三项指标与老年急性STEMI患者介入术后无复流的相关性研究

马学平; 吴鹏; 马娟; 严宁; 王默函; 贾绍斌

doi:10.12125/j.chj.202305076

三项指标与老年急性STEMI患者介入术后无复流的相关性研究

Three indicators and postoperative intervention in elderly patients with acute STEMI research on the correlation of no reflow

摘要

摘要:
目的探讨入院休克指数（shock index, SI）、入院血糖(admission plasma glucose, APG)和同型半胱氨酸(homocysteine, HCY)与老年急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction, STEMI)患者行急诊经皮冠状动脉介入（percutaneous coronary intervention, PCI）术后无复流的相关性。
方法分析行急诊PCI术379例老年急性STEMI患者的临床资料，根据PCI术后TIMI血流分为无复流组（n=71）和正常血流组(n=308)。比较两组患者的临床资料、造影及介入情况。采用单因素及多因素Logistic回归模型分析老年急性STEMI患者行急诊PCI术后出现无复流的独立危险因素，利用受试者工作特征（receiver operator characteristic, ROC）曲线评估老年急性STEMI患者行急诊PCI术后发生无复流的预测效能。
结果与正常血流组比较，无复流组患者入院心率、SI高于正常血流组，收缩压、舒张压低于正常血流组，均P<0.01。白细胞计数（white blood cell,WBC）升高（P<0.05），中性粒细胞绝对值（neutrophil absolute count, NEUT）升高（P<0.05），红细胞计数（red blood cell, RBC）降低（P<0.01），红细胞平均体积（mean red cell volume, MCV）降低（P<0.01），血红蛋白（hemoglobin, HGB）降低（P<0.05），C反应蛋白（C-reactive protein, CRP）升高（P<0.05），APG升高（P<0.05），尿素(serum urea nitrogen, UREA)升高（P<0.05），HCY升高（P<0.01），D-二聚体(D-Dimer,D-D)升高（P<0.01）多因素Logistic回归分析表示SI、APG、HCY是老年急性STEMI患者急诊PCI术后发生无复流的独立危险因素。ROC曲线分析显示SI+APG+HCY对老年STEMI患者行PCI术后发生无复流的预测价值优于SI、APG、HCY、SI+APG、SI+HCY、APG+HCY，差异有统计学意义（P<0.01）。
结论 SI、APG和HCY是老年急性STEMI患者行急诊PCI术后发生无复流的独立危险因素，且SI+APG+HCY对其有较好的预测价值。

Abstract:
AIM To explore the correlation between shock index (SI), admission plasma glucose (APG), homocysteine (HCY) and no flow after emergency percutaneous coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI).
METHODS The clinical data of 379 elderly patients with acute STEMI who underwent emergency PCI were retrospectively analyzed. According to the TIMI blood flow after PCI, the patients were divided into no-reflow group (71 cases) and normal blood flow group (308 cases). The clinical data, angiography and intervention conditions of the two groups were compared. Multivariate logistic regression analysis was used to analyze the independent risk factors of no reflow in elderly patients with acute STEMI after emergency PCI and the receiver operating characteristic curve (ROC) was used to evaluate the prediction of no reflow in elderly patients with acute STEMI after emergency PCI.
RESULTS Compared with the normal blood flow group, the admission heart rate and SI of patients in the non reflow group were higher than those in the normal blood flow group, while the systolic and diastolic blood pressure were lower than those in the normal blood flow group, all P<0.01. White blood cell count (WBC) increased (P<0.05), the absolute value of neutrophil cell (NEUT) increased (P<0.05), red blood cell count (RBC) decreased (P<0.01), mean red cell volume (MCV) decreased (P<0.01), hemoglobin (HGB) decreased (P<0.05), C-reactive protein (CRP) increased (P<0.05), The increase of APG (P<0.05), UREA (P<0.05), HCY (P<0.01), and D-dimer (D-D) (P<0.01) showed that SI, APG, and HCY were independent risk factors for no reflow in elderly patients with acute STEMI after emergency PCI. Receiver operating characteristic analysis showed that SI+APG+HCY was superior to SI, APG, HCY, SI+APG, SI+HCY, APG+HCY in predicting no reflow after PCI in elderly patients with STEMI, and the difference was statistically significant (P<0.01).
CONCLUSION SI, APG and HCY are independent risk factors for the occurrence of no-reflow after emergency PCI in elderly patients with acute STEMI and SI+APG+HCY has a good predictive value for no-reflow after intervention.

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