according to MVO occurrence status.The general data and results of laboratory tests,including myocardial infarction location,cardiac troponin T(cTnT),N-terminal pro-brain natriuretic peptide(NT-proBNP),high sensitivity C-reactive protein(hs-CRP),urea,creatinine(Cr),thyroid stimulating hormone(TSH),low-density lipoprotein-cholesterol(LDL-C)and glycated hemoglobin(HbAlc)were compared between 2 groups.The risk factors for MVO occurrence were analyzed by using multi-factor Logistic regression analysis.Results The peak value of cTnT and hs-CRP level were higher in MVO group than those in non-MVO group(P<0.05).The results of ROC curve analysis showed that AUC of cTnT was 0.794 and AUC of hs-CRP was 0.674 in predicting MVO in STEM patients(P<0.05).Conclusion The peak value of cTnT andhs-CRP level are independent risk factors for MVO in STEMI patients,and have a certain predictive value to MVOoccurrence.

关 键 词：心肌梗死 微血管阻塞 心脏磁共振 肌钙蛋白T 超敏C反应蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]