李妍博,侯昌,刘健,聂文畅

• 1:北京大学人民医院心血管内科
• 2:大同市第五人民医院心血管内科

摘要(Abstract)：

目的 探讨急性ST段抬高型心肌梗死（STEMI）接受经皮冠状动脉介入治疗（PCI的患者冠状动脉造影衍生的微循环阻力指数（caIMR）升高的因素，并对其预后进行分析。方法 回顾性纳入2018年1月至2022年1月北京大学人民医院心血管内科诊断为STEMI并行PCI的患者113例，依据术后caIMR值分为低caIMR组（caIMR<40 U,50例）和高caIMR组（caIMR≥40 U,63例），筛选出caIMR的独立危险因素，并对其1年内主要不良心血管事件（MACE）进行分析。结果 与低caIMR组相比，高caIMR组超重/肥胖患者比例[45(71.4%)比24(48.0%),P=0.011]、肌钙蛋白I(TnI)峰值[46.06(25.11,80.90)pg/ml比67.63(32.94,143.81)pg/ml,P=0.018]、谷丙转氨酶[29.00(19.00,52.00)mmol/L比21.00(16.00,35.25)mmol/L,P=0.027]均显著升高，差异均有统计学意义。Logistic回归分析显示超重/肥胖（OR 3.263,95%CI 1.397～7.619,P=0.006）、TnI峰值（OR 1.007,95%CI 1.001～1.014,P=0.021）是caIMR升高的独立危险因素；低密度脂蛋白胆固醇（OR 0.586,95%CI 0.378–0.908,P=0.017）是caIMR升高的保护因素。高caIMR(OR 5.340,95%CI1.121～25.449,P=0.035)、术前心绞痛（OR0.144,95%CI0.033～0.628,P=0.010）、左心室射血分数（OR 0.893,95%CI0.827～0.965,P=0.004）是心力衰竭再住院的独立危险因素。结论 STEMI患者行PCI后高caIMR组TnI峰值、超重/肥胖比例更高，心力衰竭再住院比例更高，提示可能远期预后不良。

关键词(KeyWords)： 冠状动脉造影衍生的微循环阻力指数;急性ST段抬高型心肌梗死;经皮冠状动脉介入治疗;预后

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金重点项目（11832003）

作者(Author): 李妍博,侯昌,刘健,聂文畅

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