STEMI患者PCI术后心肌组织灌注的相关影响因素及其对心肌组织灌注不良的预测价值

Influencing factors of myocardial tissue perfusion in STEMI patients after PCI and their predictive value for poor myocardial tissue perfusion

目的分析210例ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后心肌组织灌注的相关影响因素。方法选取2020年5月至2021年1月许昌市人民医院收治的210例行PCI术STEMI患者,按照PCI术后心肌组织灌注状况分为灌注不良组(n=36)、灌注良好组(n=174),对比两组左室射血分数(LVEF)、血清相关指标[CX3C趋化因子配体1(CX3CL1)、超敏C反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-pro BNP)]等基线资料、PCI术相关情况、PCI术后效果[心肌梗死溶栓试验(TIMI)血流分级、MBG(心肌blush分级)、TMP(TIMI心肌组织灌注分级)达3级率],并分析术后心肌灌注不良的危险因素。结果灌注良好组糖尿病病例占比、再灌注时间、血清CX3CL1、血清hs-CRP低于灌注不良组(P<0.05);灌注良好组PCI术中慢血流/无复流及应用替罗非班占比低于灌注不良组(P<0.05);灌注良好组TIMI血流、TMP灌注、MBG灌注达3级率均大于灌注不良组(P<0.05);糖尿病(有)、再灌注时间(≥4.95 h)、血清CX3CL1(≥2011.62 ng/m L)、血清hs-CRP(≥5.40 mg/L)、冠状动脉内应用替罗非班、术中慢血流/无复流是STEMI患者PCI术后心肌灌注不良的危险因素(P<0.05),LVEF(≥59.45%)是PCI术后心肌灌注不良的保护因素(P<0.05);再灌注时间、LVEF、血清CX3CL1、血清hs-CRP联合预测心肌组织灌注不良的AUC值为0.945,且灵敏性91.67%、特异性85.06%均较高。结论STEMI患者PCI术后再灌注时间、LVEF、血清CX3CL1、血清hs-CRP等多种因素联系密切,关注相关影响因素对患者心肌组织灌注恢复及预后改善具有积极作用。

Objective To analyze the influencing factors of myocardial tissue perfusion after percutaneous coronary intervention(PCI)in 210 patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 210STEMI patients who underwent PCI in Xuchang People’s Hospital from May 2020 to January 2021 were selected and divided into poor perfusion group(n=36)and good perfusion group(n=174)according to the myocardial tissue perfusion status after PCI.The left ventricular ejection fraction(LVEF),serum related parameters[CX3C chemokine ligand 1(CX3CL1),high-sensitivity C-reactive protein(hs-CRP),N-terminal pro-brain natriuretic peptide(NT-proBNP)],PCI related conditions,and PCI postoperative effect[thrombolysis in myocardial infarction test(TIMI)blood flow score,MBG(myocardial blush grade),TMP(TIMI myocardial tissue perfusion grade)grade 3 rate]were compared between the two groups,and the risk factors of postoperative myocardial poor perfusion were analyzed.Results The proportion of diabetes cases,reperfusion time,serum CX3CL1 and serum hs-CRP in the good perfusion group were lower than those in the poor perfusion group(P<0.05).The proportion of slow flow/no reflow and tirofiban in PCI in the good perfusion group was lower than that in the poor perfusion group(P<0.05).The rate of TIMI blood flow,TMP perfusion and MBG perfusion reaching grade 3 in the good perfusion group were higher than those in the poor perfusion group(P<0.05).Diabetes mellitus(yes),reperfusion time(≥4.95 h),serum CX3CL1(≥2011.62 ng/mL),serum hs-CRP(≥5.40 mg/L),intracoronary tirofiban,intraoperative slow flow/no reflow were risk factors for poor myocardial perfusion after PCI in STEMI patients(P<0.05),and LVEF(≥59.45%)was protective factor for poor myocardial perfusion after PCI(P<0.05).The AUC value of the combination of reperfusion time,LVEF,serum CX3CL1 and serum hs-CRP in predicting myocardial tissue malperfusion was 0.945,with a high sensitivity of91.67%and specificity of 85.06%.Conclusion Reperfusion time,LVEF,serum CX3CL1,serum hs-CRP and other factors are closely related in STEMI patients after PCI.Paying attention to related influencing factors has a positive effect on the recovery of myocardial tissue perfusion and the improvement of prognosis.