代谢综合征与急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后无复流现象的关系

Relationship between Metabolic Syndrome and No-reflow Phenomenon in Pa⁃tients with ST-Segment Elevation Myocardial Infarction after Primary Percu⁃taneous Coronary Intervention

目的探索代谢综合征(metabolic syndrome,MS)与急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉介入(primary percutaneous coronary intervention,pPCI)治疗后无复流现象(no-reflow phenomenon,NRP)的关系以及常见交集。方法本研究为多中心前瞻性队列研究,研究人群为《pPCI治疗后定量血流分数及微循环阻力指数对急性STEMI患者预后评估的应用价值》课题患者。入选2019年1月至2021年12月在广东省人民医院、揭阳市中心医院和广东省人民医院珠海医院因STEMI行pPCI治疗的(n=585例)患者,筛除64例数据收集不齐全患者,最终纳入521例患者。根据是否合并MS分为MS(+)组和MS(-)组,比较两组患者的临床资料及NRP发生率。MS的定义是基于国家胆固醇教育计划(NCEP)成人高血胆固醇检测、评估和治疗专家小组(成人治疗小组Ⅲ)的定义。结果本研究共纳入521例患者,其中61例(11.8%)合并MS,发现有11种类型的MS,其中原发性高血压+高三酰甘油血症+糖尿病占所有MS交集的36.1%,为最常见交集。MS(+)组患者NRP的发生率明显高于MS(-)组,差异有统计学意义[31.1%(19/61)vs.16.3%(75/460),χ^(2)=8.025,P=0.005]。结论MS增加急性STEMI患者行pPCI治疗后NRP的发生率,原发性高血压+高三酰甘油症+糖尿病是最常见交集。

Objectives To explore the correlation between metabolic syndrome(MS)and no-reflow phenomenon(NRP)in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(pPCI)and the most common intersection of MS.Methods This study was conducted in a multicenter prospective cohort of patients with the application of quantitative blood flow fraction and microcirculation resistance index in the prog⁃nosis assessment of patients with acute STEMI after pPCI.From January 2019 to December 2021 in Guangdong Provincial People′s Hospital,Jieyang Central Hospital and Guangdong Provincial People′s Hospital Zhuhai Hospita,585 pateints with STEMI who received pPCI were collected,winnowing out 64 patients with incomplete data collection,finally including 521 patients.According to whether mixed with MS,the patients were divided into MS(+)group and MS(-)group.The clinical data and the NRP rate were compared between the two groups.The definition of MS was based on the definition of the National Cholesterol Education Program Expert Panel on Adult High Blood Cholesterol Detection,Evaluation,and Treatment(Adult Treatment PanelⅢ).Results A total of 521 patients were included in this study,of which 61(11.8%)were mixed with MS.Eleven types of MS were found,among which hypertension+hypertriglyceridemia+diabetes was the most common as accounted for 36.1%of all MS intersections.The NRP rate of MS(+)group was significantly higher than that of MS(-)group[31.1%(19/61)vs.16.3%(75/460),χ^(2)=8.025,P=0.005].Conclusions MS increases the NRP rate in patients with acute STEMI after pPCI.Hypertension+hypertriglyceridemia+diabetes is the most common intersection of MS.