【摘要】：目的:觀察血小板-淋巴細(xì)胞聚集體(Platelet-lymphocytic aggregation,PlyA)在ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急診介入術(shù)后心肌無復(fù)流(Myocardial no reflow,MNR)的作用,并進(jìn)一步探討缺血后適應(yīng)(Ischemic postconditioning,IPost C)對(duì)Ply A水平的影響。方法:(1)納入于青島大學(xué)附屬煙臺(tái)毓璜頂醫(yī)院就診的初發(fā)STEMI并行急診經(jīng)皮冠狀動(dòng)脈介入治療(Percutaneous coronary intervention,PCI)的患者93例,同期收集健康體檢者50例,使用流式細(xì)胞檢測技術(shù)對(duì)兩組Ply A水平進(jìn)行檢測,比較兩組Ply A表達(dá)水平的差異;(2)將93例STEMI患者隨機(jī)分為缺血后適應(yīng)(IPost C)組和正常手術(shù)組,IPost C組于完全閉塞冠脈再通后1min內(nèi)在病變處應(yīng)用低氣壓充盈60s和灌注60s為一個(gè)循環(huán),共循環(huán)4次,然后再植入支架。正常手術(shù)組除了IPost C操作外,其余與IPost C組相同,觀察兩組MNR的發(fā)生率。(3)兩組分別于PCI術(shù)前、PCI術(shù)后即刻及術(shù)后3天采集外周靜脈血,應(yīng)用流式細(xì)胞檢測技術(shù)對(duì)兩組Ply A水平進(jìn)行檢測,比較兩組Ply A水平。MNR定義為病變冠脈經(jīng)造影證實(shí)不存在解剖性狹窄及血管痙攣,冠脈TIMI血流分級(jí)≤2級(jí)。結(jié)果:(1)與正常組相比,STEMI組冠心病危險(xiǎn)因素(如高血壓、糖尿病、吸煙等)、血白細(xì)胞總數(shù)、血小板總數(shù)明顯高于對(duì)照組(P0.05),Ply A水平也顯著高于對(duì)照組(P0.01)。單因素回歸分析顯示:高血壓、糖尿病、血小板總數(shù)、白細(xì)胞總數(shù)及術(shù)前Ply A水平均與STEMI的發(fā)生呈正相關(guān)。校正這些因素后,白細(xì)胞總數(shù)(OR=2.04,CI1.54-2.78;P0.001)及術(shù)前Ply A水平(OR=1.32,CI1.10-1.56;P=0.002)仍與STEMI的發(fā)生呈強(qiáng)正相關(guān)。(2)PCI術(shù)后,共計(jì)24例(25.8%)STEMI患者發(fā)生MNR。復(fù)流組與無復(fù)流組在年齡、冠心病危險(xiǎn)因素(如高血壓、糖尿病、吸煙、高脂血癥)、超敏肌鈣蛋白I、CK-MB峰值水平及既往用藥方面均無統(tǒng)計(jì)學(xué)差異。與復(fù)流組相比,無復(fù)流組術(shù)前Ply A水平顯著升高(P0.001),且血栓負(fù)荷評(píng)分較高(P0.001),病變長度較長(P=0.002),具有統(tǒng)計(jì)學(xué)意義。單因素回歸分析顯示,術(shù)前Ply A水平、病變長度及血栓負(fù)荷評(píng)分≥4與心肌無復(fù)流的發(fā)生相關(guān)(P0.05)。進(jìn)一步的多因素Logistic分析表明:血栓負(fù)荷評(píng)分≥4(OR=23.26,CI1.09-41.67;P=0.048)及術(shù)前Ply A水平(OR=1.69,CI1.03-2.78;P=0.036)是MNR的獨(dú)立危險(xiǎn)因子。(3)IPost C組與正常手術(shù)組患者術(shù)前Ply A水平之間無差異(P=0.742)。與正常手術(shù)組相比,IPost C組術(shù)后即刻及術(shù)后3天Ply A水平有明顯降低趨勢,但無統(tǒng)計(jì)學(xué)差異。(4)與正常手術(shù)組相比,IPost C組無復(fù)流的發(fā)生率明顯下降(P=0.021),具有統(tǒng)計(jì)學(xué)意義。結(jié)論:(1)與正常人相比,STEMI患者Ply A水平顯著升高,表明高水平的Ply A與STEMI的發(fā)生呈正相關(guān)。(2)與復(fù)流組相比,無復(fù)流組Ply A水平顯著升高,表明術(shù)前高水平Ply A能夠預(yù)測MNR的發(fā)生,可作為MNR的獨(dú)立危險(xiǎn)因素。(3)IPost C組無復(fù)流發(fā)生率明顯降低,表明IPost C能減少M(fèi)NR的發(fā)生,具有心臟保護(hù)作用。且IPost C組比正常手術(shù)組Ply A水平有明顯下降趨勢,但無統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: to observe the effect of platelet lymphocyte aggregates (Platelet-lymphocytic aggregation,PlyA) on myocardial non-reflow (Myocardial no reflow,MNR in patients with ST segment elevation myocardial infarction (ST-segment elevation myocardial infarction,STEMI), and to investigate the effect of Ischemic postconditioning,IPost C on Ply A level. Methods: (1) 93 patients with primary STEMI treated with emergency percutaneous coronary intervention (Percutaneous coronary intervention,PCI) were enrolled in Yantai Yuzhouding Hospital affiliated to Qingdao University. Flow cytometry was used to detect the level of Ply A in two groups. The difference of Ply A expression between the two groups was compared. (2) 93 patients with STEMI were randomly divided into (IPost C) adaptation group and normal operation group. 60 s of low pressure filling and 60 s perfusion of 1min were used as a circulation in the internal lesion of 1min after total occlusion coronary artery recanalization. A total of 4 cycles, and then the stent implantation. The incidence of MNR in the normal operation group was the same as that in the IPost C group except the IPost C operation. (3) Peripheral venous blood was collected before, immediately after PCI and 3 days after PCI in the two groups. The level of Ply A in the two groups was detected by flow cytometry, and the level of Ply A was compared between the two groups. MNR was defined as the absence of anatomic stenosis and vasospasm in the diseased coronary artery proved by angiography, and the grade of coronary TIMI blood flow was 鈮，

本文編號(hào)：2270532