【摘要】 目的 探讨急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入术后ST段回落不良的临床特点及相关影响因素。方法 回顾性分析石河子大学医学院第一附属医院2019年1月至2021年6月确诊为STEMI患者并于12 h内行直接经皮冠状动脉介入治疗术（pPCI）患者的临床资料。根据pPCI术后1 h内心电图ST段回落的不同程度，将患者分为ST段回落不良组（ST段回落率≤50%）和ST段回落良好组（ST段回落率>50%）。比较两组STEMI患者的临床基本资料及手术相关情况，应用二元logistic回归模型分析STEMI患者pPCI术后ST段回落不良的影响因素。结果 STEMI患者pPCI术后1 h内出现ST段回落不良的发生率为43.31%。ST段回落不良组患者的年龄、入院首次氨基末端B型脑钠肽前体（NT-proBNP）、入院首次心肌肌钙蛋白Ⅰ（cTnⅠ）、单核细胞计数、单核细胞计数与高密度脂蛋白胆固醇比值（MHR）均高于ST段回落良好组，而左心室射血分数（LVEF）水平明显低于ST段回落良好组（P <0.05）。急性心肌梗死症状出现到球囊扩张时间（SOTBT）<3 h的STEMI患者在术后ST段回落良好组中占比明显高于ST段回落不良组（P <0.05）。而SOTBT为7～12 h的患者在ST段回落不良组中的占比明显高于ST段回落良好组（P <0.05）。ST段回落不良组患者住院期间主要心血管不良事件（MACE）的发生率明显高于ST段回落良好组（P <0.05）。二元logistic回归模型分析显示，年龄、SOTBT、入院首次NT-proBNP均为ST段回落不良的独立危险因素。结论 43.31%的STIMI患者pPCI术后可能出现ST段回落不良，年龄、SOTBT、NT-proBNP是STEMI患者pPCI术后出现ST段回落不良的独立危险因素。ST段回落不良的患者发生院内心血管不良事件明显较多。更多还原

【Abstract】 Objective To investigate the clinical characteristics and relevant influencing factors of poor STsegment resolution after emergency percutaneous coronary intervention on patients with STEMI. Methods The clinical data of patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention(pPCI) within 12 hours treated in the First Affiliated Hospital of Shihezi University School of Medicine from January 2019 to June 2021 were retrospectively analyzed. Patients were divided into the poor ST-segment resolution group(ST-segment resolution rate ≤ 50%) and the good ST-segment resolution group(ST-segment regression rate >50%) according to the degrees of ST-segment resolution on electrocardiogram(ECG) within 1 h after pPCI. The basic clinical data and surgery-related conditions of patients with STEMI were compared between the two groups. The binary logistic regression model was adopted to analyze the influencing factors of poor ST-segment resolution after pPCI in patients with STEMI. Results The incidence of poor ST-segment resolution within 1 h after pPCI in patients with STEMI was 43.31%. Age, first N-terminal pro B-type natriuretic peptide(NT-proBNP) on admission, first Cardiac troponin-Ⅰ(cTn Ⅰ) on admission,monocyte count, and monocyte count to high-density lipoprotein cholesterol ratio(MHR) in the poor STsegment resolution group were higher than those in the good ST-segment resolution group, while the level of left ventricular ejection fraction(LVEF) in the poor ST-segment resolution group was significantly lower than that in the good ST-segment resolution group(P < 0.05). The proportion of the acute myocardial infarction symptom-onset-to-balloon time(SOTBT) <3 h of patients with STEMI in the good ST-segment resolution group was significantly higher than that in the poor ST-segment resolution group(P < 0.05). However, the proportion of patients with SOTBT of 7-12 h in the poor ST-segment resolution group was significantly higher than that in the good ST-segment resolution group(P < 0.05). The incidence of major adverse cardiovascular events(MACE)during hospitalization in the poor ST-segment resolution group was significantly higher than that in the good ST-segment resolution group(P < 0.05). The analysis of the binary logistic regression model showed that age,SOTBT, and first NT-proBNP on admission were all independent risk factors for poor ST-segment resolution.Conclusion 43.31% of patients with STIMI after pPCI may have poor ST-segment resolution. Age, SOTBT,and NT-proBNP were independent risk factors for poor ST-segment resolution after pPCI in patients with STEMI. Patients with poor ST-segment resolution have a significantly high occurrence of MACE during their hospitalization.更多还原