急性ST段抬高型心肌梗死患者冠脉内血栓类型的研究

发布时间：2018-05-28 18:27

  本文选题：急性心肌梗死 + 抽吸血栓　； 参考：《郑州大学》2017年硕士论文

【摘要】：研究背景冠脉内易损斑块的破裂及继发的血栓形成是急性心肌梗死的主要发病机制。病理学和影像学研究证实冠脉内血栓包括红色血栓和白色血栓。传统的理念是急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者冠脉内形成的是红色血栓。然而,Yasushi等应用光学相干断层成像(Optical coherence tomography,OCT)对40例STEMI患者的罪犯血管进行观察,结果示78%的患者冠脉内形成的是红色血栓,另有22%的患者冠脉内形成的是白色血栓;Quadros等通过肉眼分辨冠脉内抽吸血栓,发现113例STEMI患者的抽吸血栓中31%为白色血栓。介于组织病理学分析是鉴别血栓类型的金标准,且冠脉内血栓抽吸可以较为经济、方便地获取血栓,因此本研究欲通过对抽吸血栓进行病理学分析来鉴别STEMI患者冠脉内是否存在不同的血栓类型。目的探究STEMI患者冠脉内抽吸血栓的病理类型及其构成比;分析影响STEMI患者形成不同类型血栓的相关因素。方法纳入2014年3月至2016年2月在河南省人民医院确诊为STEMI并接受直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者,所有患者均于发病12小时以内接受直接PCI。对入组对象于急诊冠脉造影后行血栓抽吸,并对抽吸血栓行大体病理学观察和组织病理学分析。根据抽吸血栓的组织病理学类型将患者分为红色/混合血栓组与白色血栓组。比较两组患者的临床基线资料、冠脉造影资料及血栓外观。进行单因素及多因素Logistic回归分析,研究影响STEMI患者形成不同血栓病理类型的相关因素。结果对137例STEMI患者于急诊冠脉介入治疗时行血栓抽吸,共获得97例(70.8%)患者抽吸血栓的病理结果。其中红色/混合血栓64例(66%),白色血栓33例(34%)。红色/混合血栓组吸烟的患者多于白色血栓组(P=0.031);红色/混合血栓组患者的总缺血时间明显长于白色血栓组(P=0.013);白色血栓组患者梗死相关动脉(Infraction related artery,IRA)形成侧支循环的比例高于红色/混合血栓组(P=0.001)。红色/混合血栓多表现为灰红色、长条状,白色血栓多表现为灰白色、碎屑状(P0.001);红色/混合血栓的直径(P0.001)和长度(P=0.001)均明显长于白色血栓。多因素Logistic回归结果提示总缺血时间和IRA侧支循环是影响血栓类型的相关因素,其中总缺血时间是形成红色/混合血栓的危险因素(OR:1.741[95%CI,1.203 to 2.520];P=0.003);IRA侧支循环是形成红色/混合血栓的保护因素(OR:0.109[95%CI,0.032 to 0.376];P0.001)。结论STEMI患者冠脉内抽吸血栓中红色/混合血栓约占2/3,白色血栓约占1/3;总缺血时间和侧支循环影响STEMI患者冠脉内血栓类型:随着缺血时间的延长,形成红色/混合血栓可能性增加;无侧枝循环时更容易形成红色/混合血栓,存在侧支循环时更容易形成白色血栓。
[Abstract]:Background rupture of vulnerable plaque and secondary thrombosis are the main pathogenesis of acute myocardial infarction. Pathological and imaging studies confirm that intra-coronary thrombus includes red thrombus and white thrombus. The traditional idea is that red thrombus is formed in the coronary artery of patients with ST-segment elevation myocardial infarction (ST-segment elevation myocardial inflexion) of acute ST-segment elevation myocardial infarction. However, using optical coherence tomography (Oct), Yasushi and others observed the criminal vessels in 40 patients with STEMI. The results showed that 78% of the patients had red thrombosis in their coronary arteries. In the other 22% of the patients, white thrombus was formed in the coronary artery, such as white thrombus Quadros and so on. It was found that 31% of the 113 patients with STEMI were white thrombus. Histopathological analysis is the gold standard for distinguishing the type of thrombus, and coronary artery thrombus aspiration can be more economical and convenient to obtain thrombus. Therefore, the purpose of this study is to identify the different types of thrombus in STEMI patients by pathological analysis. Objective to investigate the pathological types and composition ratio of coronary artery aspiration thrombosis in patients with STEMI, and to analyze the related factors affecting the formation of different types of thrombosis in patients with STEMI. Methods from March 2014 to February 2016, all the patients who were diagnosed as STEMI in Henan Provincial people's Hospital and received direct percutaneous coronary intervention (PCI) were treated with STEMI within 12 hours after the onset of the disease. Thrombus aspiration was performed after emergency coronary angiography, gross pathological observation and histopathological analysis were performed. Patients were divided into red / mixed thrombus group and white thrombus group according to the histopathological types of aspiration thrombus. Clinical baseline data, coronary angiography and thrombus appearance were compared between the two groups. Univariate and multivariate Logistic regression analysis was performed to study the related factors affecting the pathological types of thrombosis in patients with STEMI. Results Thrombus aspiration was performed in 137 patients with STEMI during emergency coronary intervention, and the pathological results were obtained in 97 patients (70.8%). There were 64 cases of red / mixed thrombus and 33 cases of white thrombus. The total ischemic time in red / mixed thrombus group was significantly longer than that in white thrombus group, and in white thrombus group, the infarct related artery (Infraction related artery IRA) formed collateral circulation in the white thrombus group, the total ischemic time in the red / mixed thrombus group was significantly longer than that in the white thrombus group, and the total ischemic time in the red / mixed thrombus group was significantly longer than that in the white thrombus group. The ratio was higher than that in red / mixed thrombus group. The red / mixed thrombus showed grayish red, long stripe, white thrombus was grayish white, and the diameter of red / mixed thrombus was P0.001) and the length of P0. 001) was longer than that of white thrombus. The results of multivariate Logistic regression suggested that the total ischemic time and collateral circulation of IRA were related to the type of thrombus. The total ischemic time was the risk factor for the formation of red / mixed thrombus (OR: 1.741 [95CI1.203 to 2.520] P0.003 / IRA collateral circulation was the protective factor for the formation of red / mixed thrombus (OR0.109 [95CI0.032 to 0.376] P0.001). Conclusion in patients with STEMI, red / mixed thrombus accounts for about 2 / 3, white thrombus accounts for 1 / 3, total ischemic time and collateral circulation affect the type of coronary thrombosis in patients with STEMI. The possibility of forming red / mixed thrombus was increased, and it was easier to form red / mixed thrombus without collateral circulation, and white thrombus was more easily formed in the presence of collateral circulation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22
，

本文编号：1947731