急性心肌梗死患者急症经皮冠状动脉介入术后靶血管校正的TIMI帧数与局部心肌收缩功能关系的研究

A study on relationship between corrected TIMI frame count of infarction related artery and systolic function of local myocardium after primary percutaneous coronary intervention in patients with acute myocardial infarction

目的：观察急性心肌梗死（AMI）患者经皮冠状动脉（冠脉）介入术（PCI）后校正的TIMI帧数（CTFC）对梗死区域心肌组织收缩功能的影响。方法选择河北省沧州市中心医院行急症PCI治疗的AMI患者106例，术后测定梗死相关动脉（IRA）的CTFC，将CTFC值偏大者纳入慢血流组，偏小者纳入快血流组，每组53例。于术后6 h内及12、24、48 h测定静脉血肌酸激酶同工酶（CK-MB）水平；于术后1周和1个月、3个月用心脏超声测量左室射血分数（LVEF），并且通过斑点追踪技术（STI）测量梗死区域的径向应变（RS）和纵向应变（LS）水平。比较两组CTFC、CK-MB、RS和LS的差异；并采用Pearson线性相关分析法分析RS、LS与CTFC、CK-MB的相关性。结果术后6 h内快血流组CK-MB高于慢血流组，12 h即出现慢血流组高于快血流组的分离现象，24 h起两组比较差异有统计学意义（U/L：24 h时98.43±11.65比86.43±18.97，48 h时51.09±8.94比49.80±6.92，均P＜0.05）；快血流组CTFC明显低于慢血流组（帧：22.69±4.83比26.14±5.67， P＜0.01）。随访期间，快血流组LVEF均高于慢血流组，但两组比较差异均无统计学意义（P＞0.05）；快血流组RS和LS大于慢血流组，且从术后1个月起两组比较差异就有统计学意义（1个月RS：29.74±6.66比26.86±5.61，LS：-16.37±3.91比-15.27±3.22，3个月 RS：30.03±6.31比27.63±5.67，LS：-17.74±3.96比-15.75±4.17，均P＜0.05）。Pearson直线相关分析显示：CK-MB与RS及LS无相关性（均P＞0.05）；而两组术后1周、1个月、3个月RS及LS与CTFC呈显著正相关性（快血流组CTFC与RS的r值分别为-0.526、-0.515、-0.532，CTFC与LS的r值分别为-0.532、-0.541、-0.572；慢血流组CTFC与RS的r值分别为-0.691、-0.685、-0.702，CTFC与LS的r值分别为-0.621、-0.584、-0.605，均P＜0.01）。结论急症PCI术后CTFC与梗死区域收缩功能的恢复有关，CTFC可以作为预测PCI术后患者长期预后的一项重要指标。

Objective To study the effect of corrected TIMI frame count （CTFC） of infarction related artery on systolic function of infarct area of myocardium after primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods One hundred and six patients with AMI having undergone successful PCI in Cangzhou Central Hospital were selected, and they were divided into two groups （each, 53 cases）. The standard of fast or slow flow was in accord to the CTFC of infarction related artery （IRA） measured soon after successful PCI. The patients with greater value of CTFC were enrolled in the slow flow group, while the patients with smaller such value were assigned in the fast flow group. At 6, 12, 24 and 48 hours after PCI, the venous plasma MB isoenzyme of creatine kinase （CK-MB） level was measured. And at 1 week, 1 month and 3 months after PCI, the left ventricular ejection fraction （LVEF） was measured by cardiac ultrasound, and the levels of radial strain （RS） and longitudinal strain （LS） of the infarct area were measured via speckle tracking imaging （STI）. The differences in CTFC, CK-MB, RS and LS between the two groups were analyzed, and the correlations between the strains and CTFC, CK-MB were analyzed by Pearson linear correlation method. Results After successful PCI, the CK-MB of fast flow group was higher than that of the slow flow group at 6 hours. However, the CK-MB of slow flow group was higher than that of the fast flow group after 12 hours, appearing separate phenomenon, and the statistical significance occurred beginning from 24 hours after PCI （U/L, 24 hours：98.43±11.65 vs. 86.43±18.97, 48 hours：51.09±8.94 vs. 49.80±6.92, both P〈0.05）. CTFC in fast flow group was significantly lower than that of slow flow group （frame： 22.69±4.83 vs. 26.14±5.67, P 〈 0.01）. After 3 months of follow-up, LVEF in fast flow group was higher than that of the slow flow group, but the difference had no significance （P 〉 0.05）. RS and LS in fast flow group were higher than those in slow flow group, and the statistically significant difference appeared from 1 month after PCI （1 month RS：29.74±6.66 vs. 26.86±5.61, LS：-16.37±3.91 vs. -15.27±3.22, 3 months RS： 30.03±6.31 vs. 27.63±5.67, LS： -17.74±3.96 vs. -15.75±4.17, all P 〈 0.05）. Pearson linear correlation showed：the strains （both RS and LS） and CK-MB had no significant relation （both P〉0.05）. Both RS and LS at 1 week, 1 month and 3 months were of significantly positive correlation with CTFC of each group （fast flow group：r value of CTFC and RS was respectively-0.526,-0.515,-0.532, r value of CTFC and LS was respectively-0.532,-0.541,-0.572;slow flow group：r value of CTFC and RS was respectively-0.691,-0.685,-0.702, r value of CTFC and LS was respectively-0.621,-0.584,-0.605, all P〈0.01）. Conclusion CTFC has some relationship with the recovery of the systolic function in area of infarct myocardium after PCI, and can be regarded as an important index to predict the long-term prognosis in patients with AMI.