Relation between non-reflow after emergency PCI and changes in PLA values and renal function in patients before surgery
-
摘要: 目的 探讨术前血小板-白细胞聚集体(platelet-leukocyte aggregates, PLA)、肾功能与ST段抬高型急性心肌梗死(ST-segment elevation acute myocardial infarction, STEMI)患者行急诊经皮冠状动脉介入手术(percutaneous coronary intervention, PCI)后发生无复流的关系。方法 选取我院既往急诊PCI治疗术后出现心肌无复流患者68例作为无复流组，同期急诊PCI治疗术后心肌灌注恢复正常的患者130例作为对照组；查阅2组患者的年龄、性别、合并疾病、PCI介入治疗相关资料，采用logistic回归分析法探讨术前PLA值、肾功能与急诊PCI术后无复流的关系。结果 无复流组和对照组的血清三酰甘油(TG)、收缩压(SBP)、起病至PCI时间、病变血管支数、植入支架数、植入支架长度比较，差异有统计学意义(P < 0.05)；无复流组的术前PLA测定值为(68.21±9.42)%，高于对照组的(54.50±8.77)%，无复流组患者的估算的肾小球滤过率为(94.51±15.20) mL/(min·1.73 m2)，低于对照组的(103.75±18.17) mL/(min·1.73 m2)，差异均有统计学意义(P < 0.05)；logistic回归模型结果显示：TG升高、起病至PCI时间间隔长、术前PLA增高、估算的肾小球滤过率降低是STEMI患者PCI术后出现无复流的独立危险因素危险(P < 0.05)。结论 影响STEMI患者PCI术后出现无复流的危险因素有多种，术前PLA增高、肾功能受损是STEMI患者PCI术后无复流的风险因素。
-
关键词:
- 血小板-白细胞聚集体 /
- 肾功能 /
- ST段抬高型急性心肌梗死 /
- 急诊经皮冠状动脉介入手术 /
- 无复流
Abstract: Objective To investigate the relationship between preoperative platelet-leukocyte aggregates(PLA), renal function, and ST-segment elevation acute myocardial infarction(STEMI) in patients undergoing emergency percutaneous coronary intervention(PCI).Methods Selected 68 patients with myocardial no-reflow after emergency PCI treatment in our hospital(non-reflow group) and 130 patients with normal myocardial perfusion after emergency PCI treatment during the same period as control group; The data of gender, comorbidities, and PCI interventional treatment were analyzed by logistic regression analysis to investigate the relationship between preoperative PLA value, renal function, and no regurgitation after emergency PCI.Results The serum TG, SBP, the time from onset to PCI, the number of diseased vessels, the number of implanted stents, and the length of implanted stents in the non-reflow group and the control group were significantly different(P < 0.05); The preoperative PLA value in the non-reflow group was(68.21±9.42)%, higher than that in the control group(54.50±8.77)%, and the estimated glomerular filtration rate in the non-reflow group was(94.51±15.20) mL/(min·1.73 m2), lower than that in the control group(103.75±18.17) mL/(min·1.73 m2), with statistical significance(P < 0.05); The results of logistic regression model showed that the increase of TG, the long time interval from onset to PCI, the increase of preoperative PLA and the decrease of estimated glomerular filtration rate were independent risk factors for non-reflow in STEMI patients after PCI(P < 0.05).Conclusion There are many risk factors that affect the occurrence of non-reflow in STEMI patients after PCI. The increase of preoperative PLA and the impairment of renal function are the risk factors of non-reflow in STEMI patients after PCI. -
-
表 1 无复流组与对照组的一般资料与PCI相关参数比较
X±S 一般资料与PCI相关参数 无复流组(n=68) 对照组(n=130) t/ χ2 P 年龄/岁 63.20±7.20 61.80±10.00 1.023 0.307 性别/例(%) 1.191 0.275 男 38(55.88) 83(63.85) 女 30(44.12) 47(36.15) BMI/(kg/m2) 23.90±2.20 23.70±2.40 0.573 0.568 SBP/mmHga) 125.90±8.60 121.00±7.30 4.214 < 0.001 DBP/mmHg 74.10±6.30 73.00±7.50 1.033 0.303 TG/(mmol/L) 2.11±0.38 1.90±0.30 4.258 < 0.001 TC/(mmol/L) 4.96±0.71 4.82±0.78 1.236 0.218 HDL-C/(mmol/L) 0.98±0.14 1.02±0.20 -1.471 0.143 LDL-C/(mmol/L) 3.12±0.58 3.05±0.60 0.788 0.431 FPG/(mmol/L) 6.41±0.85 6.29±0.90 0.908 0.365 HbA1c/% 6.30±0.77 6.16±0.75 1.236 0.218 注：a)1 mmHg=0.133 kPa。 
下载: 导出CSV
表 2 无复流组与对照组的冠状动脉病变及介入治疗情况比较
X±S，例(%) 病变及介入治疗情况 无复流组(n=68) 对照组(n=130) t/ χ2 P 起病至PCI时间/h 7.40±2.41 6.58±1.89 2.631 0.009 病变血管支数/支 1.94±0.50 1.71±0.47 3.199 0.002 病变血管 1.515 0.469 左前降支 36(52.94) 62(47.69) 左回旋支 8(11.76) 24(18.46) 右冠状动脉 24(35.29) 44(33.85) 植入支架数/个 1.61±0.31 1.52±0.28 2.069 0.040 植入支架长度/mm 23.16±4.30 21.91±3.95 2.051 0.042
下载: 导出CSV
表 3 无复流组与对照组的术前PLA、eGFR比较
X±S 组别 例数 术前PLA/% eGFR/(mL/min/1.73 m2) 无复流组 68 68.21±9.42 94.51±15.20 对照组 130 54.50±8.77 103.75±18.17 t 10.181 -3.587 P < 0.001 < 0.001
下载: 导出CSV
表 4 logistic回归模型结果
参数 β SE Walds χ2 P OR 95% CI SBP 0.661 0.486 1.850 0.201 1.937 0.747~5.021 TG 0.391 0.173 5.108 0.032 1.478 1.053~2.075 起病至PCI时间 0.527 0.244 4.665 0.048 1.694 1.050~2.733 病变血管支数 1.130 0.895 1.594 0.288 3.096 0.536~17.889 植入支架数 0.774 0.693 1.247 0.412 2.168 0.558~8.434 植入支架长度 0.618 0.594 1.082 0.443 1.855 0.579~5.943 术前PLA 0.829 0.360 5.303 0.028 2.291 1.131~4.639 eGFR -0.581 0.261 4.955 0.039 0.559 0.335~0.933
下载: 导出CSV
-
[1] Wang HY, Mo R, Guan CD, et al. Establishing the optimal duration of DAPT following PCI in high-risk TWILIGHT-like patients with acute coronary syndrome[J]. Catheter Cardiovasc Interv, 2022, 99(1): 98-113. doi: 10.1002/ccd.29741
[2] Feistritzer HJ, Jobs A, de Waha-Thiele S, et al. Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials[J]. Clin Res Cardiol, 2020, 109(11): 1381-1391. doi: 10.1007/s00392-020-01637-6
[3] Li FL. Relationship between estimated glomerular filtration rate and myocardial no-reflow in patients with acute ST-elevation myocardial infarction[J]. China Med Abstr Intern Med, 2017, 34(1): 49.
[4] Zipperle J, Altenburger K, Ponschab M, et al. Potential role of platelet-leukocyte aggregation in trauma-induced coagulopathy: Ex vivo findings[J]. J Trauma Acute Care Surg, 2017, 82(5): 921-926. doi: 10.1097/TA.0000000000001410
[5] Vakili H, Shirazi M, Charkhkar M, et al. Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction[J]. Eur J Clin Invest, 2017, 47(4): 322-327. doi: 10.1111/eci.12736
[6] 马婷, 马靖雯, 关丽娜, 等. 犬急性冠脉闭塞后血小板白细胞聚集体变化特点实验研究[J]. 新疆医科大学学报, 2021, 44(9): 989-993. https://www.cnki.com.cn/Article/CJFDTOTAL-XJYY202109002.htm
[7] 孙冰莲, 胡雅娟, 靳伟, 等. 血栓弹力图参数联合血小板-白细胞聚集体检测对急性脑梗死患者早期神经功能恶化及预后的预测价值[J]. 实用医院临床杂志, 2022, 19(2): 26-29. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202202007.htm
[8] Furio E, García-Fuster MJ, Redon J, et al. CX3CR1/CX3CL1 axis mediates platelet-leukocyte adhesion to arterial endothelium in younger patients with a history of idiopathic deep vein thrombosis[J]. Thromb Haemost, 2018, 118(3): 562-571. doi: 10.1055/s-0038-1629897
[9] 蒋世亮, 季晓平, 张运. 美国心脏病学会和美国心脏病协会发布关于ST段抬高型急性心肌梗死治疗指南(2004年修订版)[J]. 中华医学杂志, 2005, 85(1): 62-64. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYX20050100M.htm
[10] 李雪, 陈燕宏, 赵中江, 等. 急性ST段抬高型心肌梗死患者PCI预后影响因素的研究进展[J]. 海南医学, 2021, 32(1): 107-111. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202101030.htm
[11] Volpe M, Patrono C. The increased mortality of STEMI patients without risk factors supports the need for evidence-based pharmacotherapy irrespective of perceived low risk[J]. Eur Heart J, 2021, 42(24): 2329-2330. doi: 10.1093/eurheartj/ehab268
[12] 孙冰, 王海昌, 孙冬冬. 急性ST段抬高型心肌梗死溶栓治疗的最新进展[J]. 心脏杂志, 2020, 32(1): 93-98. https://www.cnki.com.cn/Article/CJFDTOTAL-XGNZ202001022.htm
[13] 徐慧慧, 谢艳辉, 宋恒良, 等. PCSK9抑制剂对急性ST段抬高型心肌梗死PCI术后的微循环功能及左心室重构的影响[J]. 临床心血管病杂志, 2022, 38(1): 22-28. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202201005.htm
[14] 张乃今, 孙兆青, 于彤彤, 等. 急性ST段抬高型心肌梗死经心脏磁共振诊断新发心包积液的临床特点及危险因素分析[J]. 中国实用内科杂志, 2021, 41(8): 705-709. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202108010.htm
[15] 陈晓敏, 葛广豪, 曹华, 等. 冠脉内逆向应用重组人尿激酶原溶栓联合PCI对急性ST段抬高型心肌梗死患者预后的临床研究[J]. 临床心血管病杂志, 2022, 38(6): 489-494. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202206010.htm
[16] 王勇, 周东晖, 金元哲. 后扩张在老年急性ST段抬高型心肌梗死行急诊经皮冠状动脉介入治疗中的临床应用[J]. 中国心血管病研究, 2019, 17(5): 408-410, 415.
[17] 布楠, 郑文, 赵冠棋, 等. 慢性肾功能不全对ST段抬高型心肌梗死合并多支血管病变的临床预后影响[J]. 心肺血管病杂志, 2020, 39(7): 776-780. https://www.cnki.com.cn/Article/CJFDTOTAL-XFXZ202007010.htm
[18] 吴强, 卢春晓, 陈强华, 等. 急性ST段抬高型心肌梗死经皮冠状动脉介入治疗后急性肾损伤的预测因素[J]. 海南医学, 2022, 33(11): 1387-1390. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202211007.htm
[19] 苏昱润, 潘晨亮, 彭瑜, 等. 急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗后并发对比剂诱导的急性肾损伤的危险因素分析[J]. 中国循环杂志, 2021, 36(3): 245-250. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202103004.htm
[20] Saji KY, Namiuchi S, Sugie T, et al. Irreversible deterioration of estimated glomerular filtration rate in patients with acute myocardial infarction after primary percutaneous coronary intervention[J]. Cardiovasc Interv Ther, 2017, 32(4): 318-324.
[21] 郑瑜, 李树仁, 刘肖, 等. ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术后发生急性肾损伤的相关性分析[J]. 中国介入心脏病学杂志, 2020, 28(5): 257-263. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXB202005004.htm
[22] 李其华, 易秋艳, 徐广纳, 等. 急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术中发生慢/无复流的危险因素分析和风险预测模型构建[J]. 海南医学, 2023, 34(2): 176-180. https://www.cnki.com.cn/Article/CJFDTOTAL-XFXZ201805002.htm
[23] Brankovic M, Kardys I, van den Berg V, et al. Evolution of renal function and predictive value of serial renal assessments among patients with acute coronary syndrome: BIOMArCS study[J]. Int J Cardiol, 2020, 299: 12-19.
[24] 崔冬, 黄亚华, 刘智坚, 等. 急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术中采用球囊缓慢撤压方法预防无复流和慢血流现象的作用研究[J]. 中国介入心脏病学杂志, 2022, 30(6): 435-439. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXB202206008.htm
[25] 郑士航, 张飞飞, 高曼, 等. 急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后无复流的研究进展[J]. 国际心血管病杂志, 2022, 49(1): 32-35. https://www.cnki.com.cn/Article/CJFDTOTAL-GWXX202201009.htm
-