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目的采用心电图ST段回落指数(ST-segment elevation resolution,STR)和冠状动脉造影心肌呈色分级(myocardial blush grade,MBG)评价超重/肥胖对急性心肌梗死(AMI)直接经皮冠状动脉介入治疗(PCI)后心肌灌注以及患者预后的影响。方法120例AMI并行急诊PCI治疗的超重/肥胖和体重正常患者,分析心电图ST段回落指数和MBG,并进行临床随诊。结果超重组、肥胖组和体重正常组PCI术后TIMI血流3级的患者比较差异无统计学意义。但超重组、肥胖组心肌微循环灌注不良多于体重正常组(MBG0/1级三组分别为44.6%、64.3%和30.6%,MBG2/3级三组分别为55.4%、35.7%和69.4%,P=0.027),超重组、肥胖组ST段回落不全也多于体重正常组(STR<50%三组分别为39.3%、57.1%和22.2%,STR≥50%三组分别为60.7%、42.9%和77.8%,P=0.017)。但超重组、肥胖组和体重正常组患者联合终点事件的发生率在随访期间差异无统计学意义(三组分别为16.1%、17.8%和16.7%,P=0.978)。COX比例风险回归分析显示体重对患者的预后无明显的预测价值[RR2.46(95%可信区间0.64~6.57),P=0.128]。结论在成功接受急诊介入治疗后,超重或肥胖患者更容易出现心肌微循环的障碍,但随诊期间患者的联合终点事件发生率差异并无明显统计学意义。
Objective To evaluate the value of overweight / obesity in patients undergoing acute percutaneous coronary intervention (AMI) by ST-segment elevation resolution (STR) and myocardial blush grade (MBG) PCI) after myocardial perfusion and prognosis of patients. Methods A total of 120 patients with overweight / obesity and normal weight were enrolled in this study. The ST-segment depression index and MBG of ECG were analyzed and followed up clinically. Results There was no significant difference in the level of TIMI grade 3 after PCI between overweight group, obesity group and normal weight group. However, the perfusion of myocardial microcirculation in overweight and obesity group was more than that in normal weight group (44.6%, 64.3% and 30.6% in MBG0 / 1 group, 55.4%, 35.7% and 69.4% in MBG2 / 3 group respectively) , P = 0.027). In the overweight group and obesity group, ST-segment regression was also worse than that in the normal weight group (STR <50%, 39.3%, 57.1% and 22.2% 42.9% and 77.8%, P = 0.017). However, there was no significant difference in the incidence of combined endpoint events among overweight, obesity and normal weight groups at follow-up (16.1%, 17.8% and 16.7%, respectively, P = 0.978). COX proportional hazards regression analysis showed no significant predictive value of body weight in patients with prognosis [RR2.46 (95% confidence interval 0.64 ~ 6.57), P = 0.128]. Conclusion After the successful emergency intervention, overweight or obese patients are more prone to myocardial microcirculation disorder, but there is no statistically significant difference in the incidence of the combined end point patients during follow-up.