血清脂蛋白相关磷脂酶A2水平与急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术中无复流的关系研究

Relationship Between Serum Lp-PLA2 Level and Intra- operative No-reflow of ASTEMI Patients Treated by Primary PCI

目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平与急性ST段抬高型心肌梗死(ASTEMI)患者急诊经皮冠状动脉介入(PCI)术中无复流的关系。方法连续选取2013年8月—2014年10月东莞市第三人民医院心内科收治的因ASTEMI住院并行急诊PCI的患者158例,根据急诊PCI术中无复流发生情况分为正常复流组128例和无复流组30例。比较两组患者临床资料,包括年龄、性别、吸烟情况、血压、心率、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、血清Lp-PLA2水平、发病-再灌注时间、入院至球囊扩张时间(D2B)、球囊扩张次数、支架数量、支架长度、血栓抽吸情况、合并其他血管病变情况及冠状动脉〔左前降支(LAD)、右冠状动脉(RCA)、左回旋支(LCX)〕闭塞情况,采用多因素logistic回归分析筛选ASTEMI患者急诊PCI术中无复流的影响因素。结果两组患者年龄、性别、吸烟率、收缩压、舒张压、心率、空腹血糖、LDL-C、D2B、球囊扩张次数、支架数量、支架长度、血栓抽吸率、合并其他血管病变者所占比例及LAD、RCA、LCX闭塞发生率比较,差异无统计学意义(P>0.05);无复流组患者血清Lp-PLA2水平高于正常血流组、发病-再灌注时间长于正常血流组(P<0.05)。多因素logistic回归分析结果显示,血清Lp-PLA2水平〔OR=3.203,95%CI(1.734,5.919)〕、发病-再灌注时间〔OR=8.908,95%CI(3.698,21.464)〕是ASTEMI患者急诊PCI术中无复流的独立危险因素(P<0.05);校正发病-再灌注时间后,多因素logistic回归分析结果显示,血清Lp-PLA2水平是ASTEMI患者急诊PCI术中无复流的独立危险因素〔回归系数=1.160,OR=3.190,95%CI(1.955,5.204),P=0.000〕。结论血清Lp-PLA2水平是ASTEMI患者急诊PCI术中无复流的独立危险因素,早期检测血清Lp-PLA2水平可初步评估PCI术中无复流发生风险。

Objective To explore the relationship between serum Lp-PLA2 level and intra- operative no- reflow of ASTEMI patients treated by primary PCI. Methods A total of 158 ASTEMI patients treated by primary PCI were selected in the Third People＇s Hospital of Dongguan from August 2013 to October 2014,and they were divided into A group（ without intra-operative no- reflow,n = 128） and B group（ without intra- operative no- reflow,n = 30） according to the incidence of intra- operative no- reflow. Clinical data was compared between the two groups, including age, gender, smoking status, blood pressure,heart rate, FBG, LDL-C, serum Lp-PLA2 level, duration between attack and reperfusion, duration between admission and balloon dilatation,times of balloon dilatation,number of stents,length of stents,thrombus aspiration condition,complication of other vasculopathy,occlusion situation of LAD,RCA and LCX,and multivariate logistic regression analysis was used to analyze the influencing factors of intra- operative no- reflow of ASTEMI patients treated by primary PCI. Results No statistically significant differences of age,gender,smoking rate,systolic blood pressure,diastolic blood pressure,heart rate,FBG,LDL-C,duration between admission and balloon dilatation, times of balloon dilatation, number of stents, length of stents,thrombus aspiration rate,proportion of complication of other vasculopathy, occlusion rate of LAD, RCA or LCX was found between the two groups（ P〉0. 05）; while duration between attack and reperfusion of A group was statistically significantly longer than that of B group,serum Lp-PLA2 level of A group was statistically significantly higher than that of B group（ P 〈0. 05）. Multivariate logistic regression analysis showed that,serum Lp-PLA2 level 〔OR = 3. 203,95% CI（ 1. 734,5. 919） 〕,duration between attack and reperfusion 〔OR = 8. 908,95% CI（ 3. 698,21. 464） 〕 were independent risk factors of intra-operative no- reflow of ASTEMI patients treated by primary PCI（ P〈0. 05）; after correction of duration between attack and reperfusion,the multivariate logistic regression analysis showed that,serum Lp-PLA2 level was an independent risk factor of intra- operative no- reflow of ASTEMI patients treated by primary PCI 〔B = 1. 160,OR = 3. 190,95% CI（ 1. 955,5. 204）,P =0. 000〕. Conclusion Serum Lp-PLA2 level is an independent risk factor of intra- operative no- reflow of ASTEMI patients treated by primary PCI,early detection of serum Lp-PLA2 level is helpful to evaluate the risk of intra- operative no- reflow of ASTEMI patients treated by primary PCI.