血小板—淋巴细胞聚集体在缺血后适应减少STEMI患者心肌无复流中的作用

发布时间：2018-10-14 13:01

【摘要】：目的:观察血小板-淋巴细胞聚集体(Platelet-lymphocytic aggregation,PlyA)在ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊介入术后心肌无复流(Myocardial no reflow,MNR)的作用,并进一步探讨缺血后适应(Ischemic postconditioning,IPost C)对Ply A水平的影响。方法:(1)纳入于青岛大学附属烟台毓璜顶医院就诊的初发STEMI并行急诊经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)的患者93例,同期收集健康体检者50例,使用流式细胞检测技术对两组Ply A水平进行检测,比较两组Ply A表达水平的差异;(2)将93例STEMI患者随机分为缺血后适应(IPost C)组和正常手术组,IPost C组于完全闭塞冠脉再通后1min内在病变处应用低气压充盈60s和灌注60s为一个循环,共循环4次,然后再植入支架。正常手术组除了IPost C操作外,其余与IPost C组相同,观察两组MNR的发生率。(3)两组分别于PCI术前、PCI术后即刻及术后3天采集外周静脉血,应用流式细胞检测技术对两组Ply A水平进行检测,比较两组Ply A水平。MNR定义为病变冠脉经造影证实不存在解剖性狭窄及血管痉挛,冠脉TIMI血流分级≤2级。结果:(1)与正常组相比,STEMI组冠心病危险因素(如高血压、糖尿病、吸烟等)、血白细胞总数、血小板总数明显高于对照组(P0.05),Ply A水平也显著高于对照组(P0.01)。单因素回归分析显示:高血压、糖尿病、血小板总数、白细胞总数及术前Ply A水平均与STEMI的发生呈正相关。校正这些因素后,白细胞总数(OR=2.04,CI1.54-2.78;P0.001)及术前Ply A水平(OR=1.32,CI1.10-1.56;P=0.002)仍与STEMI的发生呈强正相关。(2)PCI术后,共计24例(25.8%)STEMI患者发生MNR。复流组与无复流组在年龄、冠心病危险因素(如高血压、糖尿病、吸烟、高脂血症)、超敏肌钙蛋白I、CK-MB峰值水平及既往用药方面均无统计学差异。与复流组相比,无复流组术前Ply A水平显著升高(P0.001),且血栓负荷评分较高(P0.001),病变长度较长(P=0.002),具有统计学意义。单因素回归分析显示,术前Ply A水平、病变长度及血栓负荷评分≥4与心肌无复流的发生相关(P0.05)。进一步的多因素Logistic分析表明:血栓负荷评分≥4(OR=23.26,CI1.09-41.67;P=0.048)及术前Ply A水平(OR=1.69,CI1.03-2.78;P=0.036)是MNR的独立危险因子。(3)IPost C组与正常手术组患者术前Ply A水平之间无差异(P=0.742)。与正常手术组相比,IPost C组术后即刻及术后3天Ply A水平有明显降低趋势,但无统计学差异。(4)与正常手术组相比,IPost C组无复流的发生率明显下降(P=0.021),具有统计学意义。结论:(1)与正常人相比,STEMI患者Ply A水平显著升高,表明高水平的Ply A与STEMI的发生呈正相关。(2)与复流组相比,无复流组Ply A水平显著升高,表明术前高水平Ply A能够预测MNR的发生,可作为MNR的独立危险因素。(3)IPost C组无复流发生率明显降低,表明IPost C能减少MNR的发生,具有心脏保护作用。且IPost C组比正常手术组Ply A水平有明显下降趋势,但无统计学意义。
[Abstract]:Objective: to observe the effect of platelet lymphocyte aggregates (Platelet-lymphocytic aggregation,PlyA) on myocardial non-reflow (Myocardial no reflow,MNR in patients with ST segment elevation myocardial infarction (ST-segment elevation myocardial infarction,STEMI), and to investigate the effect of Ischemic postconditioning,IPost C on Ply A level. Methods: (1) 93 patients with primary STEMI treated with emergency percutaneous coronary intervention (Percutaneous coronary intervention,PCI) were enrolled in Yantai Yuzhouding Hospital affiliated to Qingdao University. Flow cytometry was used to detect the level of Ply A in two groups. The difference of Ply A expression between the two groups was compared. (2) 93 patients with STEMI were randomly divided into (IPost C) adaptation group and normal operation group. 60 s of low pressure filling and 60 s perfusion of 1min were used as a circulation in the internal lesion of 1min after total occlusion coronary artery recanalization. A total of 4 cycles, and then the stent implantation. The incidence of MNR in the normal operation group was the same as that in the IPost C group except the IPost C operation. (3) Peripheral venous blood was collected before, immediately after PCI and 3 days after PCI in the two groups. The level of Ply A in the two groups was detected by flow cytometry, and the level of Ply A was compared between the two groups. MNR was defined as the absence of anatomic stenosis and vasospasm in the diseased coronary artery proved by angiography, and the grade of coronary TIMI blood flow was 鈮，

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