摘要
目的探讨甲状腺激素浓度与ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者行直接经皮冠状动脉介入(primary percutaneous coronary intervention,PPCI)治疗后发生心肌无复流的关系。方法纳入2017年至2021年广东省人民医院收治的行PPCI治疗的STEMI患者,根据术后血流情况分为正常血流组[心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级3级或TIMI心肌灌注分级(TIMI myocardial perfusion grading,TMPG)3级]和无复流组(TIMI≤2级或TMPG≤2级)。比较两组患者的临床资料,通过Logistic回归分析探讨STEMI患者行PPCI治疗后心肌无复流的独立危险因素,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)评价甲状腺激素浓度对无复流的预测价值。结果本研究共纳入患者454例,其中正常血流组333例,无复流组121例。对两组患者的临床资料分析比较,无复流组心房颤动患者比例高于正常血流组,且无复流组就诊时心功能分级劣于正常血流组,无复流组的术前TIMI血流分级、TMPG血流分级均低于正常血流组,而“罪犯”血管血栓积分及使用血栓抽吸、存在漂浮血栓、完全闭塞的比例均高于正常血流组,差异有统计学意义(P<0.05)。相较于正常血流组,无复流组血清游离三碘甲腺原氨酸(free triiodothyronine,FT3)浓度低于正常血流组,差异有统计学意义[4.75(4.34~5.18)poml/L vs.4.99(4.38~5.53)poml/L,P=0.028]。进一步分析显示,FT3浓度独立影响着STEMI患者PPCI治疗后心肌无复流的发生[OR=0.562,95%CI:0.399~0.791,P=0.001],ROC分析显示,曲线下面积为0.786(95%CI:0.734~0.837,P<0.001)。结论术前FT3低浓度是STEMI患者行PPCI治疗后心肌无复流的独立危险因素。
Objectives To investigate the relationship between concentration of thyroid hormone and the occurrence of myocardial no-reflow after primary percutaneous coronary intervention(PPCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods Patients with STEMI undergoing PPCI admitted to Guangdong Provincial People's Hospital from 2017 to 2021 were included and divided into normal flow group[thrombolysis in myocardial infarction(TIMI)grade 3 or TIMI myocardial perfusion grading(TMPG)grade 3]and no-reflow group(TIMI≤grade 2 or TMPG≤grade 2)according to their postoperative flow status.The clinical data of the two groups were compared,and the independent risk factors for myocardial no-reflow after PPCI in STEMI patients were investigated by multifactorial Logistic regression analysis,and the predictive value of concentration of thyroid hormone for no-reflow was evaluated by plotting the receiver operating characteristic curve(ROC).Results A total of 454 patients were included in this study,including 333 patients in normal flow group and 121 patients in no-reflow group.When the clinical data of the two groups were analyzed and compared,the proportion of patients with atrial fibrillation was higher in no-reflow group than in normal-flow group(P<0.05),and the cardiac function classification at the time of consultation was inferior in no-reflow group than in normal-flow group(P<0.05).The preoperative TIMI classification and TMPG flow classification were lower in no-reflow group than in normal-flow group(P<0.05),while the offender vessel thrombus score and the proportion of patients using thrombus aspiration,the presence of floating thrombus,and complete occlusion were higher than in normal-flow group(P<0.05).Concentration of clear free triiodothyronine(FT3)were lower in no-reflow group compared to normal flow group[4.75(4.34-5.18)poml/L vs.4.99(4.38-5.53)poml/L,P=0.028].Further analysis showed that concentration of FT3 independently influenced the occurrence of myocardial no-reflow after PPCI in STEMI
作者
路昊雨
张昊天
董豪坚
陈逸敏
周颖玲
LU Haoyu;ZHANG Haotian;DONG Haojian;CHEN Yimin;ZHOU Yingling(Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)
出处
《岭南心血管病杂志》
CAS
2024年第5期461-467,共7页
South China Journal of Cardiovascular Diseases
基金
国家十三五重点研发计划项目子课题:急诊再灌注治疗策略优化研究(项目编号:2016YFC1301202)。
关键词
心肌梗死
游离三碘甲状腺原氨酸
血管成形术
经腔
经皮冠状动脉
无复流现象
free triiodothyronine
primary percutaneous coronary intervention
no-reflow
ST-segment elevation myo‐cardial infarction
