急性心肌梗死介入治疗无复流过氧亚硝酸阴离子变化及危险因素分析

Assessment of peroxynitrite and impact factors in patients with no-reflow phenomenon after percutaneous coronary intervention.

目的探讨急性心肌梗死(AMI)患者行冠状动脉介入术(PCI)后发生无复流的患者血浆中过氧亚硝酸阴离子变化及相关危险因素分析。方法选取沈阳医学院沈洲医院2006年6月至2008年12月因AMI行急诊PCI治疗的患者,根据PCI术后造影结果分为无复流组和正常血流组,均为22例。所有入选者术前及术后24 h、72 h采集外周静脉血,进行心肌型肌酸激酶同工酶(CK-MB),肌钙蛋白T(cTnT)测定,并行酶联免疫分析法检测血浆中硝基化酪氨酸(NT)变化。记录一般临床特征和冠状动脉造影指标。结果无复流组在发病到再灌注时间上明显长于正常血流组(P<0.05),在Q波型梗死,多支血管病变,弥漫性病变,PCI前TIMI血流≤1级等方面明显多于正常血流组(P<0.05);正常血流组患者梗死前心绞痛发病率明显高于无复流组(P<0.05)。无复流组NT在术后24 h高于正常血流组(P<0.05)。发病到再灌注时间,Q波型梗死,PCI前TIMI血流≤1级,弥漫性病变是无复流发生的独立危险因子,而梗死前心绞痛为保护性因子。结论与无复流发生密切相关的临床因素有发病到再灌注时间,Q波型梗死,弥漫性病变和PCI前TIMI血流≤1级;而梗死前心绞痛为保护性因素。

Objective Assessment of peroxynitrite and impact factors in patients with no-reflow phenomenon after percutaneous coronary intervention. Methods The study population consisted of patients with acute myocardial infraction （AMI） referred to PCI,in from June 2006 to December 2008. noreflow group had 22 cases and normal flow group had 22 cases. The levels of plasma nitrotyrosine （NT）was assessed by enzemy-linked immunosobent assay. The collection of parameters were respectively completed in two groups. Results The time intervals from AMI onset to infarct-related arteries （IRA） flow longer in no-reflow group than normal flow group （ P 〈 0.05 ） ; and the rate of Q waves myocardial infraction, multivessel lesions, diffuse lesions, antegrade flow prior to PCI ≤ TIMI 1 grade significantly higher than normal flow group（P 〈 0. 05 ） ; per-infarction angina less in no-reflow group ; the levels of NT in noreflow group higher than that in normal flow group at 24 h after PCI（P 〈 0. 05）. The independent risk factors for no-reflow were the time intervals from AMI onset to IRA, Q waves myocardial infraction, diffuse lesions, antegrade flow prior to PCI ≤ TIMI 1 grade, and perinfarction angina was an independent protective factors. Conclusion The impact factors of no-reflow phenomenon were the time intervals from AMI onset to IRA, Q waves myocardial infraction, diffuse lesions, antegrade flow prior to PCI ≤ TIMI 1 grade, and per-infarction angina was independent protective factors.