标题:血栓抽吸术联合PCI对急性ST段抬高型心肌梗死患者血清 ITLN-1水平的影响
作者:陈伟,伍于斌 桂林市人民医院心内科,广西 桂林 541002
卷次:
2019年30卷2期
【摘要】 目的 探讨经皮冠状动脉介入术(PCI)联合抽吸血栓与单纯常规PCI术对急性ST段抬高心肌梗死(STEMI)患者血清凝集蛋白-1 (ITLN-1)、血流灌注水平、心功能和预后的影响。方法 选取2010年1月至2014年6月就诊于桂林市人民医院心内科行PCI术的STEMI患者549例,根据是否行血栓抽吸将其分为血栓抽吸联合PCI组(联合组) 381例和单纯PCI组168例。比较两组患者的术后血流TIMI分级、术后1周心功能情况[左室射血分数(LVEF)和左室舒张末期内径(LVDD)]、术后血清肌酸激酶(CK)和其同工酶(CK-MB)的峰值及ST段回落情况;酶联免疫法检测入院时、术后24 h、1周和6个月两组患者的血清 ITLN-1水平,随访术后6个月发生的主要心血管不良事件。结果 联合组与单纯PCI组患者入院时的血清ITLN-1水平分别为(141.5±87.2) ng/mL和(134.2±105.5) ng/mL,差异无统计学意义(P>0.05),术后 24 h分别为(432.7±151.4) ng/mL和(352.9±135.3) ng/mL,术后 1周分别为(338.9±141.7) ng/mL和(297.5±155.7) ng/mL,组间比较差异均有统计学意义(P<0.05),但术后6个月分别为(241.7±103.6) ng/mL和(234.8±98.6) ng/mL,组间比较差异无统计学意义(P>0.05);联合组与单纯PCI组患者无复流或慢血流发生率分别为3.9%和 10.1%,CK水平分别为(1 463.4±372.6) U/L和(1 835.1±280.3) U/L,CK-MB水平分别为(163.5±42.9) U/L和(217.2±49.4) U/L,组间比较差异均有统计学意义(P<0.05);联合组与单纯PCI组患者的ST段回落≥50%的患者比例分别为86.1%和61.3%,LVDD分别为(51.5±3.2) mm和(56.1±4.1) mm,LVEF分别为(57.2±3.5)%和(53.3±4.2)%,组间比较差异均有统计学意义(P<0.05);随访 6个月,联合组患者的心力衰竭发生率为 6.3%,明显低于单纯 PCI组的14.4%,差异有统计学意义(P<0.05),而再次心肌梗死、恶性心律失常和心源性死亡发生率比较,差异均无统计学意义(P>0.05)。结论 STEMI患者PCI术中使用血栓抽吸导管可显著减少无复流现象的发生,改善冠脉血流并减轻心肌损伤,这可能与增加血清 ITLN-1的表达,进而减少心肌损伤并改善心功能相关。
【关键词】 急性ST段抬高型心肌梗死;血栓抽吸;经皮冠状动脉介入;凝集蛋白-1;血流灌注;心功能;预后
【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350(2019)02—175—05E
ffect of thrombus aspiration combined with percutaneous coronary intervention on serum ITLN-1 level inpatients with acute ST-segment elevation myocardial infarction.
CHEN Wei, WU Yu-bin. Department of Cardiology,Guilin People's Hospital, Guilin 541002, Guangxi, CHINA
【Abstract】 Objective To investigate the effects of percutaneous coronary intervention (PCI) combined withthrombus aspiration and simple routine PCI on serum intelectin-1 (ITLN-1), blood flow level, cardiac function and prog-nosis in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods From January 2010 toJune 2014, 549 STEMI patients undergoing PCI operation in the Department of Cardiology at Guilin People's Hospitalwere enrolled. According to whether thrombus aspiration was performed, the patients were divided into thrombus aspira-tion combined with PCI group (combined group, 381 cases) and simple PCI group (168 cases). Indexes were compared be-tween both groups, including postoperative blood flow TIMI classification, cardiac function at 1 week after operation (leftventricular ejection fraction [LVEF] and left ventricular end-diastolic diameter [LVDD]), postoperative peak values of se-rum creatine kinase (CK) and its isoenzyme (CK-MB), and ST-segment decline. Enzyme-linked immunoassay was used todetect the serum levels of ITLN-1 in the two groups of patients at admission, 24 h, 1 week, and 6 months after operation.Major adverse cardiovascular events were followed up for 6 months after operation. Results The serum levels ofITLN-1 at admission were respectively (141.5±87.2) ng/mL and (134.2±105.5) ng/mL in the combined group and the sim-ple PCI group, without significant difference (P>0.05). The serum levels of ITLN-1 at 24 h after operation in the twogroups were respectively (432.7±151.4) ng/mL and (352.9±135.3) ng/mL; and were respectively (338.9±141.7) ng/mL and(297.5±155.7) ng/mL at 1 week after operation; differences between groups were statistically significant (P<0.05). Howev-er, the serum levels of ITLN-1 at 6 months after operation in the two groups were respectively (241.7±103.6) ng/mL and(234.8±98.6) ng/mL, and there was no significant difference between the two groups (P>0.05). The incidence of no-re-flow or slow-flow in the combined group and the simple PCI group were respectively 3.9% and 10.1%, the CK level in
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