Value of microcirculation resistance index in evaluating prognosis of patients with acute anterior ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention andrelated influencing factors
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摘要:目的 探讨微循环阻力指数(IMR)评估急性前壁ST段抬高型心肌梗死(STEMI)患者急诊冠状动脉介入治疗(PCI)预后的价值及影响因素。方法 选取行急诊PCI的急性前壁STEMI患者50例, 在PCI后立即测量IMR。以IMR=40 U为临界值，将IMR < 40 U定义为微循环正常组(A组)，将IMR≥40 U定义为微循环异常组(B组)。分析2组患者一般资料、实验室检查结果、术中相关情况，以及术后24 h、术后6个月、术后12个月的超声心动图结果及术后随访12个月的主要心脏不良事件(MACE)情况。结果 Logistic回归分析发现，症状发作至球囊扩张时间(STB)是影响急性前壁STEMI患者微循环障碍的独立危险因素。在PCI术后24 h、6个月、12个月时, 2组左室射血分数(LVEF)、左室舒张末容积内径(LVEDD)比较，差异有统计学意义(P < 0.05)。2组患者MACE情况比较，差异有统计学意义(P < 0.05)。结论 STB是急性前壁STEMI患者微循环障碍的独立危险因素, IMR对急性前壁STEMI患者PCI术后左心重构、左心功能恢复及主要心脏不良事件的发生可能有较好的早期预测价值。
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关键词:
- 急性ST段抬高型心肌梗死 /
- 微循环阻力指数 /
- 微循环障碍 /
- 急诊经皮冠状动脉介入治疗 /
- 心脏不良事件 /
- 左室射血分数
Abstract:Objective To investigate the value of microcirculation resistance index (IMR) in evaluating prognosis of patients with acute anterior ST-segment elevation myocardial infarction (STEMI) after emergency percutaneous coronary intervention (PCI) and related influencing factors.Methods Totally 50 patients with acute anterior STEMI by PCI were selected, and IMR was measured immediately after PCI. Taking IMR=40 U as the cutoff value, patients with IMR < 40 U was defined as normal microcirculation group (group A), and those with IMR≥40 U was defined as abnormal microcirculation group (group B). The general data, laboratory results, intraoperative information, and echocardiographic results at 24 hours, 6 months and 12 months after operation were analyzed. Major adverse cardiac events (MACE) at 12 months after operation were analyzed.Results Logistic regression analysis showed that time from onset of symptoms to balloon dilation (STB) was an independent risk factor for microcirculation disorders in acute anterior STEMI patients. At 24 hours, 6 months and 12 months after PCI, there were significant differences in the left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume diameter (LVEDD) between the two groups (P < 0.05). There was a significant difference in MACE between the two groups (P < 0.05).Conclusion STB is an independent risk factor for microcirculation disorders in acute anterior STEMI patients. IMR may have a good early predictive value for left ventricular remodeling, recovery of left cardiac function and incidence of MACE after PCI in acute anterior STEMI patients. -
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表 1 2组患者一般资料比较(x±s)[n(%)]
指标 A组(n=28) B组(n=22) 年龄/岁 <65 21(75.00) 9(40.91)* ≥65 7(25.00) 13(59.09)* 心率/(次/min) 76.50±14.74 76.05±14.69 收缩压/mmHg 135.96±20.46 125.73±20.09 舒张压/mmHg 82.96±12.95 80.78±12.69 性别 男 25(89.29) 18(81.82) 女 3(10.71) 4(18.18) 糖尿病史 无 17(60.71) 16(72.73) 有 11(39.29) 6(27.27) 高血压病史 无 9(32.14) 11(50.00) 有 19(67.86) 11(50.00) 吸烟史 无 9(32.14) 5(22.73) 有 19(67.86) 17(77.27) 高脂血症病史 无 23(82.14) 16(72.73) 有 5(17.86) 6(27.27) 与A组比较, *P < 0.05。 
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表 2 2组患者实验室检查结果比较(x±s)
指标 A组(n=28) B组(n=22) HGB/(g/L) 147.00±17.29 138.05±21.02 PLT/(×109/L) 203.39±66.69 181.23±42.08 CREA/(μmol/L) 72.71±18.81 67.45±14.61 LDL-C/(mmol/L) 2.84±0.85 2.60±0.93 尿酸/(mmol/L) 335.57±82.99 340.27±91.44 cTnI/(ng/mL) 7.75(1.25, 24.90) 10.98(2.19, 26.54) CK-MB峰值/(ng/mL) 12.90(4.00, 48.09) 44.08(13.65, 72.75)* MYO/(ng/mL) 124.60(75.12, 298.48) 298.21(75.89, 637.89) D-D/(mg/L) 0.26(0.17, 0.42) 0.35(0.18, 0.60) NLR 4.6(2.52, 7.55) 8.69(5.42, 12.31)* HGB: 血红蛋白; PLT: 血小板计数; CREA: 肌酐;
LDL-C: 低密度脂蛋白胆固醇; cTnI: 肌酐蛋白I;
CK-MB: 肌酸激酶同工酶; MYO: 肌红蛋白; D-D: D-二聚体;
NLR: 中性粒细胞计数与淋巴细胞计数比值。与A组比较, *P < 0.05。
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表 3 2组患者术中情况比较[n(%)]
指标 A组(n=28) B组(n=22) 血栓抽吸 否 22(78.57) 16(72.73) 是 6(21.43) 6(27.27) 球囊后扩 否 16(57.14) 9(40.91) 有 12(47.14) 13(59.09) Ⅱb/Ⅲa受体拮抗剂 无 12(47.14) 8(36.36) 替罗非班 16(57.14) 14(63.64) 硝普钠 否 24(85.71) 17(77.27) 有 4(14.29) 5(22.73) 合并其他冠脉病变 合并回旋支病变 14(50.00) 7(31.82) 合并右冠病变 11(39.29) 8(36.36) 同时合并回旋支及右冠病变 9(32.14) 6(27.27) 支架长/mm 25(23.25, 32.25) 30(20.00, 38.25) 支架直径/mm 3(3.00, 3.50) 3(3.00, 3.50) STB/min 240(180.00, 300.00) 383(332.25, 525.00)* STB: 症状发作至球囊扩张时间; NLR: 中性粒细胞计数与淋巴细胞计数比值。与A组比较, *P < 0.05。
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表 4 急性前壁STEMI患者发生微循环障碍的危险因素
因素 B SE P OR 95%CI 下限 上限 年龄≥65岁 1.359 0.864 0.116 3.894 0.716 21.178 CK-MB峰值 0.006 0.006 0.307 1.006 0.995 1.017 NLR 0.206 0.123 0.093 1.229 0.966 1.563 STB 0.012 0.004 0.003 1.012 1.004 1.02 CK-MB: 肌酸激酶同工酶; STB: 症状发作至球囊扩张时间; NLR: 中性粒细胞计数与淋巴细胞计数比值。
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表 5 2组患者术后左心功能比较
组别 时点 LVEF/% LVEDD/mm A组(n=28) 术后24 h 50.79±7.198 47.46±4.17 术后6个月 55.00±6.837# 47.43±3.75 术后12个月 56.32±6.700# 49.61±4.18#▲ B组(n=22) 术后24 h 43.59±6.284* 51.09±4.79* 术后6个月 49.41±10.477*# 51.14±5.83* 术后12个月 42.05±8.677*▲ 53.77±5.31*#▲ LVEF: 左室射血分数; LVEDD: 左室舒张末容积内径。
与A组相比, *P < 0.05; 与术后24 h相比, #P < 0.05;
与术后6个月相比, ▲P < 0.05。
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