血小板相关因子和hs-CRP与急性ST段抬高心肌梗死患者直接PCI术后无复流的相关性研究

发布时间：2018-04-15 21:02

本文选题：急性ST段抬高型心肌梗死 + 无复流　；参考：《河北医科大学》2013年硕士论文

【摘要】：目的：通过研究急性ST段抬高型心肌梗死（acute ST-segment elevationmyocardial infarction，STEMI）患者急性期血小板计数（PLT）、平均血小板体积（MPV）、血小板分布宽度（PDW）、纤维蛋白原（FIB）及超敏C反应蛋白（hsCRP）水平与急诊冠脉介入治疗后心肌灌注（myocardialperfusion）水平的相关性，探讨血小板及炎症相关因子对急性心肌梗死患者介入治疗后发生无复流现象的预测价值。方法：选取2012年1月至2013年3月收治于河北医科大学第二医院心血管内科的112例诊断为首次发作的ST段抬高型心肌梗死患者，所有患者于入院后直接行经皮冠脉介入治疗，根据直接PCI术后TIMI心肌灌注分级（TIMI myocardial perfusion grade，TMPG）分为无复流组（TMPG0-2级）和正常血流组（TMPG3级）。无复流组35例，其中男性28例，女性7例，年龄37-81岁（平均年龄63.76±10.40岁）；正常血流组77例，其中男性65例，女性12例，年龄37-85岁（平均年龄58.98±11.59岁）。比较正常血流和无复流两组患者入院时血小板计数、平均血小板体积、血小板分布宽度、纤维蛋白原及超敏C反应蛋白的水平，并分析STEMI患者直接PCI术后无复流现象与以上因素的相关性。所有患者术前均未服用阿司匹林等影响血小板活性的药物，采集病史资料，常规行18导联心电图检查，测量血压，抽取肘静脉血分别送检血常规、凝血常规、肝肾功能、心肌酶和超敏C反应蛋白等。统计学分析采用SPSS19.0软件，所有分析结果均以P＜0.05为差异有统计学意义。结果： 1、两组的基本临床特征：无复流组和正常血流组在性别、体重指数（BMI）、血红蛋白、高血压病史、高脂血症病史、糖尿病病史、吸烟、血脂水平（总胆固醇和甘油三酯）、血液动力学相关数据（心率、收缩压和舒张压）等方面的基本临床资料比较差异均无统计学意义（P＞0.05）；无复流组与正常血流组比较，无复流组年龄大于正常血流组（63.76±10.40岁vs58.75±11.19岁，P＜0.05），从发病至血管开通时间无复流组长于正常血流组（9.40±3.10h vs7.39±3.30h，，P＜0.05），无复流组血糖水平高于正常血流组（10.12±1.87mmol/L vs9.40±1.68mmol/L，P＜0.05），无复流组CK峰值（1849.82±702.88U/Lvs1275.13±539.44U/L，P＜0.05）和CKMB峰值（181.44±67.79U/L vs136.92±49.73U/L，P＜0.05）均明显大于正常血流组。 2、两组冠脉造影特征：两组患者的罪犯冠脉狭窄程度、病变长度、病变部位、参考血管直径等方面比较无显著统计学差异（P＞0.05）；术中两组球囊扩张次数相比，无复流组多于正常血流组（2.41±0.88vs2.07±0.82），差异有统计学意义（P＜0.05）。 3、血小板及炎症相关因子水平比较：结果显示，无复流组PDW水平显著高于正常血流组（16.76±2.17%vs15.06±1.89%，P＜0.05）；无复流组患者入院时MPV水平显著高于正常血流组（11.83±1.22fl vs10.16±1.21fl，P＜0.05）；两组hs-CRP相比，无复流组显著高于正常血流组（30.87±8.84mg/L vs23.45±9.74mg/L，P＜0.05）；无复流组与正常血流组比较，PLT和Fib水平无显著性差异（P＞0.05）。 4、相关性分析：单因素回归分析显示年龄、血糖水平、发病至血管再通时间、MPV、PDW和hs-CRP均是急诊直接PCI术后无复流的影响因素（P＜0.05），但多因素的Logistic回归分析发现，仅发病至血管再通时间（P=0.020，OR=1.47）、PDW（P=0.011，OR=1.70）、MPV（P=0.000，OR=5.93）和hs-CRP（P=0.018，OR=1.10）是PCI术后无复流的独立危险因素。结论：血小板因子PDW、MPV，炎症因子hs-CRP是STEMI患者PCI术后无复流的独立危险因子。
[Abstract]:Objective : To investigate the correlation between acute ST - segment elevation myocardial infarction ( STEMI ) and acute ST - segment elevation myocardial infarction ( STEMI ) in patients with acute ST - segment elevation myocardial infarction ( STEMI ) in acute myocardial infarction ( AMI ) .

Methods : From January 2012 to March 2013 , 112 patients with ST - segment elevation myocardial infarction admitted to the Second Hospital of Hebei Medical University were diagnosed as first - episode ST - segment elevation myocardial infarction . All patients underwent percutaneous coronary intervention after admission . The TIMI myocardial perfusion grade was divided into non - reflow group and normal blood flow group according to TIMI myocardial perfusion grade after PCI . There were 35 males and 7 females , aged 37 - 81 years ( mean age 63.76 卤 10.40 years ) .
There were 77 cases of normal blood flow , including 65 males and 12 females , aged 37 - 85 years ( mean age 58.98 卤 11.59 years ) . The correlation between platelet count , mean platelet volume , platelet distribution width , fibrinogen and hypersensitive C - reactive protein were compared between the two groups .

All patients did not take aspirin or other drugs to influence platelet activity before operation , and collected medical history data . Routine 18 - lead electrocardiogram was used to measure blood pressure . Blood pressure was measured . Blood routine , blood routine , liver and kidney function , myocardial enzyme and hypersensitive C - reactive protein were detected .

Results :

1 . The basic clinical characteristics of the two groups : there was no significant difference in the basic clinical data between no reflow group and normal blood flow group in terms of sex , body mass index ( BMI ) , hemoglobin , hypertension , hyperlipidemia , diabetes history , smoking , blood lipid level ( total cholesterol and triglyceride ) , hemodynamic related data ( heart rate , systolic pressure and diastolic pressure ) ( P > 0.05 ) ;
Compared with the normal blood flow group ( 63.76 卤 10.40 years vs 58.75 卤 11.19 years , P < 0.05 ) , no reflow group was found in the normal blood flow group ( 9.40 卤 3.10h vs 7.39 卤 3.30h , P < 0.05 ) . The peak value of CK ( 1849.82 卤 702.88U / L vs 9.40 卤 1.68mmol / L , P < 0.05 ) and CKMB peak ( 184.44 卤 67.79U / L vs 136.92 卤 49.73U / L , P < 0.05 ) were significantly higher than those in the normal blood flow group .

2 . There was no significant difference in the severity of coronary artery stenosis , lesion length , lesion location and reference vessel diameter between the two groups ( P > 0.05 ) .
Compared with the normal blood flow group ( 2.41 卤 0.88v2.07 卤 0.82 ) , there was significant difference between the two groups ( P < 0.05 ) .

3 . Compared with the normal blood flow group ( 16.76 卤 1.17 % vs 15.06 卤 1 . 89 % , P < 0 . 05 ) , the level of PDW was significantly higher than that in the normal blood group ( 16.76 卤 1.17 % vs 15.06 卤 1 . 89 % , P < 0 . 05 ) .
At the time of admission , the level of mpv was significantly higher than that in the normal group ( 11.83 卤 1.22fl vs 10.16 卤 1.21 fl , P < 0.05 ) .
Compared with the normal blood flow group ( 30.87 卤 8.84mg / L vs 23.45 卤 9.74 mg / L , P < 0.05 ) , there was no significant difference between the two groups .
There was no significant difference between PLT and Fib ( P > 0.05 ) .

4 . Correlation analysis : Single - factor regression analysis showed that age , blood sugar level , duration of onset - to - vessel re - pass , mpv , PDW and hs - CRP were the factors of no reflow after PCI ( P < 0.05 ) , but multivariate logistic regression analysis found that only the time of reperfusion ( P = 0.020 , OR = 1 . 47 ) , PDW ( P = 0.000 , OR = 5.93 ) and hs - CRP ( P = 0 . 018 , OR = 1.10 ) were independent risk factors of no reflow after PCI .

Conclusion :

Platelet factor PDW , MPV , and inflammation factor hs - CRP were independent risk factors of non - complex flow after PCI in STEMI patients .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22

【参考文献】