急性心肌梗死患者CRP、MPV水平与急诊介入术中无复流的关系研究

Relationship among CRP,MAP levels and no-reflow during emergency PCI in patients with acute myocardial infarction

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者C反应蛋白(CRP)、血小板平均容积(MPV)水平与直接经皮冠脉介入治疗(PCI)术中无复流(NR)发生的关系。方法:回顾性分析2015年1月至2016年12月156例STEMI患者行直接PCI的临床和影像资料。根据术中是否发生NR,患者被分为NR组(54例)和无NR对照组(102例)。多因素Logistic回归分析NR发生的影响因素。结果:与无NR对照组比较,NR组糖尿病比例(23.5%比42.6%)、CRP[(31.7±5.3)mg/L比(64.5±9.7)mg/L]和MPV水平[(9.31±1.05)fl比(11.29±0.98)fl]均显著升高,支架数[(1.9±0.4)枚比(2.1±0.6)枚]显著增多,症状至球囊扩张时间[(254±96)min比(315±108)min]显著延长,P<0.05或<0.01。多因素Logistic回归分析显示,糖尿病、症状至球囊扩张时间、CRP、MPV水平是NR发生的独立危险因素(OR=2.335～3.670,P<0.05或<0.01)。结论:C反应蛋白、血小板平均容积升高是STEMI患者直接PCI术中发生无复流的独立危险因素,对于无复流的发生具有一定的预测价值,值得推广。

Objective：To explore relationship among levels of C reactive protein（CRP）,mean platelet volume（MPV）and occurrence of no-reflow（NR）during primary percutaneous coronary intervention（PCI）in patients with acute ST elevation myocardial infarction（STEMI）.Methods：Clinical and imaging data of 156 STEMI patients,who received primary PCI from Jan 2015 to Dec 2016,were retrospectively analyzed.According to presence of NR during PCI,patients were divided into NR group（n=54）and no NR control group（n=102）.Multi-factor Logistic regression analysis was used to analyze influencing factors of NR occurrence.Results：Compared with no NR control group,there were significant rise in percentage of diabetes mellitus（23.5% vs.42.6%）,levels of CRP[（31.7±5.3）mg/Lvs.（64.5±9.7）mg/L]and MPV [（9.31±1.05）fl vs.（11.29±0.98）fl],number of stents[（1.9±0.4）vs.（2.1±0.6）]and symptom-onset-to-balloon[SOTB,（254±96）min vs.（315±108）min]in NR group,P〈0.05 or0.01.Multi-factor Logistic regression analysis indicated that diabetes mellitus,SOTB,levels of CRP and MPV were independent risk factors for NR occurrence（OR=2.335～3.670,P〈0.05 or0.01）.Conclusion：Rise of CRP and MPV levels are independent risk factors for no-reflow during primary PCI in STEMI patients,which possess certain predictive value for no-reflow occurrence and worth extending.