目的 探究急性心肌梗死(AMI)患者术中无复流与冠状动脉(冠脉)病变情况和内皮炎症相关性.方法 入选2013年4月~2017年1月于大连大学附属新华医院收治的105例AMI患者,将术中出现无复流者38例设为观察组,术中未出现无复流者67例为对照组,两组均行冠脉造影检查和经皮冠状动脉介入治疗(PCI),根据造影结果将观察组分为单支病变组(16例)、双支病变组(10例)和三支病变组(12例),观察并记录两组患者冠状动脉病变积分(Gensini积分)、血清中循环血内皮微粒(EMPs)和可溶性细胞间粘附分子-1(sICAM-1)水平,分析AMI患者出现无复流现象的影响因素.结果 观察组患者EMPs平均为(2453.17±252.61)个/μl,sICAM-1平均为(515.84±96.72)ng/ml,均显著高于对照组,两组间差异具有统计学意义(P<0.05).随冠脉病变程度加重,患者Gensini积分、脑钠肽(BNP)以及EMPs水平均显著上升,组间比较有统计学意义(P<0.05).AMI患者体内EMPs水平与年龄、发病时间、高血压、糖尿病、高血脂以及吸烟史无明显关系(P>0.05);与Gensini积分、BNP以及高敏C反应蛋白水平密切相关.结论 EMPs和sICAM-1是反映内皮损伤和内皮炎症的标志物,AMI患者行PCI治疗后出现无复流情况与内皮炎症反应密切相关,通过检测EMPs和sICAM-1水平可在一定程度上反映冠状动脉病变程度.
Objective To investigate the relationship between no-reflow phenomenon with coronary artery lesion and endothelial inflammation in patients with acute myocardial infarction (AMI).Methods 105 patients with AMI in Xinhua Hospital of Dalian University from April 2013 to January 2017 were enrolled in this study. 38 patients with no-reflow were treated as observation group. 67 patients with no-reflow were randomly divided into control group. Both two groups underwent coronary angiography and percutaneous coronary intervention (PCI). According to the results of angiography, the observation group was divided into single-vessel disease group with 16 cases, double-vessel disease group with 10 cases and three-vessel disease group (GMP2) with 12 cases. Serum circulating blood endothelial cells (EMPs) and soluble intercellular adhesion molecule-1 (sICAM-1) were observed and recorded. The no-reflow influencing factors were analyzed.Results The mean level of EMP was (2453.17 ±252.61)/ul and sICAM-1 was (515.84±96.72) ng/ml in the observation group, which was significantly higher than those in the control group (P<0.05). With the severity of coronary artery lesions, the Gensini scores, BNP and EMPs levels increased significantly, and there were statistical significant differences between the two groups (P<0.05). There was no significant correlation between EMPs level and age, incidence time, hypertension, diabetes mellitus, hyperlipidemia and smoking history (P>0.05). There was a significant correlation between Gensini score, BNP and Hs-CRP levels.Conclusion EMPs and sICAM-1 are the markers of endothelial injury and endothelial inflammation in patients with AMI after PCI treatment, no reflow and endothelial inflammation is closely related to the detection of EMPs and sICAM-1 can reflect the severity of coronary artery lesions to a certain extent, is conducive to the prognosis.