本文選題：急性ST段抬高型心肌梗死 + 無(wú)復(fù)流��； 參考：《河北醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：通過(guò)研究急性ST段抬高型心肌梗死（acute ST-segment elevationmyocardial infarction，STEMI）患者急性期血小板計(jì)數(shù)（PLT）、平均血小板體積（MPV）、血小板分布寬度（PDW）、纖維蛋白原（FIB）及超敏C反應(yīng)蛋白（hsCRP）水平與急診冠脈介入治療后心肌灌注（myocardialperfusion）水平的相關(guān)性，探討血小板及炎癥相關(guān)因子對(duì)急性心肌梗死患者介入治療后發(fā)生無(wú)復(fù)流現(xiàn)象的預(yù)測(cè)價(jià)值。 方法：選取2012年1月至2013年3月收治于河北醫(yī)科大學(xué)第二醫(yī)院心血管內(nèi)科的112例診斷為首次發(fā)作的ST段抬高型心肌梗死患者，所有患者于入院后直接行經(jīng)皮冠脈介入治療，根據(jù)直接PCI術(shù)后TIMI心肌灌注分級(jí)（TIMI myocardial perfusion grade，TMPG）分為無(wú)復(fù)流組（TMPG0-2級(jí)）和正常血流組（TMPG3級(jí)）。無(wú)復(fù)流組35例，其中男性28例，女性7例，年齡37-81歲（平均年齡63.76±10.40歲）；正常血流組77例，其中男性65例，女性12例，年齡37-85歲（平均年齡58.98±11.59歲）。比較正常血流和無(wú)復(fù)流兩組患者入院時(shí)血小板計(jì)數(shù)、平均血小板體積、血小板分布寬度、纖維蛋白原及超敏C反應(yīng)蛋白的水平，并分析STEMI患者直接PCI術(shù)后無(wú)復(fù)流現(xiàn)象與以上因素的相關(guān)性。 所有患者術(shù)前均未服用阿司匹林等影響血小板活性的藥物，采集病史資料，常規(guī)行18導(dǎo)聯(lián)心電圖檢查，測(cè)量血壓，抽取肘靜脈血分別送檢血常規(guī)、凝血常規(guī)、肝腎功能、心肌酶和超敏C反應(yīng)蛋白等。統(tǒng)計(jì)學(xué)分析采用SPSS19.0軟件，所有分析結(jié)果均以P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1、兩組的基本臨床特征：無(wú)復(fù)流組和正常血流組在性別、體重指數(shù)（BMI）、血紅蛋白、高血壓病史、高脂血癥病史、糖尿病病史、吸煙、血脂水平（總膽固醇和甘油三酯）、血液動(dòng)力學(xué)相關(guān)數(shù)據(jù)（心率、收縮壓和舒張壓）等方面的基本臨床資料比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；無(wú)復(fù)流組與正常血流組比較，無(wú)復(fù)流組年齡大于正常血流組（63.76±10.40歲vs58.75±11.19歲，P＜0.05），從發(fā)病至血管開(kāi)通時(shí)間無(wú)復(fù)流組長(zhǎng)于正常血流組（9.40±3.10h vs7.39±3.30h，，P＜0.05），無(wú)復(fù)流組血糖水平高于正常血流組（10.12±1.87mmol/L vs9.40±1.68mmol/L，P＜0.05），無(wú)復(fù)流組CK峰值（1849.82±702.88U/Lvs1275.13±539.44U/L，P＜0.05）和CKMB峰值（181.44±67.79U/L vs136.92±49.73U/L，P＜0.05）均明顯大于正常血流組。 2、兩組冠脈造影特征：兩組患者的罪犯冠脈狹窄程度、病變長(zhǎng)度、病變部位、參考血管直徑等方面比較無(wú)顯著統(tǒng)計(jì)學(xué)差異（P＞0.05）；術(shù)中兩組球囊擴(kuò)張次數(shù)相比，無(wú)復(fù)流組多于正常血流組（2.41±0.88vs2.07±0.82），差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 3、血小板及炎癥相關(guān)因子水平比較：結(jié)果顯示，無(wú)復(fù)流組PDW水平顯著高于正常血流組（16.76±2.17%vs15.06±1.89%，P＜0.05）；無(wú)復(fù)流組患者入院時(shí)MPV水平顯著高于正常血流組（11.83±1.22fl vs10.16±1.21fl，P＜0.05）；兩組hs-CRP相比，無(wú)復(fù)流組顯著高于正常血流組（30.87±8.84mg/L vs23.45±9.74mg/L，P＜0.05）；無(wú)復(fù)流組與正常血流組比較，PLT和Fib水平無(wú)顯著性差異（P＞0.05）。 4、相關(guān)性分析：?jiǎn)我蛩鼗貧w分析顯示年齡、血糖水平、發(fā)病至血管再通時(shí)間、MPV、PDW和hs-CRP均是急診直接PCI術(shù)后無(wú)復(fù)流的影響因素（P＜0.05），但多因素的Logistic回歸分析發(fā)現(xiàn)，僅發(fā)病至血管再通時(shí)間（P=0.020，OR=1.47）、PDW（P=0.011，OR=1.70）、MPV（P=0.000，OR=5.93）和hs-CRP（P=0.018，OR=1.10）是PCI術(shù)后無(wú)復(fù)流的獨(dú)立危險(xiǎn)因素。 結(jié)論： 血小板因子PDW、MPV，炎癥因子hs-CRP是STEMI患者PCI術(shù)后無(wú)復(fù)流的獨(dú)立危險(xiǎn)因子。
[Abstract]:Objective : To investigate the correlation between acute ST - segment elevation myocardial infarction ( STEMI ) and acute ST - segment elevation myocardial infarction ( STEMI ) in patients with acute ST - segment elevation myocardial infarction ( STEMI ) in acute myocardial infarction ( AMI ) .

Methods : From January 2012 to March 2013 , 112 patients with ST - segment elevation myocardial infarction admitted to the Second Hospital of Hebei Medical University were diagnosed as first - episode ST - segment elevation myocardial infarction . All patients underwent percutaneous coronary intervention after admission . The TIMI myocardial perfusion grade was divided into non - reflow group and normal blood flow group according to TIMI myocardial perfusion grade after PCI . There were 35 males and 7 females , aged 37 - 81 years ( mean age 63.76 鹵 10.40 years ) .
There were 77 cases of normal blood flow , including 65 males and 12 females , aged 37 - 85 years ( mean age 58.98 鹵 11.59 years ) . The correlation between platelet count , mean platelet volume , platelet distribution width , fibrinogen and hypersensitive C - reactive protein were compared between the two groups .

All patients did not take aspirin or other drugs to influence platelet activity before operation , and collected medical history data . Routine 18 - lead electrocardiogram was used to measure blood pressure . Blood pressure was measured . Blood routine , blood routine , liver and kidney function , myocardial enzyme and hypersensitive C - reactive protein were detected .

Results :

1 . The basic clinical characteristics of the two groups : there was no significant difference in the basic clinical data between no reflow group and normal blood flow group in terms of sex , body mass index ( BMI ) , hemoglobin , hypertension , hyperlipidemia , diabetes history , smoking , blood lipid level ( total cholesterol and triglyceride ) , hemodynamic related data ( heart rate , systolic pressure and diastolic pressure ) ( P > 0.05 ) ;
Compared with the normal blood flow group ( 63.76 鹵 10.40 years vs 58.75 鹵 11.19 years , P < 0.05 ) , no reflow group was found in the normal blood flow group ( 9.40 鹵 3.10h vs 7.39 鹵 3.30h , P < 0.05 ) . The peak value of CK ( 1849.82 鹵 702.88U / L vs 9.40 鹵 1.68mmol / L , P < 0.05 ) and CKMB peak ( 184.44 鹵 67.79U / L vs 136.92 鹵 49.73U / L , P < 0.05 ) were significantly higher than those in the normal blood flow group .

2 . There was no significant difference in the severity of coronary artery stenosis , lesion length , lesion location and reference vessel diameter between the two groups ( P > 0.05 ) .
Compared with the normal blood flow group ( 2.41 鹵 0.88v2.07 鹵 0.82 ) , there was significant difference between the two groups ( P < 0.05 ) .

3 . Compared with the normal blood flow group ( 16.76 鹵 1.17 % vs 15.06 鹵 1 . 89 % , P < 0 . 05 ) , the level of PDW was significantly higher than that in the normal blood group ( 16.76 鹵 1.17 % vs 15.06 鹵 1 . 89 % , P < 0 . 05 ) .
At the time of admission , the level of mpv was significantly higher than that in the normal group ( 11.83 鹵 1.22fl vs 10.16 鹵 1.21 fl , P < 0.05 ) .
Compared with the normal blood flow group ( 30.87 鹵 8.84mg / L vs 23.45 鹵 9.74 mg / L , P < 0.05 ) , there was no significant difference between the two groups .
There was no significant difference between PLT and Fib ( P > 0.05 ) .

4 . Correlation analysis : Single - factor regression analysis showed that age , blood sugar level , duration of onset - to - vessel re - pass , mpv , PDW and hs - CRP were the factors of no reflow after PCI ( P < 0.05 ) , but multivariate logistic regression analysis found that only the time of reperfusion ( P = 0.020 , OR = 1 . 47 ) , PDW ( P = 0.000 , OR = 5.93 ) and hs - CRP ( P = 0 . 018 , OR = 1.10 ) were independent risk factors of no reflow after PCI .

Conclusion :

Platelet factor PDW , MPV , and inflammation factor hs - CRP were independent risk factors of non - complex flow after PCI in STEMI patients .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R542.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張軍;蔣健剛;;冠狀動(dòng)脈內(nèi)注射替羅非班對(duì)急性冠脈綜合征介入治療中無(wú)復(fù)流的影響[J];安徽醫(yī)學(xué);2012年02期

2 隗功賢;王志鵬;王健;;急性心肌梗死直接PCI術(shù)后無(wú)復(fù)流患者的臨床特點(diǎn)及CRP水平測(cè)定[J];中國(guó)醫(yī)藥導(dǎo)刊;2012年02期

3 魏宇淼;李大主;曾秋棠;;冠狀動(dòng)脈介入治療術(shù)中無(wú)復(fù)流的處理對(duì)策[J];臨床心血管病雜志;2011年01期

4 楊斌;王旭;邵一兵;王正忠;要英杰;;主動(dòng)脈內(nèi)球囊反搏治療急性心肌梗死急診冠狀動(dòng)脈介入治療術(shù)后無(wú)復(fù)流現(xiàn)象的臨床研究[J];臨床心血管病雜志;2011年04期

5 張勵(lì)庭;袁勇;黃炫生;董劍廷;馮力;劉衛(wèi)其;韓瑩;鄧志華;張勁;;血管遠(yuǎn)端保護(hù)裝置預(yù)防介入術(shù)中無(wú)復(fù)流現(xiàn)象[J];嶺南心血管病雜志;2008年02期

6 李巧汶;邱健;;炎癥標(biāo)記物與冠心病關(guān)系的研究進(jìn)展[J];心臟雜志;2008年03期

7 楊偉;王爽;;冠狀動(dòng)脈無(wú)復(fù)流現(xiàn)象的研究進(jìn)展[J];心血管病學(xué)進(jìn)展;2009年01期

8 屈曉冰,孫振球,陳美娟,陳瓏瓏;冠心病患者P-選擇素水平及其與冠狀動(dòng)脈病變程度間的關(guān)系[J];中華流行病學(xué)雜志;2005年08期

9 楊勝利,何秉賢;C-反應(yīng)蛋白與冠心病[J];中華心血管病雜志;2001年03期

10 楊新春,郭軍,王樂(lè)豐,程祖亨,葛永貴,王紅石,鄒陽(yáng)春,佟子川,李惟銘,徐立;急診經(jīng)皮冠狀動(dòng)脈介入治療冠狀動(dòng)脈造影無(wú)復(fù)流的相關(guān)因素[J];中國(guó)介入心臟病學(xué)雜志;2004年02期

本文編號(hào)：1755770