【摘要】 目的 通过光学相干断层成像（OCT）量化巨噬细胞浸润程度，分析巨噬细胞浸润与经皮冠状动脉介入治疗（PCI）围手术期心肌损伤（PMI）之间的关系。方法 本研究为前瞻性单中心观察性研究，连续纳入从2024年4月至2025年1月于中国人民解放军总医院第六医学中心行择期PCI时接受OCT检查的冠状动脉粥样硬化性心脏病患者，根据术后48 h内患者肌钙蛋白I(cTnI)水平将患者分为PMI组和非PMI组。通过OCT扫描定量评估巨噬细胞浸润特征，与临床资料、OCT图像斑块特征相结合，评估其对PMI的预测价值。结果 研究共纳入104例患者，共计116处病变，其中PMI组38例（42处），非PMI组66例（74处）。多因素Logistic回归分析提示糖尿病史、饮酒史、低密度脂蛋白胆固醇（LDL-C）、白细胞介素-6(IL-6)与PMI发生独立相关，且糖尿病史、饮酒史为PMI发生保护性因素（OR 0.160,95%CI 0.053～0.478,P=0.006;OR 0.151,95%CI 0.050～0.456,P=0.007）,LDL-C与IL-6是PMI的危险因素（OR 2.152,95%CI1.248～3.713,P=0.015;OR 1.245,95%CI 1.095～1.414,P<0.001）。巨噬细胞浸润长度、平均角度、浸润指数三者在PMI组均高于非PMI组，但巨噬细胞浸润长度、平均角度差异在两组间无统计学意义。将基于OCT的巨噬细胞浸润特征与临床资料、OCT斑块特征相结合，可提高预测PMI发生的准确性。结论 在择期PCI中，OCT观察的靶病变巨噬细胞浸润定量指标（巨噬细胞浸润角度和指数）与PMI显著相关，联合临床资料与OCT其他斑块特征，可在识别有PMI风险的患者方面提供增量获益。更多还原

【Abstract】 Objective Macrophages play a critical role in the development of coronary atherosclerotic plaques. Measurement of macrophage infiltration by optical coherence tomography(OCT) serves as a potential marker of coronary inflammation. However, the relationship between macrophage inf iltration and periprocedural myocardial in jury(PMI) f ollowing percutaneous coronary intervention(PCI) remains unclear. Methods This prospective singlecenter observational study consecutively enrolled patients with coronary atherosclerotic heart disease who underwent elective PCI with OCT imaging at the Sixth Medical Center of Chinese PLA General Hospital from April 2024 to January 2025. Patients were divided into PMI and nonPMI groups based on cardiac troponin(cTn) I levels within 48 hours post-PCI. Macrophage infiltration observed on OCT images was analyzed along with clinical data and other plaque characteristics OCT-derived to evaluate its predictive value for PMI. Results A total of 104 patients(116 lesions)were included,with 38 in the PMI group(42 lesions)and 66 in the nonPMI group(74 lesions). Multivariate logistic regression analysis revealed that diabetes history, drinking history,low-density lipoprotein cholesterol(LDL-C),and interleukin-6(IL-6) were independently associated with PMI. Notably, diabetes history and drinking history were found to be protective factors against PMI(OR 0.160,95%CI 0.053-0.478,P =0.006;OR 0.151,95%CI 0.050-0.456,P =0.007), whereas LDL-C and IL-6 were identified as risk factors(OR 2.152,95%CI 1.248-3.713, P =0.015;OR 1.245,95%CI 1.095-1.414,P<0.001). The results indicated that the macrophage infiltration length,mean angle, and index were all elevated in the PMI group relative to the non-PMI group. However,macrophage infiltration length and mean angle showed no statistically significant association with PMI. Integrating OCT-derived macrophage infiltration features with clinical data and other plaque characteristics obtained from OCT improves the accuracy of predicting the occurrence of PMI. Conclusions In elective PCI,OCT-derived quantitative indices of macrophage inf iltration(macrophage angle and index)at the target lesion were significantly correlated with PMI. Combination of these metrics with clinical data and additional OCT plaque features yields incremental value in identifying patients at risk of PMI.更多还原