2020 年第 2 期 第 15 卷

一氧化氮及内皮素1与急性ST段抬高型心肌梗死直接经皮冠状动脉介入患者无复流相关性研究

Relation among nitric oxide, endothelin-1 and no-reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作者：蒋志丽王成钢李艳芳阙斌聂绍平

英文作者：

单位：首都医科大学附属北京安贞医院急诊科100029

英文单位：

关键词：急性ST段抬高型心肌梗死；直接经皮冠状动脉介入；一氧化氮；内皮素1

英文关键词：

• 摘要：

• 【摘要】目的    探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入（PCI）术后血清一氧化氮、内皮素1与PCI术后心肌组织再灌注水平的关系。方法    选取首都医科大学附属北京安贞医院2017年1月至2018年7月首次因STEMI行急诊直接PCI治疗的患者共292例，按PCI术后心肌梗死溶栓试验(TIMI)血流分级情况分为3组，A组（TIMI 3级，185例）、B组（TIMI 2级，73例）、C组（TIMI 0~1级，无复流，34例），比较3组患者血清一氧化氮及内皮素1浓度差异。结果    A组及B组患者血清一氧化氮浓度均低于C组［（58±12）、（50±11）μmol/L比（44±13）μmol/L］，且B组明显低于A组（均P＜0.05）；A组及B组患者血清内皮素1浓度均高于C组［（8.0±2.2）、（6.1±1.2）ng/L比（5.1±1.2）ng/L，均P＜0.05］，A组与B组内皮素1差异无统计学意义（P＞0.05）。Logistic回归分析发现，内皮素1是STEMI患者PCI术后发生无复流的危险因素（比值比=2.013，95%置信区间：1.563～3.015，P=0.032），一氧化氮则对无复流具有保护性作用（比值比=0.502，95%置信区间：0.261～2.011，P=0.044）。结论    STEMI患者血清一氧化氮及内皮素1表达水平同直接PCI术后心肌灌注水平显著相关，检测血清一氧化氮及内皮素1对评估患者病情具有重要意义。

• 【Abstract】Objective    To investigate the relation among nitric oxide（NO）, endothelin-1（ET-1） and myocardial reperfusion after primary percutaneous coronary intervention（PCI） in acute ST-segment elevation myocardial infarction（STEMI） patients. Methods    A total of 292 patients with initial diagnosis of STEMI undergoing PCI in Beijing Anzhen Hospital, Capital Medical University from January 2017 to July 2018 were enrolled. The patients were divided into 3 groups by thrombolysis in myocardial infarction(TIMI): group A（TIMI grade 3， 185 cases）, group B（TIMI grade 2， 73 cases）, group C（TIMI grade 0-1， no-reflow, 34 cases）. Serum levels of NO and ET-1 were analyzed. Results    Serum NO concentration in group A and B was significantly lower than that in group C［(58±12), (50±11)μmol/L vs (44±13)μmol/L, P＜0.05］, and it was significantly lower in group B than that in group A(all P＜0.05). Serum ET-1 concentration in group A and B was significantly higher than that in group C［(8.0±2.2), (6.1±1.2)ng/L vs (5.1±1.2)ng/L, P＜0.05］; no statistical difference was noticed between group A and group B(P＞0.05). Logistic regression analysis showed that ET-1 was a risk factor of no-reflow(odds ratio=2.013, 95% confidence interval: 1.563-3.015, P=0.032); NO was a protective factor of no-reflow after PCI in STEMI patients(odds ratio=0.502, 95% confidence interval:0.261-2.011, P=0.044). Conclusion    Serum NO and ET-1 in STEMI patients are associated with myocardial perfusion after primary PCI.