临床医学精神应激在AMI直接PCI后非梗死相关动脉病变进展中的作用

Impact of Mental Stress on Non-Culprit Lesions Progression in Patients with ST Elevation Myocardial Infarction after Primary PCI

目的:探讨接受直接经皮冠脉介入治疗(PCI)治疗的ST段抬高型心肌梗死(STEMI)患者静脉儿茶酚胺水平与非梗死相关动脉病变进展的相关性研究的关系。方法:直接PCI治疗的急性STEMI患者492例,分为研究组:45例患者,接受了临床驱动的非梗死相关动脉病变PCI治疗;对照组:447例患者,未接受PCI治疗。进行12个月临床和造影随访。主要终点:临床驱动的非梗死相关动脉PCI。测定血清儿茶酚胺水平和血清C-反应蛋白(CRP)水平,并与非梗死相关动脉狭窄程度进行相关性分析。结果:对492例患者12个月的临床和造影随访显示,两组患者在血清儿茶酚胺水平,血清CRP水平,血清肌钙蛋白I(cTnI)峰值方面均有显著性差异(P<0.05)。非梗死相关动脉病变狭窄程度与血清肾上腺素水平、血清去甲肾上腺素水平、血清CRP水平、和血清cTnI峰值的相关性分析显示,血清肾上腺素水平、血清去甲肾上腺素水平、血清CRP水平、以及血清cTnI峰值与非梗死相关动脉病变的狭窄程度存在显著的相关性(P<0.01)。结论:精神应激和炎症机制可能涉及非梗死相关动脉病变进展。

Objective： To investigate receive direct percutaneous coronary intervention（PCI） treatment of ST-segment elevation myocardial infarction（STEMI） in patients with venous catecholamine levels with non-infarct-related artery lesions progress to study the correlation relationship.Methods： Treatment of primary PCI for acute STEMI patients with 492 cases,divided into study group： 45 patients patients underwent clinical driven non infarct-related artery lesions treated with PCI;control group： 447 patients did not undergoing PCI treatment.For 12-month clinical and angiographic follow-up.The primary endpoint： Clinical-driven non-infarct-related artery PCI.Serum catecholamine levels and serum C-reactive protein（CRP） level,and with non-infarct-related artery stenosis correlation analysis.Results： 12-month on 492 cases of patients with clinical and angiographic follow-up showed that serum catecholamine levels in two groups of patients,serum CRP levels,serum troponin I（cTnI） peak areas were significant differences（P＆lt;0.05）.Non-culprit lesion stenosis and serum levels of epinephrine,norepinephrine levels in serum,serum CRP levels,and serum cTnI peak correlation analysis showed that serum levels of epinephrine,norepinephrine levels in serum,serum CRP levels,and serum cTnI peak and non-culprit lesion stenosis there was a significant correlation（P＆lt;0.01）.Conclusions： Patients with acute STEMI PCI again directly after PCI was mainly due to non-infarct-related artery lesions progress actions,progress in non-culprit lesions may involve mental stress and inflammatory mechanisms.