术前尿酸水平对急诊冠脉介入治疗后冠脉无复流现象的影响

目的了解术前血尿酸水平对急性ST段抬高型心肌梗死（STEMI）患者行急诊冠脉介入（PCI）治疗术后冠脉无复流现象的影响。方法选择2006年10月-2011年12月在首都医科大学大兴医院诊断为STEMI，并接受急诊PCI治疗的患者385例，其中高尿酸血症患者共81例为高尿酸血症组，余尿酸正常者为正常尿酸组（n=304）。观察并比较两组临床情况及无复流现象的发生，采用Logistic多因素回归分析影响无复流现象发生的因素。结果高尿酸血症发病率为2l％（8l／385）；高尿酸血症组与正常尿酸组高血压（58％比41％）、既往MI病史（11．1％比4．9％）、Kmip〉l级（26％比16％）、多支病变（63％比50％）等方面，差异有统计学意义（P〈0．05）；高尿酸血症组在TIMl分级〈2级、CTFC〉40、TMPG〈2级所占比例高于正常尿酸组，差异有统计学意义（P〈0．05）。多因素Logistic回归分析显示，高尿酸血症是无复流现象发生的独立的危险因素（P〈0．05）。结论高尿酸血症增加PCI治疗后冠脉无复流现象的发生．值得临床注意。

Impact of preoperative serum uric acid levels on no-reflow phenomenon after urgent coronary interventions

Objective To analyze the effect of preoperative serum uric acid （SUA） levels on no-reflow phenomenon in patients with ST-segment elevation myocardial infarction （STEMI） undergoing urgent percutaneous coronary interven- tions Methods 385 patients diagnosed as STEMI and treated with PCI in Daxing Hospital of Capital Medical Universi- ty from October 2006 to December 2011 were enrolled; 81 cases with high serum uric acid were seen as elevated SUA group, 304 cases with normal serum uric acid were seen as normal SUA group. Clinical circumstance and no-reflow phenomenon were observed and compared between the two groups; Logistic muhi-factor regression was used to analyze the influence factors of no-reflow phenomenon. Results Incidence rate of hyperuricemia was 21% （81/385）; the differ- ence of hypertension （58% vs 41%）, previous history of MI （11.1% vs 4.9%）, Killip〉l grade （26% vs 16%）, multives- sel lesions （63% vs 50%） in elevated SUA group and normal SUA group were statistically significant （P 〈 0.05）; the proportion of TIMI〈2 grade, CTFC〉40, TMPG〈2 grade in elevated SUA group were all higher than those in normal SUA group, the difference were statistically significant （P 〈 0.05）. Hyperuricemia was the independent risk factor in no-reflow phenomenon （P 〈 0.05）. Conclusion Hyperuricemia elevates the occurrence of no-reflow phenomenon after PCI, it is worthy of clinical attention.