影响经皮冠状动脉介入治疗术后心肌酶及炎症指标变化的多因素研究

Multivariate Analysis of Cardiac Enzyme and Inflammatory Factor Fluctuation After Selective Percutaneous Coronary Intervention

目的:分析对于择期经皮冠状动脉介入治疗(PCI)术后心肌酶及炎症指标有显著影响意义的危险因素。方法:对2007-03至2007-09于我院心内科行择期经皮冠状动脉介入治疗的冠心病患者178例术后12～24小时取血查肌酸激酶(CK),肌酸激酶MB同工酶(CK-MB),心肌肌钙蛋白T(cTnT)以及高敏C反应蛋白(hsCRP)。结果:共178例入选。其中CK-MB增高27例(15.2%),cTnT增高44例(24.7%),hsCRP升高66例(37.1%)。Lo-gistic多元回归分析显示:对CK-MB值增高有显著影响的因素为:左心室射血分数(P=0.0223);术中出现心肌梗死溶栓治疗临床试验(TIMI)血流<3级(P=0.0250)。对cTnT值增高有显著影响的因素为:既往冠状动脉旁路移植术(CABG)史(P=0.0203)。对hsCRP值增高有显著影响的因素为:使用钙离子拮抗剂类药物(P=0.0340);左心室射血分数(P=0.0504);支架离散度(P=0.0465)。结论:左心室射血分数降低,术中出现TIMI血流<3级,是造成择期冠状动脉介入治疗术后心肌酶增高的独立危险因素,既往冠状动脉旁路移植术史是造成择期冠状动脉介入治疗术后cTnT增高的独立危险因素。左心室射血分数降低,支架离散度增加是造成择期冠状动脉介入治疗术后hsCRP增高的独立危险因素。使用钙离子拮抗剂类药物可以使增高的hsCRP降低,可能对患者的预后有益处。

Objective ： To investigate the risk factors for cardiac enzyme and inflammatory factor elevation after selective percutaneous coronary intervention（PCI）. Methods ：This study included 178 patients who underwent PCI from March 2007 to September 2007 in our Hospital. Blood creatin kinase （CK） , MB isoenzyme of creatine kinase （CK-MB）, cardiac troponin T（cTnT） and high sensitivity C-reactive protein （hsCRP） were analyzed 12-24 hours after PCI. Results： In this study,27 patieuts （15 % ）showed C K-MB elevation after PCI,44 patients （24. 7% ） had cTnT elevation and 66 patient（37.1% ） had hsCRP elevation after selective PCI respectively. The muhivariate logistic regression and stepwise selec- tion analysis showed that left ventricular ejection fraction （LVEF） （P = 0. 0223 ） and thrombolysis in myoxardial infarction trial （TIMI） flow 〈 3 （ P = 0. 0250 ） were independent risk factors of CK-MB elevation after the procedure ; the history of coronary artery bypass grafting （CABG） was the risk factor of cTnT elevation （ P = 0. 0203 ） ; calcium-channel blocker （ CCB ） usage （ P = 0. 0340）, LVEF （P =0. 0504 ） and the diversity of stents＇ length （P = 0. 0465 ）were the risk factors for hsCRP elevation. Conclusion： The patients who had decreased LVEF,TIMI flow 〈 3 during the procedure were the independent risk factors for cardiac enzyme elevation after selective PCI; the history of CABG was the independent risk factor for cTnT elevation; decreased LVEF and increased diversity of stents＇ length were the independent risk factors for hsCRP elevation. CCB therapy may decrease the elevated hsCRP and it might be beneficiary for the patients＇ prognosis after selective PCI treatment.