本文選題：急性心肌梗死 + 抽吸血栓�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：研究背景冠脈內(nèi)易損斑塊的破裂及繼發(fā)的血栓形成是急性心肌梗死的主要發(fā)病機(jī)制。病理學(xué)和影像學(xué)研究證實(shí)冠脈內(nèi)血栓包括紅色血栓和白色血栓。傳統(tǒng)的理念是急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者冠脈內(nèi)形成的是紅色血栓。然而,Yasushi等應(yīng)用光學(xué)相干斷層成像(Optical coherence tomography,OCT)對(duì)40例STEMI患者的罪犯血管進(jìn)行觀察,結(jié)果示78%的患者冠脈內(nèi)形成的是紅色血栓,另有22%的患者冠脈內(nèi)形成的是白色血栓;Quadros等通過(guò)肉眼分辨冠脈內(nèi)抽吸血栓,發(fā)現(xiàn)113例STEMI患者的抽吸血栓中31%為白色血栓。介于組織病理學(xué)分析是鑒別血栓類(lèi)型的金標(biāo)準(zhǔn),且冠脈內(nèi)血栓抽吸可以較為經(jīng)濟(jì)、方便地獲取血栓,因此本研究欲通過(guò)對(duì)抽吸血栓進(jìn)行病理學(xué)分析來(lái)鑒別STEMI患者冠脈內(nèi)是否存在不同的血栓類(lèi)型。目的探究STEMI患者冠脈內(nèi)抽吸血栓的病理類(lèi)型及其構(gòu)成比;分析影響STEMI患者形成不同類(lèi)型血栓的相關(guān)因素。方法納入2014年3月至2016年2月在河南省人民醫(yī)院確診為STEMI并接受直接經(jīng)皮冠狀動(dòng)脈介入治療(percutaneous coronary intervention,PCI)的患者,所有患者均于發(fā)病12小時(shí)以?xún)?nèi)接受直接PCI。對(duì)入組對(duì)象于急診冠脈造影后行血栓抽吸,并對(duì)抽吸血栓行大體病理學(xué)觀察和組織病理學(xué)分析。根據(jù)抽吸血栓的組織病理學(xué)類(lèi)型將患者分為紅色/混合血栓組與白色血栓組。比較兩組患者的臨床基線資料、冠脈造影資料及血栓外觀。進(jìn)行單因素及多因素Logistic回歸分析,研究影響STEMI患者形成不同血栓病理類(lèi)型的相關(guān)因素。結(jié)果對(duì)137例STEMI患者于急診冠脈介入治療時(shí)行血栓抽吸,共獲得97例(70.8%)患者抽吸血栓的病理結(jié)果。其中紅色/混合血栓64例(66%),白色血栓33例(34%)。紅色/混合血栓組吸煙的患者多于白色血栓組(P=0.031);紅色/混合血栓組患者的總?cè)毖獣r(shí)間明顯長(zhǎng)于白色血栓組(P=0.013);白色血栓組患者梗死相關(guān)動(dòng)脈(Infraction related artery,IRA)形成側(cè)支循環(huán)的比例高于紅色/混合血栓組(P=0.001)。紅色/混合血栓多表現(xiàn)為灰紅色、長(zhǎng)條狀,白色血栓多表現(xiàn)為灰白色、碎屑狀(P0.001);紅色/混合血栓的直徑(P0.001)和長(zhǎng)度(P=0.001)均明顯長(zhǎng)于白色血栓。多因素Logistic回歸結(jié)果提示總?cè)毖獣r(shí)間和IRA側(cè)支循環(huán)是影響血栓類(lèi)型的相關(guān)因素,其中總?cè)毖獣r(shí)間是形成紅色/混合血栓的危險(xiǎn)因素(OR:1.741[95%CI,1.203 to 2.520];P=0.003);IRA側(cè)支循環(huán)是形成紅色/混合血栓的保護(hù)因素(OR:0.109[95%CI,0.032 to 0.376];P0.001)。結(jié)論STEMI患者冠脈內(nèi)抽吸血栓中紅色/混合血栓約占2/3,白色血栓約占1/3;總?cè)毖獣r(shí)間和側(cè)支循環(huán)影響STEMI患者冠脈內(nèi)血栓類(lèi)型:隨著缺血時(shí)間的延長(zhǎng),形成紅色/混合血栓可能性增加;無(wú)側(cè)枝循環(huán)時(shí)更容易形成紅色/混合血栓,存在側(cè)支循環(huán)時(shí)更容易形成白色血栓。
[Abstract]:Background rupture of vulnerable plaque and secondary thrombosis are the main pathogenesis of acute myocardial infarction. Pathological and imaging studies confirm that intra-coronary thrombus includes red thrombus and white thrombus. The traditional idea is that red thrombus is formed in the coronary artery of patients with ST-segment elevation myocardial infarction (ST-segment elevation myocardial inflexion) of acute ST-segment elevation myocardial infarction. However, using optical coherence tomography (Oct), Yasushi and others observed the criminal vessels in 40 patients with STEMI. The results showed that 78% of the patients had red thrombosis in their coronary arteries. In the other 22% of the patients, white thrombus was formed in the coronary artery, such as white thrombus Quadros and so on. It was found that 31% of the 113 patients with STEMI were white thrombus. Histopathological analysis is the gold standard for distinguishing the type of thrombus, and coronary artery thrombus aspiration can be more economical and convenient to obtain thrombus. Therefore, the purpose of this study is to identify the different types of thrombus in STEMI patients by pathological analysis. Objective to investigate the pathological types and composition ratio of coronary artery aspiration thrombosis in patients with STEMI, and to analyze the related factors affecting the formation of different types of thrombosis in patients with STEMI. Methods from March 2014 to February 2016, all the patients who were diagnosed as STEMI in Henan Provincial people's Hospital and received direct percutaneous coronary intervention (PCI) were treated with STEMI within 12 hours after the onset of the disease. Thrombus aspiration was performed after emergency coronary angiography, gross pathological observation and histopathological analysis were performed. Patients were divided into red / mixed thrombus group and white thrombus group according to the histopathological types of aspiration thrombus. Clinical baseline data, coronary angiography and thrombus appearance were compared between the two groups. Univariate and multivariate Logistic regression analysis was performed to study the related factors affecting the pathological types of thrombosis in patients with STEMI. Results Thrombus aspiration was performed in 137 patients with STEMI during emergency coronary intervention, and the pathological results were obtained in 97 patients (70.8%). There were 64 cases of red / mixed thrombus and 33 cases of white thrombus. The total ischemic time in red / mixed thrombus group was significantly longer than that in white thrombus group, and in white thrombus group, the infarct related artery (Infraction related artery IRA) formed collateral circulation in the white thrombus group, the total ischemic time in the red / mixed thrombus group was significantly longer than that in the white thrombus group, and the total ischemic time in the red / mixed thrombus group was significantly longer than that in the white thrombus group. The ratio was higher than that in red / mixed thrombus group. The red / mixed thrombus showed grayish red, long stripe, white thrombus was grayish white, and the diameter of red / mixed thrombus was P0.001) and the length of P0. 001) was longer than that of white thrombus. The results of multivariate Logistic regression suggested that the total ischemic time and collateral circulation of IRA were related to the type of thrombus. The total ischemic time was the risk factor for the formation of red / mixed thrombus (OR: 1.741 [95CI1.203 to 2.520] P0.003 / IRA collateral circulation was the protective factor for the formation of red / mixed thrombus (OR0.109 [95CI0.032 to 0.376] P0.001). Conclusion in patients with STEMI, red / mixed thrombus accounts for about 2 / 3, white thrombus accounts for 1 / 3, total ischemic time and collateral circulation affect the type of coronary thrombosis in patients with STEMI. The possibility of forming red / mixed thrombus was increased, and it was easier to form red / mixed thrombus without collateral circulation, and white thrombus was more easily formed in the presence of collateral circulation.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R542.22
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本文編號(hào)：1947731