心肌血流量预测高血栓负荷急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗短期预后的价值  

Myocardial blood flow in predicting short-term prognosis of high thrombus burden patients receiving primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

作　　者：李小宁 李方江[1] 彭海英 王艳丽 刘思铄 LI Xiaoning;LI Fangjiang;PENG Haiying;WANG Yanli;LIU Sishuo(Department of Cardiology,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Internal Medicine,Zhangjiakou Maternal and Child Health Hospital,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院心血管内科,河北张家口075000 [2]张家口妇幼保健医院内科,河北张家口075000

出　　处：《中华实用诊断与治疗杂志》2024年第11期1105-1110,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河北省卫生健康委员会科研基金项目(20242281)。

摘　　要：目的探讨急诊经皮冠状动脉介入治疗(pPCI)后24 h内心肌血流量(MBF)对高血栓负荷急性ST段抬高型心肌梗死(STEMI)患者短期预后的预测价值。方法2020年6月—2022年6月河北北方学院附属第一医院行pPCI的高血栓负荷急性STEMI患者228例,术中血栓抽吸、冠状动脉内重组尿激酶原溶栓治疗后均置入药物洗脱支架。pPCI后24 h内行超声心动图检查测量左室射血分数(LVEF),行心肌声学造影检查测定MBF,采集空腹静脉血检测心肌肌钙蛋白I、肌酸激酶同工酶等生化指标。术后随访1年,发生不良心血管事件(MACEs)者为预后不良组,未发生MACEs者为预后良好组。比较2组年龄≥70岁、男性、吸烟、高血压、糖尿病、高脂血症、病变血管≥2支比率,体质量指数、pPCI后24 h内白细胞计数、血小板计数、血红蛋白、高敏C反应蛋白、总胆固醇、低密度脂蛋白胆固醇、心肌肌钙蛋白I、肌酸激酶同工酶;采用多因素logistic回归分析高血栓负荷急性STEMI患者pPCI后短期预后不良的影响因素;绘制ROC曲线,评估肌酸激酶同工酶、心肌肌钙蛋白I、LVEF、MBF预测高血栓负荷急性STEMI患者行pPCI后短期预后的效能。结果(1)随访期间26例患者发生MACEs,其中心源性死亡1例,不稳定型心绞痛7例,非致死性心肌梗死9例,充血性心力衰竭6例,脑卒中3例。(2)预后不良组年龄≥70岁(34.62%)、吸烟(53.85%)、高血压(73.08%)、糖尿病(57.69%)、病变血管≥2支(65.38%)比率均高于预后良好组(12.38%、32.18%、48.51%、33.66%、44.55%)(χ^(2)=4.013~8.979,P均<0.05),pPCI后24 h内心肌肌钙蛋白I[(63.34±13.44)μg/L]、肌酸激酶同工酶[(227.89±44.05)μg/L]水平均高于预后良好组[(52.64±7.35)、(177.88±48.48)μg/L](t=6.226、4.999,P均<0.001),pPCI后24 h内LVEF[(46.45±8.15)%]、MBF[(45.54±5.60)dB·dB/s]均低于预后良好组[(55.33±6.22)%、(58.47±11.25)dB·dB/s](t=6.595、5.761,P均<0.001)。(3)pPCI后24 h内肌酸激酶同�Objective To explore the value of myocardial blood flow(MBF)within 24 h after primary percutaneous coronary intervention(pPCI)to the prediction of short-term prognosis of high thrombus burden patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Totally 228 high thrombus burden acute STEMI patients underwent pPCI in the First Affiliated Hospital of Hebei North University from June 2020 to June 2022.All the patients were implanted with drug-eluting stents after thrombus aspiration and intracoronary recombinant prourokinase thrombolysis.Within 24 h after pPCI,echocardiography was performed to measure the left ventricular ejection fraction(LVEF),myocardial contrast echocardiography was performed to detect the MBF,and fasting venous blood sample was collected to test biochemical indicators as cardiac troponin I and creatine kinase isoenzyme.The patients with major adverse cardiovascular events(MACEs)in one-year follow-up were as poor prognosis group and those without MACEs were as good prognosis group.The proportions of patients with age of≥70 years,male,history of smoking,hypertension,diabetes,hyperlipidemia,and lesions≥2 vessels,body mass index,and biochemical indicators within 24 h after pPCI as white blood cell count,platelet count,hemoglobin,high-sensitivity C-reactive protein,total cholesterol,low-density lipoprotein cholesterol,cardiac troponin I and creatine kinase isoenzyme were compared between two groups.Multivariate logistic regression analysis was conducted to identify the factors influencing the short-term poor prognosis of high thrombus burden acute STEMI patients.ROC curves were plotted to evaluate the efficiencies of creatine kinase isoenzyme,cardiac troponin I,LVEF and MBF on predicting short-term prognosis.Results(1)MACEs occurred in 26 patients during the follow-up period,including 1 case of cardiac death,7 cases of unstable angina pectoris,9 cases of non-fatal myocardial infarction,6 cases of congestive heart failure,and 3 cases of stroke.(2)The proportions of patients

关 键 词：急性ST段抬高型心肌梗死 高血栓负荷 急诊经皮冠状动脉介入治疗 心肌声学造影 心肌血流量 左室射血分数 心肌肌钙蛋白Ⅰ 肌酸激酶同工酶 

分 类 号：R542.22[医药卫生—心血管疾病]