ST段抬高型心肌梗死患者再灌注治疗后心肌微循环损伤的心脏磁共振分析

Cardiac Magnetic Resonance Analysis of Post-reperfusion Myocardial Microcirculation Injury in Cases with ST segment Elevation Myocardial Infarction

目的探讨ST段抬高型心肌梗死(STEMI)患者再灌注治疗后发生心肌微循环损伤的情况。方法运用心脏磁共振(CMR)技术识别再灌注后存在心肌微循环损伤的STEMI患者,通过CMR分析患者的心肌梗死体积/左室体积、微循环阻塞体积/左室体积、微循环阻塞体积/心肌梗死体积、LVEF,结合BNP、肌钙蛋白T等指标,并分成心肌内出血组,仅微循环阻塞组,和无微循环损伤组,进行对比分析,探究这些预后因素与心肌微循环的相关性。结果心肌梗死体积与心肌微循环损伤存在正相关,微循环阻塞体积与心肌内出血正相关,LVEF值与心肌微循环损伤存在相关性。结论心肌梗死体积与心肌微循环损伤存在正相关,心肌梗死体积越大,越可能出现心肌微循环阻塞,甚至心肌内出血。并且心肌微循环阻塞体积越大,越可能存在心肌内出血。

Objective To investigate the occurrence of post-reperfusion myocardial microcirculation injury in cases with ST segment elevation myocardial infarction(STEMI).Methods Post-reperfusion myocardial microcirculation in cases with STEMI were identified by cardiac magnetic resonance(CMR)and based on the analysis of myocardial infarction volume/left ventricular volume,obstruction volume of microcirculation/left ventricular volume,obstruction volume of microcirculation/myocardial infarction volume,LVEF in CMR images plus the analysis of the lab test index including BNP and troponin T,3 groups were set up:intramardial hemorrhage group,microcirculation obstruction group,and non-microcirculation injury group;a comparative analysis was made to explore the correlation between the factors in prognosis and myocardial microcirculation.Results Myocardial infarction volume was in positive correlation to myocardial microcirculation injury,the obstruction volume was positively correlated to intromyocardial hemorrhage;certain correlation existed between the value of LVEF and myocardial microcirculation injury.Conclusions The myocardial infarction volume is positively correlated to myocardial microcirculation injury,bigger volume of myocardial infarction indicates a bigger possibility of the occurrence of myocardial microcirculation obstruction,and even intramyocardial hemorrhage;the larger the myocardial microcirculation obstruction volume is,the more likely intramardial hemorrhage will occur.