李亚然,姜云发,支伟,汪雁博,郝国贞

• 1:河北医科大学第二医院心内科

摘要(Abstract)：

目的本研究旨在对急性冠状动脉综合征(ACS)患者血运重建后微循环阻力指数(IMR)相关性因素进行分析。方法入选2017年8月至2019年2月就诊于河北医科大学第二医院,因ACS行经皮冠状动脉介入治疗并对罪犯血管进行IMR测定的患者31例。根据IMR值分为高IMR组(IMR>40,20例)和低IMR组(IMR≤40,11例)。比较两组患者一般临床资料、实验室检查资料、造影结果;采用Pearson和Spearman相关分析对年龄、肌酸激酶(CK)峰值、肌酸激酶同工酶(CKMB)峰值、心肌肌钙蛋白I(cTnI)峰值及GRACE风险评分与IMR的相关性进行分析。结果高IMR组的平均年龄[(65.60±9.61)岁比(56.00±10.48)岁,P=0.015]、CK峰值[1366.00(2226,2489.00)U/L比139.00(76.00,896)U/L,P=0.009]、CK-MB峰值[129.50(44.25,258.25)U/L比34.00(21.00,123.00)U/L,P=0.041]、cTnI峰值[97.00(23.31,100.25)ng/ml比19.00(0.10,66.00)ng/ml,P=0.011]及GRACE风险评分[(170.45±46.45)分比(128.64±27.24)分,P=0.011]显著高于低IMR组,差异均有统计学意义。IMR值升高与年龄(r=0.333,P=0.047)、CK峰值(r=0.534, P=0.002)、CK-MB峰值(r=0.439, P=0.014)、c TnI峰值(r=0.534,P=0.002)显著相关。GRACE风险评分与IMR呈正相关(r=0.532,P=0.002),ROC曲线下面积为0.768(OR 1.029,95%CI1.003～1.055,P=0.028),最佳截点值为154.5时,预测冠状动脉血运重建后IMR>40的敏感度为65%,特异度为91%,约登指数为0.56。结论 (1)年龄、心肌损伤标志物水平、GRACE风险评分与PCI术后IMR水平升高具有相关性。(2)ACS患者血运重建后IMR和GRACE风险评分存在正相关性,以GRACE风险评分154.5为截点,预测患者存在微血管损伤和(或)功能障碍的可能性的敏感度和特异度较高。

关键词(KeyWords)： 微循环阻力指数;急性冠状动脉综合征;全球急性冠状动脉事件注册风险评分;微血管功能障碍

Abstract:

Keywords:

基金项目(Foundation): 河北省2017年度医学科学研究重点课题计划(20170569)

作者(Author): 李亚然,姜云发,支伟,汪雁博,郝国贞

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