作者：任玥 ，张纯溪，杨洋，范秋颖 ，黄雷

单位：

1.300170天津市第三中心医院急诊科　2.300170天津市重症疾病体外生命支持重点实验室　3.300170天津市人工细胞 工程技术研究中心　4.300170天津市肝胆研究所　5.300170天津市第三中心医院心脏中心

Units：

1.Emergency Department, the Third Central Hospital of Tianjin, Tianjin 300170, China 2.Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China 3.Artificial Cell Engineering Technology Research Center, Tianjin 300170, China 4.Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China 5.Heart Center, the Third Central Hospital of Tianjin, Tianjin 300170, China

关键词：

ST段抬高型心肌梗死；经皮冠状动脉介入治疗；无复流现象；γ-谷氨酰转移酶

Keywords：

ST elevation myocardial infarction; Percutaneous coronary intervention; No-reflow phenomenon; γ-glutamyltransferase

CLC：

R 542.22

DOI：

10.12114/j.issn.1008-5971.2023.00.305

Funds：

天津市科技计划项目（21JCYBJC01590）

摘要：

目的　探讨血清γ-谷氨酰转移酶（GGT）对急性ST段抬高型心肌梗死（STEMI）患者PCI后发生无复 流现象的预测价值。方法　回顾性选取2020年1月至2022年9月在天津市第三中心医院接受PCI的急性STEMI患者 236例 为研究对象。收集患者的临床资料及实验室检查指标，根据PCI后无复流现象发生情况将患者分为无复流组（ n=34 ） 和对照组（n=202）。采用多因素Logistic回归分析探讨急性STEMI患者PCI后发生无复流现象的影响因素；采用ROC 曲线分析年龄、心率、收缩压、发病至球囊开通时间、血清GGT对急性STEMI患者PCI后发生无复流现象的预测价 值。结果　两组年龄、心率、收缩压、Killip分级≥Ⅱ级者占比、发病至球囊开通时间、白细胞计数、血清GGT、 ALT、AST、肌酸激酶同工酶（CK-MB）比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示， 年龄〔OR=1.047，95%CI（1.007，1.090）〕、心率〔OR=1.029，95%CI（1.005，1.054）〕、收缩压〔OR=0.970， 95%CI（0.950，0.991）〕、发病至球囊开通时间〔OR=1.174，95%CI（1.030，1.339）〕、血清GGT〔OR=1.013， 95%CI（1.004，1.022）〕为急性STEMI患者PCI后发生无复流现象的独立影响因素（P＜0.05）。ROC曲线分析结果显 示，年龄、心率、收缩压、发病至球囊开通时间、血清GGT预测急性STEMI患者PCI后发生无复流现象的AUC分别为 0.608、0.613、0.628、0.616、0.662，最佳截断值分别为65岁、78次/min、124 mm Hg、2.2 h、28 U/L。结论　年龄、 心率、收缩压、发病至球囊开通时间、血清GGT为急性STEMI患者PCI后发生无复流现象的独立影响因素，但血清GGT 对急性STEMI患者PCI后发生无复流现象的预测价值一般。

Abstract：

Objective To explore the predictive value of serum γ-glutamyltransferase (GGT) for no-reflow phenomenon after PCI in patients with acute ST elevation myocardial infarction (STEMI) . Methods A retrospective study was conducted on 236 patients with acute STEMI who underwent PCI in the Third Central Hospital of Tianjin from January 2020 to September 2022. The clinical data and laboratory examination indicators of the patients were collected, and the patients were divided into no-reflow group (n=34) and control group (n=202) according to the occurrence of no-reflow phenomenon after PCI. Multivariate Logistic regression analysis was used to explore the influencing factors of no-reflow phenomenon after PCI in patients with acute STEMI. The ROC curve was used to explore the predictive value of the age, heart rate, systolic blood pressure, time from onset to balloon opening, and serum GGT for no-reflow phenomenon after PCI in patients with acute STEMI. Results There were significant differences in age, heart rate, systolic blood pressure, proportion of patients with Killip grading of ≥ Ⅱ, time from onset to balloon opening, white blood cell count, serum GGT, ALT, AST, and creatine kinase isoenzymes (CK-MB) between the two groups (P < 0.05) . Multivariate Logistic regression analysis showed that age [OR=1.047, 95%CI (1.007, 1.090) ] , heart rate [OR=1.029, 95%CI (1.005, 1.054) ] , systolic blood pressure [OR=0.970, 95%CI (0.950, 0.991) ] , time from onset to balloon opening [OR=1.174, 95%CI (1.030, 1.339) ] , and serum GGT [OR=1.013, 95%CI (1.004, 1.022) ] were the independent influencing factors of no-reflow phenomenon after PCI in patients with acute STEMI (P < 0.05) . ROC curve analysis showed that the AUC of the age, heart rate, systolic blood pressure, time from onset to balloon opening, and serum GGT for predicting no reflow phenomenon after PCI in patients with acute STEMI were 0.608, 0.613, 0.628, 0.616, 0.662, the optimal cut-off values were 65 years old, 78 times/min, 124 mm Hg, 2.2 h, 28 U/L, respectively. Conclusion Age, heart rate, systolic blood pressure, time from onset to balloon opening, and serum GGT are the independent influencing factors of no-reflow phenomenon after PCI in patients with acute STEMI. While the predictive value of serum GGT for no-reflow phenomenon after PCI in patients with acute STEMI is average.

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