急性 ST 段抬高型心肌梗死患者冠状动脉介入术后心肌灌注影响因素分析

Influence factors of myocardial perfusion in patients with ST-segment myocardial infarction after primary percutaneous coronary intervention

目的：探讨急性 ST 段抬高型心肌梗死（STEMI）患者行经皮冠状动脉介入治疗（PCI）术后心肌灌注不良的影响因素。方法对2010年4月至2014年5月住院的首次发作的、并于12 h 内行直接PCI 术的 STEMI 患者143例临床资料进行回顾分析。根据直接 PCI 手术前、后心电图的 ST 段抬高总和回落百分比（sumSTR）和 TIMI 心肌灌注分级（ TMP），将患者分为心肌灌注良好组（ sumSTR≥50%或TMP 2、3级）和心肌灌注不良组（sumSTR ＜50%并且 TMP 0、1级），对两组患者的性别、年龄、发病至球囊开通时间、入院时血压、左心室射血分数、外周血白细胞计数、中性粒细胞比例（NR）、超敏 C 反应蛋白（hs-CRP）、血脂水平及既往高血压、糖尿病病史等进行比较分析。结果（1）心肌灌注不良组患者与心肌灌注良好组相比，WBC 计数[（11.60±3.57）×109/ L 与（9.51±2.59）×109/ L，t =3.497，P =0.001]、NR（0.84±0.06与0.77±0.11，t =3.390，P =0.001）及 hs-CRP[（9.80±11.37）mg/ L 与（3.83±5.58） mg/ L，t =3.973、P ＜0.001]均明显升高，差异有统计学意义。（2）多元逐步回归分析显示，NR 是影响直接 PCI 心电图 sumSTR 的独立危险因素（P =0.000）。结论 WBC 计数、NR 及 hs-CRP 升高与患者直接PCI 术后心肌灌注不良有关；NR 升高是心肌灌注不良的独立危险因素。

Objective To explore the influence factors of poor myocardial perfusion in patients with ST-segment elevation myocardial infarction( STEMI) after primary percutaneous coronary intervention(PCI). Methods One hundred and forty-three patients with first STEMI who were on admission from April 2010 to May 2014 and underwent primary PCI within 12 hours were enrolled as our subjects. According to the sum-ST-segment resolution(sumSTR)and TIMI myocardial perfusion grade(TMP)after primary PCI,all patients were divided into well myocardial perfusion group( sumSTR ≥ 50% or TMP 2 - 3 grade)and poor myocardial perfusion group(sumSTR < 50% and TMP 0 - 1 grade). The influence factors between two groups were collected and analyzed,including sex,age,pain to balloon time,blood pressure on admission,left ventricular ejection fraction,leucocyte count,neutrophil ratio(NR),high-sensitivity C-reactive protein(hs-CRP),blood lipid,and the history of hypertension,diabetes mellitus. Results The leucocytes count,NR,hs-CRP in patients of poor myocardial perfusion group were(11. 60 ± 3. 57)× 109 / L,0. 84 ± 0. 06 and 9. 80 ± 11. 37 mg/ L,higher than those in well myocardial perfusion group((9. 51 ± 2. 59)× 109 / L,0. 77 ± 0. 11 and(3. 83 ± 5. 58)mg/ L),and the differences were significant(t = 3. 497,P = 0. 001;t = 3. 390,P = 0. 001;t = 3. 973,P < 0. 001). Multiple linear regression analysis showed that neutrophil ratio was independent risk factor of sumSTR in STEMI patient after primary PCI(P = 0. 000). Conclusion The increase of leucocyte count,NR and hs-CRP are related to the poor myocardial perfusion after primary PCI. The increase of neutrophil ratio is an independent risk factor of poor myocardial perfusion.