中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
44期
3100-3103
,共4页
王锦纹%陈韵岱%王长华%朱小玲
王錦紋%陳韻岱%王長華%硃小玲
왕금문%진운대%왕장화%주소령
心肌梗死%尿酸%无复流
心肌梗死%尿痠%無複流
심기경사%뇨산%무복류
Myocardial infarction%Uric acid%No-reflow
目的 评价急性ST段抬高型心肌梗死(STEMI)患者入院时血尿酸水平与经皮冠状动脉介入治疗(PCI)后冠状动脉血流的相关性.方法 入选在发病后12 h内行PCI治疗的276例STEMI患者进行前瞻性分析.将患者分为无复流组(TIMI血流0～2级)和复流正常组.采用多元Logistic回归分析评价血尿酸水平与急诊PCI后冠状动脉血流的相关性.结果 无复流组的尿酸水平显著高于冠状动脉血流正常组.无复流组主要心血管事件(MACE)发生率高于血流正常组.受试者工作特征(ROC)曲线分析显示尿酸水平预测无复流的最佳切点值为345 mmol/L,其预测无复流的敏感度和特异度分别为61.2％和77.5％.多元Logistic回归分析显示,入院时血尿酸(OR 1.01,95％ CI 1.01～1.01,P＜0.01)、中性粒细胞计数(OR 1.02,95％CI 1.00～1.06,P＜0.01)、入院时血糖水平(OR 1.14,95％ CI 1.08 ～ 1.21,P＜0.01)、术前Killip分级≥4级(OR 2.01,95％ CI 1.01 ～3.94,P=0.042)、再灌注时间(OR 1.67,95％ CI 0.46～ 5.97,P=0.012)、PCI前血栓评分≥4级(OR 2.67,95％CI 1.29 ～5.13,P=0.008)、侧支循环分级≤1级(OR 1.86,95％CI 1.27 ～2.73,P=0.008)是直接PCI术无复流现象的独立危险因素.结论 血尿酸水平是STEMI患者急诊PCI后无复流现象的独立危险因素,对于预测STEMI患者PCI后无复流并进行危险分层具有一定参考价值.
目的 評價急性ST段抬高型心肌梗死(STEMI)患者入院時血尿痠水平與經皮冠狀動脈介入治療(PCI)後冠狀動脈血流的相關性.方法 入選在髮病後12 h內行PCI治療的276例STEMI患者進行前瞻性分析.將患者分為無複流組(TIMI血流0～2級)和複流正常組.採用多元Logistic迴歸分析評價血尿痠水平與急診PCI後冠狀動脈血流的相關性.結果 無複流組的尿痠水平顯著高于冠狀動脈血流正常組.無複流組主要心血管事件(MACE)髮生率高于血流正常組.受試者工作特徵(ROC)麯線分析顯示尿痠水平預測無複流的最佳切點值為345 mmol/L,其預測無複流的敏感度和特異度分彆為61.2％和77.5％.多元Logistic迴歸分析顯示,入院時血尿痠(OR 1.01,95％ CI 1.01～1.01,P＜0.01)、中性粒細胞計數(OR 1.02,95％CI 1.00～1.06,P＜0.01)、入院時血糖水平(OR 1.14,95％ CI 1.08 ～ 1.21,P＜0.01)、術前Killip分級≥4級(OR 2.01,95％ CI 1.01 ～3.94,P=0.042)、再灌註時間(OR 1.67,95％ CI 0.46～ 5.97,P=0.012)、PCI前血栓評分≥4級(OR 2.67,95％CI 1.29 ～5.13,P=0.008)、側支循環分級≤1級(OR 1.86,95％CI 1.27 ～2.73,P=0.008)是直接PCI術無複流現象的獨立危險因素.結論 血尿痠水平是STEMI患者急診PCI後無複流現象的獨立危險因素,對于預測STEMI患者PCI後無複流併進行危險分層具有一定參攷價值.
목적 평개급성ST단태고형심기경사(STEMI)환자입원시혈뇨산수평여경피관상동맥개입치료(PCI)후관상동맥혈류적상관성.방법 입선재발병후12 h내행PCI치료적276례STEMI환자진행전첨성분석.장환자분위무복류조(TIMI혈류0～2급)화복류정상조.채용다원Logistic회귀분석평개혈뇨산수평여급진PCI후관상동맥혈류적상관성.결과 무복류조적뇨산수평현저고우관상동맥혈류정상조.무복류조주요심혈관사건(MACE)발생솔고우혈류정상조.수시자공작특정(ROC)곡선분석현시뇨산수평예측무복류적최가절점치위345 mmol/L,기예측무복류적민감도화특이도분별위61.2％화77.5％.다원Logistic회귀분석현시,입원시혈뇨산(OR 1.01,95％ CI 1.01～1.01,P＜0.01)、중성립세포계수(OR 1.02,95％CI 1.00～1.06,P＜0.01)、입원시혈당수평(OR 1.14,95％ CI 1.08 ～ 1.21,P＜0.01)、술전Killip분급≥4급(OR 2.01,95％ CI 1.01 ～3.94,P=0.042)、재관주시간(OR 1.67,95％ CI 0.46～ 5.97,P=0.012)、PCI전혈전평분≥4급(OR 2.67,95％CI 1.29 ～5.13,P=0.008)、측지순배분급≤1급(OR 1.86,95％CI 1.27 ～2.73,P=0.008)시직접PCI술무복류현상적독립위험인소.결론 혈뇨산수평시STEMI환자급진PCI후무복류현상적독립위험인소,대우예측STEMI환자PCI후무복류병진행위험분층구유일정삼고개치.
Objective To explore the association of the uric acid levels and coronary blood flow in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods A total of 276 STEMI patients undergoing primary PCI were enrolled and divided into 2 groups based upon the Thrombolysis in Myocardial Infarction(TIMI)flow grade.No-reflow was defined as TIMI Grade 0,1 and 2 flows.The association of uric acid levels on admission with TIMI flow grade after PCI was assessed by multivariate Logistic regression.Major adverse cardiac events (MACE) were defined as death,non-fatal myocardial infarction and need for repeat percutaneous revascularization or coronary artery bypass grafting.Results The uric acid level was significantly higher in the no-reflow group (n=57) than that of the normal-flow group (n =219,372 ± 111 vs 303 ± 102,P ＜ 0.01).In-hospital MACEs were significantly higher in the patients with no reflow (8.8％ vs 1.8％,P =0.016).A uric acid level ≥ 345 mmol/L measured on admission had a 61.2％ sensitivity and 77.5％ specificity in predicting no-reflow at ROC curve analysis.At multivariate analyses,high plasma uric acid (OR 1.01,95％ CI 1.01-1.01,P ＜ 0.01),neutrophil count (OR 1.02,95 ％ CI 1.00-1.06,P ＜ 0.01),admission plasma glucose (OR 1.14,95％ CI 1.08-1.21,P ＜ 0.01),time from pain to PCI (OR 1.67,95％ CI 0.46-5.97,P =0.012),pre PCI thrombus score ≥ 4 (OR 2.67,95％ CI 1.29-5.13,P =0.008),collateral circulation grade ≤ 1 (OR 1.86,95％ CI 1.27-2.73,P =0.008),and Killip classes (OR 2.01,95％ CI 1.01-3.94,P =0.042) were independent predictors of no-reflow post primary PCI.Conclusions The plasma level of uric acid on admission is a strong and independent predictor of poor coronary blood flow following at post-primary PCI among STEMI patients.Uric acid levels may be a useful biomarker of risk stratification.
