急性前壁ST段抬高型心肌梗死介入治疗后冠状动脉微循环灌注对心肌重构的影响  

The effect of coronary microcirculation perfusion on myocardial remodeling after interventional therapy in patients with acute anterior ST segment elevation myocardial infarction

作　　者：于铭 王裕星 杨松 任佳禹 梅佳杰 刘珍竹[1] 曲鹏[1,2] 牛楠[1] YU Ming;WANG Yuxing;YANG Song;REN Jiayu;MEI Jiajie;LIU Zhenzhu;QU Peng;NIU Nan(The Second Affiliated Hospital of Dalian Medical University,Dalian,Liaoning 116023,China;Department of Medicine,Dalian University of Technology,Dalian,Liaoning 116081,China)

机构地区：[1]大连医科大学附属第二医院,辽宁省大连市116023 [2]大连理工大学医学部,辽宁省大连市116081

出　　处：《中国动脉硬化杂志》2025年第3期235-243,共9页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金重大项目(91739119);国家自然科学基金面上项目(81670406)。

摘　　要：[目的]应用冠状动脉造影衍生的微循环阻力指数(caIMR)评估急性前壁ST段抬高型心肌梗死(STEMI)介入治疗术后冠状动脉微循环灌注对心肌重构的影响。[方法]本研究为横断面研究,分析2021年1月—2022年7月在大连医科大学附属第二医院心内一科因急性前壁STEMI,住院并接受经皮冠状动脉介入治疗(PCI)且规律随诊的患者的资料。根据caIMR值将纳入患者分为低冠状动脉微循环阻力(L-caIMR)组、中冠状动脉微循环阻力(M-caIMR)组及高冠状动脉微循环阻力(H-caIMR)组。分析比较三组患者围手术期及术后1个月、3个月、6个月及1年的超声心动图结果,包括左心房内径、左心室舒张末内径、室间隔厚度、二尖瓣口血流速度E/A、二尖瓣环间隔侧e′及二尖瓣环侧壁侧e′等,并比较外周血中白细胞介素1β(IL-1β)、IL-6、肿瘤坏死因子α(TNF-α)等炎症因子水平。[结果]共入选急性前壁STEMI患者75例,其中男性55例,L-caIMR组、M-caIMR组和H-caIMR组分别为26、26和23例。与L-caIMR组比较,M-caIMR组和H-caIMR组左心房内径、室间隔厚度在PCI术后1个月时呈增加趋势,且H-caIMR组增加幅度大于M-caIMR组(P<0.05)。与L-caIMR组和M-caIMR组比较,H-caIMR组射血分数在术后1个月、3个月时显著降低(P<0.05)。与L-caIMR组比较,M-caIMR组和H-caIMR组在术后6个月时二尖瓣口血流速度E/A,以及在围手术期和术后1、3、6个月时二尖瓣环间隔侧e′和侧壁侧e′均显著降低(P<0.05)。与L-caIMR组比较,M-caIMR组和H-caIMR组外周血IL-1β、IL-6和TNF-α的水平呈上升趋势,且H-caIMR组上升幅度大于M-caIMR组(P<0.05)。多因素分析发现caIMR是IL-1β和IL-6水平的影响因素。[结论]急性前壁STEMI介入治疗术后冠状动脉微循环障碍可能参与心肌重构过程,炎症反应在其中可能具有一定作用。Aim To apply coronary angiography derived index of microcirculatory resistance(caIMR)to evaluate the effect of coronary microcirculation perfusion on myocardial remodeling after interventional therapy in patients with acute anterior ST segment elevation myocardial infarction(STEMI).Methods This was a cross-sectional study.The analysis was performed among the patients who were hospitalized for acute anterior STEMI in the First Department of the Second Affiliated Hospital of Dalian Medical University from January 2021 to July 2022 and received percutaneous coronary intervention(PCI)with regtelar follow-up visits.The patients were divided into low caIMR(L-caIMR)group,medium caIMR(M-caIMR)group and high caIMR(H-caIMR)group according to the results of caIMR.The results of echocardiography at perioperative period,1 month,3 months,6 months and 1 year were analyzed and compared,including left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),interventricular septum thickness(IVST),mitral orifice flow velocity E/A,mitral annular septum e′and mitral annular wall e′,etc.The difference of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and other inflammatory factors in peripheral blood of the three groups were also compared.Results A total of 75 patients diagnosed with acute anterior STEMI were recruited,including 55 males.The L-caIMR group,M-caIMR group,and H-caIMR group had 26,26 and 23 cases,respectively.Compared with the L-caIMR group,the LAD and IVST in the M-caIMR group and the H-caIMR group exhibited an increasing tendency one month after PCI,and the increase in the H-caIMR group was more significant than that in the M-caIMR group(P<0.05).The ejection fraction in the H-caIMR group was notably lower than that in the L-caIMR group and the M-caIMR group at 1 and 3 months after PCI(P<0.05).Compared with the L-caIMR group,the mitral flow velocity E/A at 6 months after PCI,and the e′at the septal side and the lateral wall of the mitral annulus at 1,3,and 6 months after PCI

关 键 词：急性前壁ST段抬高型心肌梗死 冠状动脉微循环障碍 心肌重构 

分 类 号：R541.4[医药卫生—心血管疾病]