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目的:明确ST段抬高型心肌梗死（STEMI）患者的炎症反应水平及罪犯斑块形态特征与经皮冠状动脉介入治疗（PCI）术前心肌梗死溶栓（TIMI）血流分级的关系。方法:本研究为回顾性研究。选取1 268例PCI术前对罪犯斑块行光学相干断层成像（OCT）检查的STEMI患者，按照TIMI血流分级分为TIMI 0~1组964例（76.0%）和TIMI 2~3组304例（24.0%）。收集2组的基线临床资料；采集血样检测炎症反应标志物高敏C反应蛋白（hsCRP）、心肌损伤标志物及血脂等指标；行心脏超声检测左心室射血分数；行冠状动脉造影及OCT检查，收集梗死相关动脉的病变长度、狭窄程度，有无复杂病变，以及罪犯斑块类型、狭窄程度及易损性相关指标并比较。采用多因素logistic回归模型分析TIMI 0~1级的独立相关因素，并确定其最佳截断值。结果:1 268例STEMI患者年龄为（57.6±11.4）岁，男性923例（72.8%）。与TIMI 2~3组相比，TIMI 0~1组患者年龄较大，N末端B型钠尿肽原水平较高，左心室射血分数及肌钙蛋白I水平较低，hsCRP水平较高［5.16（2.06，11.78）mg/L比3.73（1.51，10.46）mg/L］，且斑块破裂亚组中TIMI 0~1组患者hsCRP水平较高（n P均16.14 mm和hsCRP>3.29 mg/L是STEMI患者TIMI血流分级降低（TIMI 0~1级）的独立相关因素。n 结论:斑块易损性和炎症反应与STEMI患者PCI术前TIMI血流分级降低密切相关。“,”Objective:To determine the impact of inflammatory reaction levels and the culprit plaque characteristics on preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods:The is a retrospective study. A total of 1 268 STEMI patients who underwent pre-intervention optical coherence tomography (OCT) examination of culprit lesion during emergency PCI were divided into 2 groups by preprocedural TIMI ?ow grade (TIMI 0-1 group (n n =964, 76.0%) and TIMI 2-3 group (n n =304, 24.0%)). Baseline clinical data of the 2 groups were collected; blood samples were collected for the detection of inflammatory markers such as high sensitivity C-reactive protein (hsCRP), myocardial injury marker, blood lipid, etc.; echocardiography was used to determine left ventricular ejection fraction; coronary angiography and OCT were performed to define the lesion length, diameter stenosis degree of the infarct-related arteries, presence or absence of complex lesions, culprit lesion type, area stenosis degree and vulnerability of culprit plaques. Multivariable logistic regression analysis was performed to identify independent correlation factors. The receiver operating characteristic (ROC) curve of continuous independent correlation factors was analyzed, and the best cut-off value of TIMI 0-1 was respectively determined according to the maximum value of Youden index.n Results:The mean age of 1 268 STEMI patients were (57.6±11.4) years old and 923 cases were males (72.8%). Compared with TIMI 2-3 group, the patients in TIMI 0-1 group were older and had higher N-terminal-pro-B-type natriuretic peptide level, lower cardiac troponin I (cTnI) level, lower left ventricular ejection fraction, and higher hsCRP level (5.16(2.06, 11.78) mg/L vs. 3.73(1.51, 10.46) mg/L). Moreover, the hsCRP level of patients in TIMI 0-1 group was higher in the plaque rupture subgroup (all n P16.14 mm, and hsCRP>3.29 mg/L were the independent correlation factors of reduced preprocedural TIMI flow grade in STEMI patients.n Conclusions:Plaque vulnerability and inflammation are closely related to reduced preprocedural TIMI flow grade in STEMI patients.