许文亮,王旭,邵一兵,惠波,武越,要英杰,张纯全

• 1:青岛市市立医院心内科

摘要(Abstract)：

目的观察接受直接经皮冠状动脉介入(PPCI)治疗的ST段抬高型急性心肌梗死(STEMI)患者血小板体积的变化及与冠状动脉影像和血流的关系。方法 163例接受PPCI治疗的STEMI患者,入院时测定平均血小板体积(MPV)、大血小板比例(P-LCR)等血小板功能参数和血生化指标,阅读冠状动脉影像资料,评估梗死相关动脉(IRA)行PPCI前后的TIMI血流分级,计算IRA行PPCI后校正的TIMI血流帧数计数(CTFC)。同期冠状动脉造影等确诊的107例稳定性心绞痛患者作为对照。结果 STEMI患者MPV和P-LCR显著高于稳定性心绞痛组[(10.30±0.82)fl比(9.89±0.98)fl,t=3.656,P=0.000;(27.24±6.43)%比(24.51±5.88)%,t=3.524,P=0.000]。STEMI患者各亚组间比较,MPV和P-LCR于多支病变亚组显著高于单支病变亚组[(10.40±0.85)fl比(10.04±0.69)fl,t=-2.558,P=0.011;(27.96±6.64)%比(25.40±5.52)%,t=-2.319,P=0.022]。左前降支亚组显著高于回旋支亚组[(10.42±0.86)fl比(9.98±0.62)fl,P<0.05;(28.07±6.63)%比(24.48±4.76)%,P<0.05]。IRA无自发性开通亚组显著高于自发性开通亚组[(10.39±0.84)fl比(10.04±0.69)fl,t=-2.460,P=0.015;(27.83±6.61)%比(25.64±5.70)%,t=-2.082,P=0.040]。IRA行PPCI后血流未达TIMI3级亚组显著高于达TIMI3级亚组[(10.68±1.02)fl比(10.22±0.76)fl,t=2.225,P=0.003;(30.42±7.84)%比(26.61±5.95)%,t=2.393,P=0.023]。多元线性回归分析显示,MPV或P-LCR是IRA行PPCI后CTFC的独立影响因素(r=0.294,P=0.001;r=0.243,P=0.004)。结论 STEMI患者血小板体积显著增加,血小板体积与冠状动脉病变及IRA行PPCI前后血流的受损程度有密切关系。

关键词(KeyWords)： 心肌梗死;血小板;血管成形术,经腔,经皮冠状动脉

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 许文亮,王旭,邵一兵,惠波,武越,要英杰,张纯全

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