糖化血红蛋白对直接冠状动脉介入术后心肌组织灌注的影响

Effect of glycosylated hemoglobin on myocardial tissue perfusion inpatients with acute myocardial infarction undergoing primarypercutaneous coronary intervention

目的:观察糖化血红蛋白(HbA1c)水平对急性心肌梗死(AMI)患者接受直接冠状动脉介入(PCI)术后心肌组织灌注的影响。方法:选择因AMI行直接PCI的患者492例,根据HbA1c水平将所有患者分为HbA1c≥6.5%组189例和HbA1c<6.5%组(对照组)303例。通过观察TIMI心肌灌注(TMP)分级、心肌blush分级(MBG)及术后ST段回落率(STR),评价2组患者的术后心肌组织灌注及预后。结果:与对照组比较,HbA1c≥6.5%组的病变血管数、术中出现无复流/慢血流比例、住院期间病死率及梗死相关动脉开通时间显著增加,而术后达到TIMI血流3级、MBG 3级、TMP 3级和STR的比例及LVEF均明显降低(均P<0.05)。多因素分析结果显示,HbA1c≥6.5%是影响术后STR(OR=2.156,95%CI:1.057～4.328,P=0.036)及住院期间病死率(OR=1.021,95%CI:0.418～2.412,P=0.022)的独立危险因素。结论:HbA1c升高的AMI患者心肌组织灌注较差,住院期间病死率高。应重视这些高危患者,并尽早处理,从而改善患者的预后。

Objective：To investigate the effect of glycosylated hemoglobin （HbAlc） on myocardial tissue per-fusion in patients with acute myocardial infarction （AMI） during primary percutaneous coronary intervention （PCI）. Method： A total of 492 patients with AMI undergoing primary PCI were enrolled and divided into HbAlc≥ 6.5% group and HbAlc〈6.5% group （control group）. The TIMI myocardial perfusion （TMP） grade, myocar-dial blush grade （MBG） and ST-segment resolution （STR） were recorded. Result：Compared with control group, the number of diseased vessels, the no reflow/slow flow ratio, the in-hospital mortality and the opening time of infraction-related arteries were significantly higher, while the rate of TIMI flow 3 grade, MBG 3 grade, TMP 3 grade, STR post intervention and LVEF were lower in the HbAlc≥6.5% group（all P〈0.05）. Logistic analysis showed that HbAlc≥6.5%0 was an independent risk factor for STR （OB=2. 156, 95%CI： 1. 057-4. 328, P= 0. 036） and in-hospital mortality （OR= 1. 021, 95%CI： 0. 418-2. 412,P=0. 022）. Conclusion：The high level of HhAlc is a predictor of poor myocardial tissue perfusion after PCI in patients with AMI. Patients with high HbAlc should be paid more attention and treated early to improve the prognosis.