摘要
目的探讨急性心肌梗死（AMI）患者同型半胱氨酸（Hcy）水平与直接经皮冠状动脉内介入治疗（PCI）后心肌灌注水平的关系及对患者临床预后的影响。方法选择2009年3月-2011年3月在我院心内科住院并诊断为急性ST段抬高型心肌梗死（STEMI）患者350例，根据入院后空腹Hcy水平的三分位数间距将患者分为A组（〈17．5μmol／L）110例，B组（17．5～25．6μmoL／L）组128例和C组（〉25．6μmol／L）112例。比较三组患者直接PCI后心肌灌注指标包括术后2小时sT段回落（STR），TIMI心肌灌注分级（TMPG）及心肌肌酸激酶同工酶（CK—MB）峰值的差异，并追踪观察三组患者术后随访12个月内心血管不良事件（MACE）的发生情况。结果三组患者随Hcy水平升高，术后2小时STR良好比例及TMPG2—3级比例均降低[72．7％vs54．7％vs44．6％（P〈0．05）；76．4％VS56．3％VS46．4％（P〈0．05）]；术后CK—MB峰值升高[（172．3±83．4）mmol／1VS（201．6±78．5）mmol／l VS（245．8±79．2）mmol／L（P〈0．01）]且术后7—10天左室射血分数（LVEF）明显降低[（52．6±7．3）％vs（50．9±5．8）％VS（48．9±5．3）％，P〈0．01）]。多因素Logistic回p-3分析显示高Hey水平是STEMI患者直接PCI术后MACE发生的独立预测因子。结论AMI患者出现高Hcy血症可影响直接PCI再灌注治疗后心肌灌注水平，Hey水平对STE—MI患者的临床预后具有预测价值。
Objective To investigate the relationship between homocysteine （Hcy） and myocardial reperfusion level of acute myocardial infarction （AMI） patients underwent primary percutaneous coronary intervention （PCI）, and assess its predic- tive value for patients＇ prognosis. Methods 350 patients with ST-segment elevation myocardial infarction （STEMI） who un- derwent primary PCI from March 2009 to March 2011 in our department of cardiology were enrolled and followed up. Patients were divided into three groups according to their Hcy levels on admission： A group （Hcy 〈 17.5μmol/L） including 110 cases; B group （17. 5 -25.6μmol/L） including 128 cases and C group （Hcy 〉 25.6μmol/L） including 112 cases. ST segment reso- lution （STR）, TIMI myocardial perfusion grade （TMPG）, peak value of CK-MB, left ventricular ejection （LVEF） post opera- tion of patients in three groups were measured, and patients＇ major cardiac adverse events （MACE） during follow-up were re- corded. Results Compared with A group, patients in B or C group had lower STR and TMPG, higher peak value of CK-MB, and lower LVEF. After 12 months of follow-up, Binary logistic regression analysis indicated that elevated Hcy was a strong inde- pendent predictor for the recent prognosis of STEMI patients. Conclusion Elevated Hcy will reduce myocardial reperfusion level in AMI patients after primary PCI therapy. Hyperhomocysteinaemia is valuable in predicting the prognosis of AMI patients underwent primanry PCI.
出处
《广州医药》
2013年第5期8-11,共4页
Guangzhou Medical Journal
关键词
半胱氨酸
心肌梗死
血管成形术
心肌灌注
Cysteine
Myocardial infarction
Angioplasty transluminal
Percutaneous Coronary
