急性心肌梗死PCI术后预后与侧枝循环形成的关系研究
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摘要
目的:探讨急性心肌梗死(acute myocardial infarction,AMI)经皮冠状动脉介入治疗(percutaneous coronary interventions,PCI)术后预后与侧枝循环形成的关系。方法:选取2014年6月-2016年6月我院心脑血内科收治的AMI患者128例为研究对象,所有患者均行PCI术,根据是否有侧枝循环形成分为侧枝循环组(n=58)和无侧枝循环组(n=70)。比较两组患者的临床资料及随访6个月时左心射血分数(Left Ventricular Ejection Fractions,LVEF)和左心室舒张末期内径(left ventricular end diastolic diameter,LVDD)以及不良心血管事件(major adverse cardiovascular events,MACE)的发生情况。结果:两组性别、年龄、糖尿病、高血压、吸烟、缺血时间、甘油三酯(Triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,HDL-C)、血糖水平比较差异均无统计学意义(P>0.05)。侧枝循环组术前低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)和心肌肌钙蛋白I(Cardiac troponin I,CTnl)峰值均显著低于无侧枝循环组,差异有统计学意义(P<0.05)。治疗前,两组LVEF、LVD比较,差统无计学意义(P>0.05);治疗后,侧枝循环组LVEF为(55.52±5.30)%,显著大于无侧枝循环组,LVDD为(46.43±3.37)mm,显著小于无侧枝循环组(P<0.05);侧枝循环组总MACE发生率18.97%,显著低于无侧枝循环组的45.71%(P<0.05)。经多因素分析,无侧枝循环形是MACE发生的独立危险因素(OR=1.648,95%CI:1.046-2.832,P=0.018)。结论:LDL-C和CTnl可能不利于侧枝循环形成,侧枝循环的存在可改善AMI患者PCI术后心功能、抑制心肌重构,降低MACE发生率,改善预后。
Objective: To explore the relationship between the collateral circulation formation and prognosis of acute myocardial infarction(AMI) patients after percutaneous coronary interventions(PCI). Methods: 128 cases of AMI patients treated in cardiac cerebral blood medicine department of our hospital from June 2014 to June 2016 were selected for the study, and all patients were treated with PCI surgery and divided into the collateral circulation group(n=58) and the non-collateral circulation group(n=70) according to whether the collateral circulation was formed. The clinical data of two groups were compared, and the follow-up was taken for 6 months. The left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVDD) and adverse cardiovascular events(MACE) were compared between the two groups. Results: There was no significant difference in the gender, age, diabetes, hypertension, smoking,ischemic time, Triglyceride(TG), total cholesterol(TC), High-density lipoprotein cholesterol(HDL-C), blood glucose between the two groups(P>0.05). The peak values of low density lipoprotein cholesterol(LDL-C)and Cardiac troponin I(CTnl)of collateral circulation group before operation were significantly lower than those of the non-collateral circulation group(P<0.05). Before treatment, there was no significant difference in the LVEF and LVD between the two groups(P>0.05). After treatment, the LVEF was(55.52±5.30) % in the collateral circulation group, which was significantly higher than that in the non-collateral circulation group while the LVDD was(46.43±3.37)mm, which was significantly lower than that in the non-collateral circulation group(P<0.05). The incidence rate of total MACE was 18.97 % in the collateral circulation group, which was significantly lower than that in the non-collateral circulation group with 45.71 %(P<0.05). Multivariate analysis showed that the non-collateral circulation was an independent risk factor for MACE(OR=1.648, 95% CI: 1.046-2.832, P=0.018). Conclusions: LDL-C and CTnl may be not beneficial to the formation of collateral circulation.The presence of collateral circulation can improve cardiac function, inhibit myocardial remodeling, decrease the incidence of MACE and improve the prognosis of patients with AMI after PCI.
Objective: To explore the relationship between the collateral circulation formation and prognosis of acute myocardial infarction(AMI) patients after percutaneous coronary interventions(PCI). Methods: 128 cases of AMI patients treated in cardiac cerebral blood medicine department of our hospital from June 2014 to June 2016 were selected for the study, and all patients were treated with PCI surgery and divided into the collateral circulation group(n=58) and the non-collateral circulation group(n=70) according to whether the collateral circulation was formed. The clinical data of two groups were compared, and the follow-up was taken for 6 months. The left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVDD) and adverse cardiovascular events(MACE) were compared between the two groups. Results: There was no significant difference in the gender, age, diabetes, hypertension, smoking,ischemic time, Triglyceride(TG), total cholesterol(TC), High-density lipoprotein cholesterol(HDL-C), blood glucose between the two groups(P>0.05). The peak values of low density lipoprotein cholesterol(LDL-C)and Cardiac troponin I(CTnl)of collateral circulation group before operation were significantly lower than those of the non-collateral circulation group(P<0.05). Before treatment, there was no significant difference in the LVEF and LVD between the two groups(P>0.05). After treatment, the LVEF was(55.52±5.30) % in the collateral circulation group, which was significantly higher than that in the non-collateral circulation group while the LVDD was(46.43±3.37)mm, which was significantly lower than that in the non-collateral circulation group(P<0.05). The incidence rate of total MACE was 18.97 % in the collateral circulation group, which was significantly lower than that in the non-collateral circulation group with 45.71 %(P<0.05). Multivariate analysis showed that the non-collateral circulation was an independent risk factor for MACE(OR=1.648, 95% CI: 1.046-2.832, P=0.018). Conclusions: LDL-C and CTnl may be not beneficial to the formation of collateral circulation.The presence of collateral circulation can improve cardiac function, inhibit myocardial remodeling, decrease the incidence of MACE and improve the prognosis of patients with AMI after PCI.
引文
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[2]李富军.急性前壁心肌梗死急诊经皮冠状动脉介入治疗后ST段回落程度与预后关系的研究[J].中国医师进修杂志,2013,36(10):50-52Li Fu-jun.Relationshipstudy between ST segment decline and prognosis after emergency percutaneous coronary intervention in acute anterior wall myocardial infarction[J].Chinese Journal of Postgraduates of Medicine,2013,36(10):50-52
[3]高晓津,杨进刚,杨跃进,等.中国急性心肌梗死患者心血管危险因素分析[J].中国循环杂志,2015(3):206-210Gao Xiao-jing,Yang Jin-gang,Yang Yue-jin,et al.Cardiovascular Risk Factor Analysis for Acute Myocardial Infarction Patients in China[J].Chinese Circulation Journal,2015(3):206-210
[4]李彦明,张韩,何瑞利,等.低剂量促红细胞生成素用于急性心肌梗死患者经皮冠状动脉介入治疗术后的疗效和安全性[J].中国循环杂志,2015(1):17-21Li Yan-ming,Zhang Han,He Rui-li,et al.Efficacy and Safety of Low Dose Erythropoietin for Treating the Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention[J].Chinese Circulation Journal,2015(1):17-21
[5]黄梦照,刘华勇,梁东,等.急性心肌梗死患者血浆脑钠肽水平与心肌梗死面积及预后的关系[J].安徽医药,2013,17(3):426-427Huang Meng-zhao,Liu Hua-yong,Liang Dong,et al.Relevance of plasma BNP level to myocardial infarction size and AMI patients'prognosis[J].Anhui medical and pharmaceutical journal,2013,17(3):426-427
[6]高润霖.急性心肌梗死诊断和治疗指南[J].中国循环杂志,2001,16(6):407-422Gao Run-lin.Acute myocardial infarction diagnosis and treatment guidelines[J].Chinese Circulation Journal,2001,16(6):407-422
[7]李英,韩丽,崔立锋,等.通心络胶囊联合阿托伐他汀治疗急性心肌梗死PCI术后炎性反应的临床研究[J].现代药物与临床,2015,30(1):36-39Li Ying,Han Li,Cui Li-feng,et al.Clinical study on Tongxinluo Capsules combined with atorvastatin in treatment of acute myocardial infarction with PCI postoperative inflammatory reaction[J].Drugs&Clinic,2015,30(1):36-39
[8]吴萃荣,王湛.瑞舒伐他汀与阿托伐他汀对急性心肌梗死患者PCI术后左室重构及近期预后影响的比较[J].实用医学杂志,2015,31(3):470-472Wu Cui-rong,Wang Zhan.Comparison of rosuvastatin and atorvastatin on left ventricular remodeling and recent prognostic effects of patients with acute myocardial infarction after PCI surgery[J].The Journal of Practical Medicine,2015,31(3):470-472
[9]王红丽,高颖,李庆军,等.急性心肌梗死患者侧枝循环形成多因素分析[J].心肺血管病杂志,2015,34(4):305-306Wang Hong-li,Gao Ying,Li Qing-jun,et al.Multifactor analysis of collateral circulation in patients with acute myocardial infarction[J].Journal of Cardiovascular and Pulmonary Diseases,2015,34(4):305-306
[10]苏方成,赵芳.替格瑞洛配合急诊PCI治疗急性心肌梗死的临床疗效和安全性探讨[J].临床心血管病杂志,2015,31(1):27-30Su Fang-cheng,Zhao Fang.Clinical efficacy and safety of ticagrelor with primary PCI for acute my ocardial infarction in the perioperative period[J].Journal of Clinical Cardiology,2015,31(1):27-30
[11]冯绿竹.氯吡格雷联合尿激酶静脉溶栓治疗急性心肌梗死的疗效分析[J].中国药物与临床,2015,15(4):568-569Feng Lv-zhu.Treatment of acute myocardial infarction by clopidogrel combined with urokinase intravenous thrombolysis[J].Chinese Remedies&Clinics,2015,15(4):568-569
[12]陈泽芳,陈宋璋,王晓群,等.溶栓后介入治疗和直接PCI治疗急性心肌梗死的疗效和安全性探讨[J].血栓与止血学,2015,21(2):80-82Chen Ze-fang,Chen Song-zhang,Wang Xiao-qun,et al.Discussion of Clinical Effect and Safety of Interventional Therapy After Thrombolysis and Direct PCI for Treatment of Acute Myocardial Infarction[J].Chinese Journal of Thrombosis and Hemostasis,2015,21(2):80-82
[13]余巍,王德荣,魏朝阳.静脉溶栓(TT)后经皮冠状动脉介入(PCI)联合治疗与直接PCI治疗急性心肌梗死的疗效对比观察[J].世界中医药,2015,10(a01):63-64Yu Wei,Wang De-rong,Wei Chao-yang.Efficacy comparison of percutaneous coronary intervention(PCI)combined therapy after intravenous thrombolysis(TT)and direct PCI in the treatment of acute myocardial infarction[J].World Chinese Medicine,2015,10(a01):63-64
[14]Traupe T,Gloekler S,de Marchi S F,et al.Assessment of the human coronary collateral circulation[J].Circulation,2010,122(12):1210
[15]陶四明,郭涛,王钰,等.心脏震波对猪心肌梗死后早期侧枝循环重建及左心功能的影响[J].昆明医科大学学报,2016,37(2):15-20Tao Si-ming,Guo Tao,Wang Yu,et al.Effects of Cardiac Shock Wave Therapy on Myocardial Collateral Circulation and Global Cardiac Function after Acute Myocardial Infarction at Early Stage in Pigs[J].Journal of Kunming Medical University,2016,37(2):15-20
[16]于洁,陈晓杰,李宁,等.冠状动脉慢性完全闭塞病变成功介入治疗后心功能改善的影响因素[J].山东医药,2016,56(33):47-49Yu Jie,Chen Xiao-Jie,Li Ning,et al.Factors affecting the cardiac functionimprovement after successful coronary intervention in patients with chronic complete occlusion of coronary artery[J].Shandong Medical Journal,2016,56(33):47-49
[17]朱华刚,贾若飞,孟帅,等.侧支循环对ST段抬高急性心肌梗死再灌注治疗后心功能的影响[J].中国介入心脏病学杂志,2014,22(3):149-152Zhu Hua-gang,Jia Ruo-fei,Meng Shuai,et al.Effects of collateral circulation on ventricular function of patients with ST-segmentelevationmyocardial infarction treated with primary coronary intervention[J].Chinese Journal of Interventional Cardiology,2014,22(3):149-152
[18]谢飞.急性心肌梗死患者冠状动脉侧枝循环形成的相关因素[D].吉林大学,2015Xie Fei.Related factors of collateral circulation formation in patients with acute myocardial infarction[D].Jinlin university,2015
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