Hcy与急性ST段抬高型心肌梗死患者急诊PCI 术后无复流的关系及机制

目的通过检测急性ST段抬高型心肌梗死(STEMI)患者血浆中同型半胱氨酸(Hcy)水平,探讨Hcy与急诊经皮冠状动脉介入治疗术(PPCI)后无复流现象的关系,并分析影响其发生发展的可能机制。方法选择2016年4月-2018年4月期间蚌埠医学院第一附属医院心血管内科收治的113例急性STEMI并接受PPCI术患者,整理其临床基本资料、化验室检查结果、冠状动脉造影及急诊经皮冠脉介入治疗的手术资料,依据PPCI术后是否出现无复流现象分为2组,其中33例患者急诊PCI术后出现无复流现象,另外80例患者急诊PCI术后血流正常;同时留取患者血浆标本,检测并计算2组患者的血浆Hcy水平差异,统计学分析及探讨Hcy导致急诊PCI术后发生无复流现象的可能机制。结果急诊PCI术后血流正常组患者,其血浆中Hcy水平、中性粒细胞与淋巴细胞计数比值(NLR)及C反应蛋白(CRP)水平均低于急诊PCI术后无复流组患者,差异有统计学意义(均P<0.05),而其他传统心血管危险因素,如高血压病、糖尿病的发生率及胆固醇水平,差异均无统计学意义(均P>0.05)。结论血浆Hcy水平与急性STEMI患者急诊PCI术后无复流现象的发生相关,无复流组患者血浆Hcy水平高于正常血流组,同时无复流组NLR、CRP水平亦高于正常血流组;因此推测血浆Hcy可能通过NLR及CRP相关的炎症反应,影响患者急诊PCI术后无复流现象的发生发展。

Relationship between HCY level and no-reflow phenomenon in patients with acute ST segment elevation myocardial infarction after primary PCI and its mechanisms

Objective To detect plasma homocysteine (Hcy) levels in patients with acute ST segment elevation myocardial infarction (STEMI), explore the relationship between Hcy level and no-reflow phenomenon after primary percutaneous coronary intervention (PPCI), and analyze the possible mechanism influencing its occurrence and development. Methods The basic clinical data, laboratory test results, data of coronary angiography and primary interventional therapy of 113 acute STEMI patients treated with PPCI in our hospital from April 2016 to April 2018 were retrospectively analyzed. The no-reflow phenomenon during the operation was observed in 33 patients, and blood flow was normal in the others 80 patients. Meanwhile, the plasma samples of the patients were collected to test the level of Hcy. The possible metabolism that Hcy leads to no-reflow phenomenon was analyzed statistically. Results The plasma levels of Hcy, NLR and CRP in patients with normal blood flow were all lower than those in the group with no-reflow, while there was no apparent statistical difference in traditional danger factors such as occurrence of hypertension, diabetes and cholesterol level. Conclusion The Hcy level in plasma is associated with the occurrence of no-reflow phenomenon during PPCI in acute STEMI patients. Hcy level in plasma of the NRF group is higher than that of normal blood flow group, meanwhile NLR and CRP level is higher too in NRF group; so the pathogenesis of NRF in acute STEMI after PPCI may be related to the inflammatory response associated with NLR and CRP.