叶豪奕,崔思美,韩泽君,张茜,李勤,高磊

• 1:中国人民解放军总医院心血管病医学部
• 2:解放军医学院
• 3:南开大学医学院
• 4:北京理工大学医学技术学院

摘要(Abstract)：

目的 通过光学相干断层成像（OCT）量化巨噬细胞浸润程度，分析巨噬细胞浸润与经皮冠状动脉介入治疗（PCI）围手术期心肌损伤（PMI）之间的关系。方法 本研究为前瞻性单中心观察性研究，连续纳入从2024年4月至2025年1月于中国人民解放军总医院第六医学中心行择期PCI时接受OCT检查的冠状动脉粥样硬化性心脏病患者，根据术后48 h内患者肌钙蛋白I(cTnI)水平将患者分为PMI组和非PMI组。通过OCT扫描定量评估巨噬细胞浸润特征，与临床资料、OCT图像斑块特征相结合，评估其对PMI的预测价值。结果 研究共纳入104例患者，共计116处病变，其中PMI组38例（42处），非PMI组66例（74处）。多因素Logistic回归分析提示糖尿病史、饮酒史、低密度脂蛋白胆固醇（LDL-C）、白细胞介素-6(IL-6)与PMI发生独立相关，且糖尿病史、饮酒史为PMI发生保护性因素（OR 0.160,95%CI 0.053～0.478,P=0.006;OR 0.151,95%CI 0.050～0.456,P=0.007）,LDL-C与IL-6是PMI的危险因素（OR 2.152,95%CI1.248～3.713,P=0.015;OR 1.245,95%CI 1.095～1.414,P<0.001）。巨噬细胞浸润长度、平均角度、浸润指数三者在PMI组均高于非PMI组，但巨噬细胞浸润长度、平均角度差异在两组间无统计学意义。将基于OCT的巨噬细胞浸润特征与临床资料、OCT斑块特征相结合，可提高预测PMI发生的准确性。结论 在择期PCI中，OCT观察的靶病变巨噬细胞浸润定量指标（巨噬细胞浸润角度和指数）与PMI显著相关，联合临床资料与OCT其他斑块特征，可在识别有PMI风险的患者方面提供增量获益。

关键词(KeyWords)： 冠心病;光学相干断层成像;巨噬细胞浸润;经皮冠状动脉介入治疗;围手术期心肌损伤

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项项目（首发2024-2-5072）;; 北京市自然科学基金项目（7242138）

作者(Author): 叶豪奕,崔思美,韩泽君,张茜,李勤,高磊

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