血清脂蛋白相关磷脂酶 A2水平与急性 St 段抬高型心肌梗死患者急诊经皮冠状动脉介入术中无复流的关系研究

摘要

目的：探讨血清脂蛋白相关磷脂酶 A2（Lp-PLA2）水平与急性 St 段抬高型心肌梗死（AStEMI）患者急诊经皮冠状动脉介入（PCI）术中无复流的关系。方法连续选取2013年8月—2014年10月东莞市第三人民医院心内科收治的因 AStEMI 住院并行急诊 PCI 的患者158例，根据急诊 PCI 术中无复流发生情况分为正常复流组128例和无复流组30例。比较两组患者临床资料，包括年龄、性别、吸烟情况、血压、心率、空腹血糖、低密度脂蛋白胆固醇（LDL-C）、血清Lp-PLA2水平、发病-再灌注时间、入院至球囊扩张时间（D2B）、球囊扩张次数、支架数量、支架长度、血栓抽吸情况、合并其他血管病变情况及冠状动脉〔左前降支（LAD）、右冠状动脉（RCA）、左回旋支（LCX）〕闭塞情况，采用多因素 logistic 回归分析筛选 AStEMI 患者急诊 PCI 术中无复流的影响因素。结果两组患者年龄、性别、吸烟率、收缩压、舒张压、心率、空腹血糖、LDL-C、D2B、球囊扩张次数、支架数量、支架长度、血栓抽吸率、合并其他血管病变者所占比例及 LAD、RCA、LCX 闭塞发生率比较，差异无统计学意义（P >0.05）；无复流组患者血清Lp-PLA2水平高于正常血流组、发病-再灌注时间长于正常血流组（P 0. 05);while duration between attack and reperfusion of A group was statistically significantly longer than that of B group,serum Lp-PLA2 level of A group was statistically significantly higher than that of B group( P <0. 05). Multivariate logistic regression analysis showed that,serum Lp-PLA2 level〔OR = 3. 203,95& CI(1. 734,5. 919)〕, duration between attack and reperfusion〔OR = 8. 908,95& CI(3. 698,21. 464)〕 were independent risk factors of intra -operative no - reflow of AStEMI patients treated by primary PCI( P < 0. 05);after correction of duration between attack and reperfusion,the multivariate logistic regression analysis showed that,serum Lp-PLA2 level was an independent risk factor of intra- operative no - reflow of AStEMI patients treated by primary PCI〔B = 1. 160,OR = 3. 190,95& CI(1. 955,5. 204),P =0. 000〕. Conclusion Serum Lp-PLA2 level is an independent risk factor of intra - operative no - reflow of AStEMI patients treated by primary PCI,early detection of serum Lp-PLA2 level is helpful to evaluate the risk of intra - operative no - reflow of AStEMI patients treated by primary PCI.