【摘要】 目的 探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后左心室血栓(LVT)的发生率及危险因素。方法 纳入因急性STEMI行PCI并完成超声心动图检查的患者2 147例，将随访期间并发LVT的患者53例作为LVT组，根据1∶3比例随机抽取无LVT的患者159例作为无LVT组。比较两组患者的一般临床资料、超声心动图测量指标、入院后首次静脉血检测指标及PCI相关资料。采用二元logistic回归分析评估急性STEMI患者PCI后LVT的影响因素；采用受试者工作特征(ROC)曲线分析各因素对急性STEMI患者PCI后LVT的预测价值。结果 LVT组男性、有吸烟史、酗酒史、急性前壁心肌梗死、左心室射血分数(LVEF)≤40%、室壁瘤形成、罪犯血管为前降支患者比例、心率、左心室舒张末内径(LVEDD)、平均血小板体积(MPV)、血浆D-二聚体(D-D)、高敏肌钙蛋白T(hs-cTnT)峰值、血尿酸(SUA)、血肌酐(SCr)、尿素氮(BUN)、同型半胱氨酸(Hcy)水平、发病至首次球囊扩张(SO-to-B)时间均高于无LVT组，LVEF、直接PCI患者比例均低于无LVT组(P<0.05)。二元logistic回归分析结果显示，急性前壁心肌梗死、室壁瘤形成、吸烟史、SO-to-B时间、hs-cTnT峰值、BUN、Hcy是急性STEMI患者PCI后LVT的独立危险因素，直接PCI是其独立保护因素(P<0.05)。ROC曲线分析结果显示，BUN=5.56 mmol/L、hs-cTnT峰值=5.40μg/L、Hcy=12.95μmol/L、SO-to-B时间=200.00 min作为预测急性STEMI患者PCI后LVT的最佳截断值时，对应的敏感度分别为0.679、0.434、0.472、0.781,特异度分别为0.560、0.774、0.811、0.741。结论 急性STEMI患者PCI后LVT的发生率较低，且LVT几乎均出现于左心室心尖部；缩短SO-to-B时间和早期行直接PCI可能有助于降低LVT的发生率。更多还原

【Abstract】 Objective To investigate the incidence and risk factors for left ventricular thrombosis(LVT) in patients with acute ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI).Methods A total of 2 147 patients underwent PCI due to acute STEMI and completed echocardiography examination were enrolled.A total of 53 patients with LVT during follow-up were selected as LVT group, and 159 patients without LVT were randomly selected as non-LVT group according to the ratio of 1∶3.General clinical data, echocardiographic measurements, first venous blood test indicators after admission and PCI related data were compared between two groups.Binary logistic regression analysis was used to evaluate influencing factors for LVT in patients with acute STEMI after PCI.Receiver operating characteristic(ROC) curve was used to analyze predictive value of each factor for LVT in patients with acute STEMI after PCI.Results Proportion of patients with male, smoking history, alcoholism history, acute anterior myocardial infarction, left ventricular ejection fraction(LVEF)≤40%,ventricular aneurysm formation, whose culprit vessel were left anterior descending artery and heart rate, left ventricular end-diastolic diameter(LVEDD),mean platelet volume(MPV),levels of plasma D-dimer(D-D),peak high-sensitivity troponin T(hs-cTnT),serum uric acid(SUA),serum creatinine(SCr),blood urea nitrogen(BUN),homocysteine(Hcy),time from symptom onset-to-balloon(SO-to-B) in LVT group were all higher than those in non-LVT group, LVEF and proportion of patients with primary PCI were all lower than those in non-LVT group(P<0.05).Binary logistic regression analysis showed that acute anterior myocardial infarction, ventricular aneurysm formation, smoking history, SO-to-B time, peak hs-cTnT,BUN and Hcy were independent risk factors for LVT in patients with acute STEMI after PCI,and primary PCI was its independent protective factor(P<0.05).ROC curve analysis showed that BUN=5.56 mmol/L,peak hs-cTnT=5.40 μg/L,Hcy=12.95 μmol/L,SO-to-B time=200.00 min were the best cut-off values for predicting LVT in patients with acute STEMI after PCI,and sensitivity were 0.679,0.434,0.472,0.781,specificity were 0.560,0.774,0.811,0.741 respectively.Conclusion The incidence of LVT in patients with acute STEMI after PCI is low, and LVT almost all occur in the left ventricular apex.Shorter SO-to-B time and early primary PCI may help to reduce the incidence of LVT.更多还原