急性心肌梗死患者内皮炎症与无复流及冠脉病变严重程度的相关性

摘要

目的：研究急性心肌梗死(AMI)患者内皮炎症与无复流及冠脉病变严重程度的相关性。方法入选行经皮冠状动脉介入(PCI)治疗的 AMI 患者120例,其中术中出现无复流的患者40例为病例组,未出现无复流的 AMI 患者80例作为对照组。无复流组又根据冠状动脉造影结果分为单支病变组14例、两支病变组10例和三支病变组16例。分别采用流式细胞术和 ELISA 方法对上述患者术后即刻循环血内皮微粒(EMPs)及可溶性细胞间粘附分子-1(sICAM-1)水平进行测定。结果病例组PCI术后即刻循环血 EMPs及sICAM-1水平均高于对照组,差异具有统计学意义。病例组EMPs和sICAM-1曲线下面积分别为0.755和0.701,表明EMPs和sICAM-1水平与AMI患者PCI术后发生无复流具有良好的相关性。冠脉病变Gensini积分和EMPs随病变支数的增加呈上升趋势,且EMPs水平与Gensini积分呈正相关。结论 AMI患者循环血EMPs及sICAM-1水平能够较好地预测无复流的发生,并对冠脉病变的严重程度也有较好的预测价值。%Objective To investigate the correlation of endothelial inflammation in patients with acute myocardial infarction (AMI)with no-reflow and severity of coronary lesion.Methods A total of 120 patients with AMI were all treated with percutaneous coronary intervention (PCI).The patients who had intraoperative no-reflow were in case group (n=40).The patients who were also treated by PCI but did not have no-reflow in the same period in our hospital served as the control group (n=80).According to the results of coronary angiography, no-reflow group patients were divided into three subgroups:single lesion group (n=14),two-lesion group (n=10), and three-lesion group (n=1 6 ).We monitored these patients’immediate postoperative endothelial microparticles (EMPs)and soluble intercellular adhesion molecule-1 (sICAM-1 )levels in both groups with flow cytometry and ELISA methods.Results In the case group,immediate postoperative EMPs and sICAM-1 levels in the blood circulation were significantly higher than those in the control group.EMPs area and sICAM-1 area under the curve in the case group were 0.755 and 0.701,which showed that EMPs and sICAM-1 levels had a good correlation with the occurrence of non-reflow in AMI patients after PCI.Gensini score and EMPs level rose with the increase of the lesion counts,and the level of EMPs was positively correlated with Gensini score.Conclusion In patients with AMI,the EMPs and sICAM-1 levels can well predict the occurrence of no-reflow and are of some value in predicting the severity of coronary lesion.