绝经后内源性雌激素水平与急性ST段抬高型心肌梗死患者心肌再灌注后无复流的关系

Relationship Between Endogenous Estrogen Level and Myocardial No-reflow After Reperfusion in Postmenopausal Acute ST-elevation Myocardial Infarction Patients

目的:探讨绝经后内源性雌激素水平与急性ST段抬高型心肌梗死(STEMI)患者心肌再灌注后无复流的关系。方法:共纳入绝经后女性STEMI行急诊经皮冠状动脉介入治疗(PCI)的患者100例,根据心肌再灌注后有无复流发生分为复流组77例和无复流组23例。心肌无复流定义为心肌再灌注后心肌梗死溶栓治疗临床试验(TIMI)血流≤2级或TIMI血流3级且心肌呈色分级(MBG)≤2级。所有患者均术前抽血检测内源性性激素水平。Logistic回归分析内源性性激素水平与心肌再灌注后无复流之间的关系。结果 :与复流组相比,无复流组雌酮、雌二醇和高敏C-反应蛋白(hs-CRP)水平明显升高(P<0.05),而性激素结合球蛋白(SHBG)水平则降低(P<0.05)。单因素分析结果提示病灶长度、血栓负荷评分≥4分、雌酮、雌二醇和hs-CRP水平与心肌再灌注后无复流发生呈正相关(P<0.05)。进一步的多因素Logistic回归分析表明血栓负荷评分≥4分(OR=4.994,95%CI:1.987~10.518,P=0.035)和雌二醇水平(OR=4.091,95%CI:1.105~8.582,P=0.046)是心肌再灌注后无复流发生的独立危险因素。结论 :在绝经后女性STEMI患者中,高水平内源性雌二醇和心肌再灌注后无复流的发生呈正相关,提示内源性雌二醇可能是心肌再灌注后无复流发生的独立危险因素。

Objective： To explore the relationship between endogenous estrogen level and myocardial no-reflow after reperfusion in postmenopausal acute ST-elevation myocardial infarction （STEMI） patients. Methods： A total of 100 postmenopausal STEMI patients with percutaneous coronary intervention （PCI） were enrolled and divided into 2 groups： Reflow group,n=77 and No-reflow group,n=23. Myocardial no-reflow was defined by TIMI≤2 grade or TIMI 3 grade and MBG≤2 grade after PCI. Blood levels of endogenous estrogen were examined before PCI; the relationship between endogenous estrogen level and myocardial no-reflow was assessed by Logistic regression analysis. Results： Compared with Reflow group, No-reflow group showed increased blood levels of estrone, estradiol, high sensitivity C-reaction protein （hs-CRP）,P〈0.05 and decreased sex hormone binding globulin （SHBG）,P〈0.05. Univariate analysis indicated that the length of lesion, thrombus score≥4, blood levels of estrone, estradiol and hs-CRP were positively related to no-reflow occurrence,P〈0.05. Multi Logistic regression analysis presented that thrombus score≥4 （OR=4.994, 95%CI 1.987-10.518,P=0.035） and estradiol level （OR=4.091, 95% CI 1.105-8.582;P=0.046） were the independent risk factors for no-reflow occurrence. Conclusion： High blood level of endogenous estrogen was positively related to myocardial no-reflow after PCI in＆nbsp;postmenopausal STEMI patients, which implied that endogenous estrogen might be the independent risk factor for no-reflow occurrence.