介入治疗H型高血压并心肌梗死无复流现象相关因素分析

目的 探讨急诊经皮冠状动脉介入治疗（PCI）H型高血压合并急性心肌梗死（AMI）患者冠状动脉造影无复流现象发生的相关因素分析.方法 以120例急性心肌梗死患者为研究对象,所有病例均予以PCI,以梗死相关冠状动脉前向血流冠状动脉狭窄程度（TIMI）分级≤2级作为无复流判断标准,将患者分为两组：其中无复流组患者35例,其余的85例归入正常血流组,通过对患者年龄、性别、身体质量指数（BMI）、糖尿病史、高脂血症病史、家族史、血糖、同型半胱氨酸（Hcy）、白细胞计数、C反应蛋白（CRP）、红细胞沉降率（ESR）、磷酸肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、三酯甘油、总胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、肌钙蛋白-Ⅰ（cTn-Ⅰ）、就诊至治疗时间等因素进行观察和比较,并应用Logistic逐步回归分析,以明确无复流发生的相关因素.结果 急诊PCI患者120例,无复流患者35例,发生率为30.1％.无复流患者与恢复正常血流患者的性别、吸烟史、高脂血症史、糖尿病史、心绞痛史、以及治疗前的Killip分级、胸痛至治疗前时间等差异无统计学意义（t=1.275,P＞0.05）.多因素Logistic回归分析表明：年龄、糖尿病、三酯甘油、Hcy、cTn-Ⅰ、CK-MB、CRP是无复流的相关因素（（t=3.427,P＜0.05）.结论 高龄、无梗死前心绞痛史、冠脉开通时间长、入院时心功能分级低、白细胞计数高、CK-MB与cTn-Ⅰ水平高等是无复流现象发生的独立的危险因素,PCI时出现无复流现象提示预后不良.

Analysis of the relative factors of angiographic no reflow phenomenon after percutaneous coronary intervention of patients with H type hypertension merge acute myocardial infarction

Objective To study the related factors of coronary no-reflow phenomenon in H-hypertensive acute myocardial infarction （AMI） patients after percutaneous coronary intervention （PCI）. Methods 120 AMI patients were selected as the study subjects, all patients were given PCI, the infarct-related coronary artery stenosis forward flow（TIMI） grade ≤ 2 level was the no-flow criteria. The patients were divided into two groups：the no-reflow group （35 patients） ,the other 85 cases classified as normal blood group. The age, gender, body mass index （BMI）, history of diabetes, hyperlipidemia hyperlipidemia history, family history, blood glucose, homocysteine （ Hcy）, white blood cell count, C-reactive protein （ CRP）, erythroeyte sedimentation rate （ ESR ）, creatine kinase （ CK）, creatine kinase （ CK-MB ）, triglycerides, total cholesterol, high density lipoprotein （ HDL）, low density lipoprotein （ LDL）, tropo- nin-I （ eTn-I）, treatment time and other factors were observed and compared. Logistic regression analysis was used to i- dentify relevant factors of no-reflow. Results 120 patients with primary PCI, no-reflow in 35 patients, the incidence rate was 30.1%. The sex, smoking history, history of hyperlipidemia, diabetes, history of angina, and Killip classification before treatment, time from chest pain to before treatment between no-reilow patients and normal blood flow patients had no significant differences（ t = 1. 275 ,P 〉 0.05 ）. Multivariate Logistic regression analysis showed that：age, diabetes, triglycerides, HCY, cTn-I, CK-MB, CRP were related factors of no-reflow （ t = 3. 427, P 〈 0.05 ）. Conclusion Age, without pre-infarction history of angina, coronary artery open long hours, admission NYHA low, white blood cell count high, CK-MB and cTn-I levels higher are independent risk factors of no-reflow phenomenon, PCI with no-reflow phenomenon indicates the poor prognosis.