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目的 :评价急性心肌梗死 (AMI)发病 6h内的C反应蛋白 (CRP)水平对直接经皮冠状动脉介入治疗 (PCI)后近期预后的预测价值。方法 :76例首次前壁AMI患者于发病 6h内测定血浆CRP水平 ,分为A组(CRP≥ 3mg/L ,2 0例 )和B组 (CRP <3mg/L ,5 6例 ) ,所有患者均接受PCI治疗。每例均随访 6个月并复查冠状动脉造影 (CAG)行定量CAG分析 (QCA) ,比较两组患者入院期间和 6个月随访时主要恶性心血管事件 (MACE ,急性支架内再闭塞、再梗死、靶血管重建、心源性死亡 )的发生率及再狭窄率。结果 :两组间一般临床资料无统计学意义。A组住院期间MACE发生率明显多于B组 (2 5 .0 0 %∶ 0 % ,P <0 .0 1) ,6个月随访CAG最小管腔直径(MLD)明显小于、晚期丢失明显高于B组 [(1.80± 0 .5 7)∶(2 .2 3± 0 .31)mm ,(0 .96± 0 .37)∶(0 .5 1± 0 .18)mm ,均P <0 .0 5 ],再狭窄率A组明显高于B组 (4 1.18%∶16 .0 7% ,P <0 .0 5 )。且经多因素相关分析AMI发作后 6h内CRP≥ 3mg/L是住院期间MACE的惟一独立预测因子 (OR =6 .98,P <0 .0 1)。结论 :AMI发作后 6h内CRP水平对直接PCI术后的近期和远期临床预后有一定的预测价值。
PURPOSE: To evaluate the predictive value of C-reactive protein (CRP) within 6 hours after acute percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: The plasma levels of CRP were measured in 76 patients with AMI in the first anterior wall within 6 hours of onset. The patients were divided into three groups: group A (CRP≥3mg / L, 20 cases) and group B (CRP <3mg / L, 56 cases) All received PCI. Each case was followed up for 6 months and coronary angiography (CAG) was performed for quantitative CAG analysis (QCA). The major malignant cardiovascular events (MACE, acute stent reocclusion) during admission and at 6-month follow-up were compared between the two groups Infarction, target revascularization, cardiac death) and the rate of restenosis. Results: The general clinical data between the two groups was not statistically significant. The incidence of MACE during hospitalization in group A was significantly higher than that in group B (25.0%: 0%, P <0.01). The minimum CAG (MLD) at 6 months follow-up was significantly less than that in group B, and the late loss was significantly higher (1.80 ± 0.57): (2.23 ± 0.31) mm, (0.96 ± 0.37) mm (P> 0.05 ± 0.18) mm, all P < 0.05). The restenosis rate in group A was significantly higher than that in group B (4 1.18%: 16.07%, P <0.05). The only independent predictor of MACE during hospitalization was CRP ≥ 3 mg / L within 6 hours after AMI (m = 0.98, P <0.01). CONCLUSIONS: The level of CRP within 6 hours after onset of AMI has some predictive value for the clinical outcome after immediate PCI.