血清总胆红素水平与ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术前梗死相关动脉血流及院内主要心脏不良事件的相关性研究

摘要

目的：探讨血清总胆红素水平与 ST 段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（pCI）术前梗死相关动脉（IRA）血流及院内主要心脏不良事件的相关性。方法选取2013年6月—2015年10月肇庆市第一人民医院心血管内科收治的 STEMI 患者230例，均行 pCI。根据血清总胆红素水平将患者分成高水平总胆红素组152例（>9.0 mg/ L）和低水平总胆红素组78例（≤9.0 mg/ L）。比较两组患者一般资料、实验室检查结果、冠状动脉造影结果及院内主要心脏不良事件发生情况。结果两组患者年龄、性别、体质指数（BMI）、吸烟史阳性率、合并疾病发生率、pCI 史阳性率、左心室射血分数、胸痛持续时间及梗死部位比较，差异无统计学意义（P >0.05）；高水平总胆红素组患者 Killip 分级劣于低水平总胆红素组（P <0.05）。高水平总胆红素组患者血清总胆红素、直接胆红素、肌酸激酶峰值、超敏 C 反应蛋白及尿酸水平高于低水平总胆红素组（P <0.05）；两组患者血红蛋白、血小板体积、白细胞计数及血脂指标比较，差异无统计学意义（P >0.05）。两组患者 IRA 和冠状动脉狭窄支数比较，差异无统计学意义（P >0.05）；高水平总胆红素组患者 pCI 术前 TIMI 血流分级劣于低水平胆红素组，Gensini 积分高于低水平胆红素组（P <0.05）。两组患者重度心力衰竭、晚期肺水肿、急性支架血栓发生率比较，差异无统计学意义（P >0.05）；高水平总胆红素组患者心源性休克、严重室性心律失常、院内死亡、心肺复苏及心搏骤停发生率高于低水平总胆红素组（P <0.05）。结论血清总胆红素水平与 STEMI 患者 pCI 术前 IRA 血流及院内主要心脏不良事件具有一定关系。%Objective To analyze the correlations between serum total bilirubin level and blood flow of infarction related artery before pCI,and major adverse cardiac events during hospitalization in patients with ST - segment elevation myocardial infarction. Methods From June 2013 to October 2015,a total of 230 patients with ST - segment elevation myocardial infarction were selected in the First people′s Hospital of Zhaoqing,all of them received pCI,and they were divided into A group(with serum total bilirubin level over 9. 0 mg/ L,n = 152)and B group(with serum total bilirubin level equal or less than 9. 0 mg/ L,n = 78) according to serum total bilirubin level. General information,laboratory test results,coronary angiography examination results and incidence of major adverse cardiac events during hospitalization were compared between the two groups. Results No statistically significant differences of age,gender,BMI,positive rate of smoking history,incidence of type 2 diabetes mellitus,incidence of hypertension,incidence of coronary heart disease,positive rate of pCI history,LVEF, duration of chest pain or infarction locations was found between the two groups(P > 0. 05),while Killip grade of A group was statistically significantly worse than that of B group(P < 0. 05). Serum levels of total bilirubin,of direct bilirubin,of peak value of creatine kinase,of hs-CRp,of uric acid of A group were statistically significantly higher than those of B group(P <0. 05);while no statistically significant differences of hemoglobin,platelet volume,white blood cell count or blood lipids index was found between the two groups(P > 0. 05). No statistically significant differences of infarction related artery or number of vessels with stenosis was found between the two groups(P > 0. 05);TIMI flow grade of A group was statistically significantly worse than that of B group before pCI,Gensini score of A group was statistically significantly higher than that of B group before pCI(P < 0. 05). No statistically significant differences of incidence of severe heart failure,of advanced pulmonary edema,of acute in - stent thrombosis was found between the two groups( P > 0. 05);while incidence of cardiogenic shock,of severe ventricular arrhythmias,of in - hospital death,of CpR,of sudden cardiac arrest of A group was statistically significantly higher than that of B group,respectively(P < 0. 05). Conclusion Serum total bilirubin level has some correlations with blood flow of infarction related artery before pCI,and with major adverse cardiac events during hospitalization in patients with ST - segment elevation myocardial infarction.