【摘要】 目的:探讨血凝状态对急诊冠状动脉介入治疗(AMI-PCI)发生无复流的评价。方法:连续入选首诊AMI,12 h内行急诊PCI的患者187例,观察术后无复流发生;检测血浆血管性假血友病因子(v WF)、P-选择素(Ps)、组织因子(TF)。结果 :AMI急诊PCI无复流发生率为23.5%。AMI无复流组高凝状态高于正常血流组(P=0.003)。Logistic分析显示高凝状态为无复流的独立预测因子(OR=2.361,95%CI 1.083~5.148,P=0.031)。结论 :血浆v WF、Ps、TF水平升高提示存在高凝状态,对无复流发生具有一定预测价值。更多还原

【Abstract】 Objective To investigate the predictive value of coagulation state on the occurrence of no-reflow phenomenon after primary percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI). Methods A total of 187 consecutive patients with the first AMI underwent PCI within 12 h post-onset of symptom. The clinical features and angiographic findings were collected. According to the thrombolysis in myocardial infarction(TIMI) flow grade with related artery and myocardial blush grade(MBG), the patients were divided into the no-reflow group(TIMI ≤ 2, or MBG ≤ 1) and the normal reflow group. Blood samples were taken immediately on admission before coronary angiography. The levels of plasma von Willebrand factor(v WF),P-selectin(Ps) and Tissue factor(TF) were measured by enzyme-linked immunosorbent assay. Results 23.5%patients of 187 patients developed the no-reflow phenomenon. The plasma level of v WF and Ps and TF were(4 574± 1 677) U / L and(16.8 ± 5.1) ng / m L and(283 ± 81) ng / L in the no-reflow group, and(4 074 ± 1 063)U / L and(14.8 ± 4.2) ng / m L and(254 ± 54) ng / L in the normal group, with significant differences(P = 0.020,0.010 and 0.007, respectively). The hypercoagulation patients in the no-reflow group were much more than patients in the normal reflow group(P = 0.003). Multivariate stepwise logistic regression analysis revealed that hypercoagulation was independent predictor of no-reflow phenomenon(OR = 2.361, 95% CI 1.083 ~ 5.148,P = 0.031). Conclusion The high levels of plasma v WF, Ps and TF present the evidences of hypercoagulation,which might imply the development of no-reflow after PCI.更多还原