目的 探讨急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术后6个月内预后不良的影响因素及术前血清髓过氧化物酶（MPO）、淀粉样蛋白A（SAA）、肌酸激酶同工酶（CK-MB）水平联合检测对预后不良的预测效能。方法 前瞻性选取2023年1月～2025年1月许昌市人民医院诊治的204例AMI患者作为AMI组，另选取同期102例健康志愿者作为对照组。比较两组血清MPO、SAA、CK-MB水平。AMI组患者予以PCI术治疗，依据PCI术后6个月内（失访8例）预后情况将分为预后不良亚组（42例）和预后良好亚组（154例），比较不同预后AMI患者临床资料及术前血清MPO、SAA、CK-MB水平。分析AMI患者PCI术后6个月内预后不良的影响因素；分析术前血清MPO、SAA、CK-MB水平联合检测对预后不良的预测效能。结果 AMI组血清MPO、SAA、CK-MB水平高于对照组（P＜0.05）；预后不良亚组多支病变占比、Killip分级Ⅲ级占比、支架置入数、术前血清MPO、SAA、CK-MB水平高于预后良好亚组（P＜0.05）；校正病变支数、Killip分级、支架置入数后，术前血清MPO、SAA、CK-MB水平是AMI患者PCI术后6个月内预后不良的独立影响因素（P＜0.05）；术前血清MPO、SAA、CK-MB联合预测预后不良的AUC值明显高于各血清指标单度指标预测（P＜0.05）。结论 AMI患者血清MPO、SAA、CK-MB水平明显升高，且是AMI患者PCI术后预后不良的独立影响因素，联合检测其水平对预后不良具有较高的预测效能。

目的 探讨血清白蛋白（ALB）、纤维蛋白原（FIB）、乳酸脱氢酶（LDH）水平联合检测对急性心肌梗死患者短期预后的预测价值，以期为临床早期制定相应干预方案、改善患者预后提供参考。 方法 回顾性选取我院2023年1月~2025年1月收治的132例急性心肌梗死患者，入院后均接受经皮冠脉介入术（PCI）术治疗，根据术后6个月是否发生心血管主要不良事件（MACE）分为预后不良组（n=34）、预后良好组（n=98），比较两组临床资料及入院时血清ALB、FIB、LDH水平，Logistic回归方程分析血清ALB、FIB、LDH水平与急性心肌梗死患者PCI术后预后的关系，受试者工作特征（ROC）曲线分析其预测价值。 结果 两组病变血管支数、Killip分级及入院时血清ALB、FIB、LDH水平比较，差异具有统计学意义（P＜0.05）；入院时血清ALB、FIB、LDH水平与PCI术后预后显著相关，均为其独立影响因素（P＜0.05）；绘制ROC曲线结果显示，入院时血清ALB、FIB、LDH对于PCI术后预后不良的预测AUC分别为0.795、0.856、0.832，联合预测预后不良的AUC为0.927（95%CI：0.892~0.963），大于各方案单独预测，敏感度为91.18%，特异度为89.80%；危险度分析显示，血清ALB低水平患者预后不良风险是高水平患者的6.127倍，血清FIB、LDH高水平患者预后不良风险是低水平患者的10.493、8.170倍（P＜0.05）。 结论 血清ALB、FIB、LDH水平联合检测对急性心肌梗死患者PCI术后预后具有较高预测价值，临床可根据其早期评估患者预后不良风险，以制定个体化干预方案，改善患者预后。

目的 探讨基于5A模式对急性心肌梗死经皮冠状动脉介入治疗（PCI）术后患者早期心脏康复的应用效果。方法 根据随机数字表法将2021年1月—2022年6月来我院接受治疗的80例急性心肌梗死PCI术后患者分为对照组40例与干预组40例。对照组患者在常规护理模式下进行早期心脏康复,干预组患者在基于5A模式下进行早期心脏康复。对比2组患者的心功能与运动能力情况、自我管理能力以及护理依从性。结果 干预2个月后2组患者的左室射血分数、6分钟步行试验距离水平高于干预前,且干预组高于对照组（P<0.05）;左室收缩末期内径水平低于干预前,且干预组低于对照组（P<0.05）;2组患者干预2个月后的日常生活、疾病管理、情绪控制以及自我管理总分均高于干预前,且干预组高于对照组（P<0.05）;干预组的护理总依从率高于对照组（P<0.05）。结论 对急性心肌梗死PCI术后患者给予基于5A模式进行的早期心脏康复可改善其心功能,提升预后自我管理能力,增强护理干预依从性。

目的 探讨急性心肌梗死患者细胞色素P450酶基因(cytochrome P450,family 2,subfamily C,polypeptide 19,CYP2C19)多态性与高敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin- 6,IL-6)及临床预后的相关性。方法 选取2019年5月—2020年5月入住我院心血管内科的急性心肌梗死患者182例作为研究对象,研究对象均接受经皮冠脉介入术,采取RT-PCR方法进行外周全血CYP2C19基因多态性的检测,并进行分组。口服阿司匹林300 mg和氯吡格雷300 mg后次日,测定血中hs-CRP和IL-6含量,治疗后12个月内,随访主要心血管不良事件。结果 182例急性心肌梗死患者中,快代谢组(CYP2C19*1/*1)患者最多,为78例(42.8%);中等代谢组(CYP2C19*1/*2、CYP2C19*1/*3),为65例(35.7%);慢代谢型组(CYP2C19*2/*2、CYP2C19*2/*3、CYP2C19*3/*3)最少,为39例(21.5%)。与快代谢组比较,中代谢组及慢代谢组hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05);与中代谢组比较,慢代谢组患者hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05)。CYP2C19基因型与hs-CRP及IL-6呈正相关(r=0.163、0.175,P<0.05)。中代谢组、慢代谢组患者1年内主要心血管不良事件发生率高于快代谢组患者(P<0.05)。结论 CYP2C19基因型与hs-CRP及IL-6具有相关性,CYP2C19基因型为中代谢型和慢代谢型能够激活机体炎症反应,影响急性心肌梗死患者的临床预后。

Objective To explore the correlation of cytochrome P450 gene (CYP2C19) polymorphism with hypersensitive C-reaction protein (hs-CRP), interleukin-6 (IL-6) and prognosis in patients with acute myocardial infarction (AMI). Methods A total of 182 patients with AMI admitted to cardiology department from May 2019 to May 2020 were selected as the research objects, all subjects underwent percutaneous coronary intervention (PCI), and CYP2C19 gene polymorphism in peripheral blood was detected by RT-PCR, which was grouping basis. One day after taking aspirin 300 mg and clopidogrel 300 mg orally, the levels of hs-CRP and IL-6 in patients' plasma were measured. The major adverse cardiovascular events (MACE) were followed up for 12 months after treatment. Results Among 182 patients with AMI, 78 patients (42.8%) were in the fast metabolism group (CYP2C19*1/*1), 65 patients (35.7%) in medium metabolism group (CYP2C19*1/*2, CYP2C19*1/*3), 39 patients (21.5%) in the slow metabolism group (CYP2C19*2/*2, CYP2C19*2/*3, CYP2C19*3/*3).Compared with the fast metabolism group, hs-CRP and IL-6 levels in the medium and slow metabolism group were significantly higher (P<0.05); compared with the medium metabolism group, hs-CRP and IL-6 levels in the slow metabolism group were significantly increased (P<0.05). CYP2C19 genotype was positively correlated with hs-CRP and IL-6 levels (r=0.163, 0.175,P<0.05). The incidences of MACE in the medium and slow metabolism groups were higher than that in the fast metabolism group (P<0.05). Conclusion CYP2C19 genotypes were associated with hs-CRP and IL-6 levels. Medium and slow metabolism types of CYP2C19 gene can activate the inflammatory response and affect the clinical prognosis of patients with AMI.

尼可地尔是一种ATP敏感型钾离子通道开放剂,同时兼有类硝酸酯作用,具有舒张冠脉和外周血管及通过缺血预适应对心脏起保护作用等双重功效,主要用于抗心绞痛的治疗。介于尼可地尔这种特殊结构及其作用机制能否降低急性心肌梗死患者PCI术后无复流的发生率及改善临床预后,目前临床研究仍在探索中。现就尼可地尔的作用机制、模拟的药物预适应作用、及综合作用与急性心肌梗死的关系做一综述,评估尼可地尔作为辅助药物在AMI行介入治疗中的作用及临床预后,指导临床用药。

Nicorandil is an ATP-sensitive potassium (K-ATP) channel opener, meanwhile has an effect like nitrate, has dual actions including coronary and peripheral vasodilatation and cardioprotective effects through ischemic preconditioning, mainly for the treatment of anti-angina. Whether the specific structure of nicorandil and its mechanism can reduce the incidence of no-reflow in patients with acute myocardial infarction (AMI) after PCI and improve the clinical prognosis, the current clinical research is still under investigation. We will expound mechanisms of nicorandil, drug preconditioning and its comprehensive effect. The role of nicorandil in the interventional therapy of AMI was reviewed to guide clinical medication.

目的 分析与比较不同血运重建策略对急性心肌梗死合并多支血管病变患者的疗效,以探讨其临床价值。方法 选取本院在2012年8月—2015年8月期间收治的急性心肌梗死合并多支血管病变患者,对每个患者均成功行PCI后,按随机数字表法分为实验组与对照组,实验组于发病后7～10天行预防性急诊PCI,并对非梗死相关血管病变进行干预;对照组则根据患者的缺血情况对非梗死相关血管病变行急诊PCI。随访2年,并记录2组患者主要心脏不良事件、其它心血管事件以及再次急诊PCI情况。结果 共有450例患者完成2年的随访,实验组患者有226例,对照组患者有224例。2组患者的全因病死率(χ²=7.040,P=0.008)、心脏不良事件(P均>0.05)以及心力衰竭发生率(χ²=1. 527,P=0.217)均无统计学差异。与对照组相比,实验组再发心绞痛(χ²=21.092,P<0.001)、心因性再住院(χ²=22.893,P<0.001)和再次支架治疗(χ²=17.835,P<0.001)的发生率均明显较低,而其相关血管血运重建率较高。且实验组随访2年时,β受体阻滞剂(χ²=7.040,P=0.008)和硝酸酯类药物(χ²=63.889,P<0.001)服用率均明显较高。结论 急性心肌梗死合并多支血管病变患者在成功行急诊干预梗死相关血管后,且预防性干预非梗死相关血管,可使再发心绞痛、再次支架治疗以及心因性再住院的发生率显著降低。

Objective By analyzing and comparing the effects of different revascularization strategies on patients with acute myocardial infarction complicated with multi-vessel disease, to explore its clinical value.Methods Selecting the patients with acute myocardial infarction complicated with multi-vessel disease from August, 2012 to August, 2015 in our hospital (Zhaoqing No.2 People's Hospital), after each patient was successfully treated with PCI, divided them into experimental group and control group by random number table method, the experimental groups were treated with preventive emergency PCI after the onset 7-10 days, and the intervention of non-infarct-related vascular diseases were done;the control groups were treated with emergency PCI for the non-infarct-related vascular diseases according to the patient's lack of blood. Visiting them randomly for 2 years, the main cardiac adverse events, other cardiovascular events and one more emergency PCI situation in the two groups were recorded.Results A total of 450 patients completed two years of follow-up, with 226 patients in the experimental group and 224 patients in the control group. All-cause mortality (χ2=7.040,P=0.008), cardiac adverse events (P> 0.05)and incidence of heart failure (χ2=1. 527,P=0.217) were no statistically significant difference between the two groups. Compared with the control group, the incidence of angina pectoris (χ2=21.092,P<0.001), cardiologic rehospitalization (χ2=22.893,P<0.001)and one more stent treatment (χ2=17.835,P<0.001) of the experimental group was significantly lower, but the revascularization rate was higher of their related blood vessels. And when the experimental group was followed up for 2 years, the taking rate of β-blockers (χ2=7.040,P=0.008) and nitrates (χ2=63.889,P<0.001) was significantly higher.Conclusion After the patients with acute myocardial infarction complicated with multi-vessel disease were successfully treated with emergency PCI to intervene the infarct-related blood vessels, and at the same time the intervention of the non-infarct-related blood vessels were done, the recurrence of angina pectoris, stent treatment and cardiopulmonary rehospitalization was significantly reduced.

目的 探讨急性心肌梗死患者入院首次中心粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与院内主要不良心血管事件(MACE)发生的相关性。方法 回顾分析2016年1月—2016年12月入住我院的急性心肌梗死患者179例,分为发生院内不良事件组(n=46)和未发生组(n=133)。采用单因素及多因素Logistics回归分析评估NLR与MACE风险的相关性。结果 179例患者中,46例患者发生院内MACE。发生院内MACE组患者的淋巴细胞计数低于未发生组(P<0.05),NLR高于未发生组(P<0.05),发生院内MACE组患者入院时的心、肾功能较未发生组差(P<0.05)。单因素回归分析显示,NLR水平与院内MACE发病率相关(OR=1.079,95%CI:1.014～1.147, P＜0.05)。多因素logistic回归分析校正性别、年龄、高血压病史、糖尿病史、Killip II级以上、收缩压、入院首次白细胞、eGFR、超敏C反应蛋白、左室射血分数及多支病变后显示,NLR是院内MACE的独立危险因素(OR=1.182,95%CI:1.034～1.352,P＜0.05);此外,超敏C反应蛋白及LVEF<50也是院内MACE的独立危险因素(P＜0.05)。结论 入院首次高NLR与急性心肌梗死患者发生院内MACE相关,是患者发生院内MACE的独立危险因素。

Objective To explore the correlation between first neutrophil/lymphocyte ratio(NLR) and in-hospital major adverse cardiac events (MACE) in patients with in patients with acute myocardial infarction. Methods Total of 179 patients with acute myocardial infarction in Guangzhou First People's Hospital from Jan 2016 to Dec 2016 were enrolled. MACE was defined as malignant arrhythmia, recurrence of myocardial infarction, target vascular reconstruction, acute left heart failure, stroke, cardiac shock and death.Baseline data and in-hospital clinical adverse events were compared among two groups. All patients were divided into two groups:MACE(+) group and MACE(-) group. Univariate and multivariate logistic regression was used to assess the correlation between NLR and in-hospital MACE. Results In-hospital MACE occurred in 46(25.7%)patients. Univariate logistic analysis showed that NLR was strongly related with MACE incidence(OR=1.079,95%CI:1.014～1.147, P＜0.05). Multivariate logistic regression analysis found that after adjusting other traditional risk factors including female gender, age, hypertension,diabetes, overKillip II grade, systolic blood pressure,first white blood cells after admitted,basic renal dysfunction,Hs-CRP,LVEF and multivessel lesions. NLR was still a significant independent predictor of in-hospital MACE in patients with acute myocardial infarction. Additionally, hs-CRP and LVEF<50% were also associated with in-hospital MACE(P＜0.05). Conclusion NLR is the independent risk factor for in-hospital MACE occurrence in acute myocardial infarction at the early admission.

目的 探讨血清胱抑素C、尿酸及降钙素原对诊断急性心肌梗死的临床价值。方法 回顾性分析我院134例心肌梗死患者及89名健康人血清胱抑素C、尿酸及降钙素原水平。结果 与健康对照组相比,实验组患者血清Cys-C、UA和PCT均有不同程度的升高,且差异有统计学意义。此外,血清Cys-C和PCT升高的水平与心肌梗死程度有关。结论 血清Cys-C、UA和PCT水平均可以作为AMI的临床指标,并且血清Cys-C和PCT在一定程度反映心肌梗死的严重程度。

目的 建立大鼠急性心肌梗死缺血再灌注后无复流模型,并初步验证细胞焦亡在其中的发生情况。方法 选用20只标准成年雄性Sprague Dawley大鼠（体质量260~320 g）,随机分为对照组（n=5）和手术组（n=15）。对照组仅穿线冠状动脉,未行结扎;手术组结扎左前降支0.5 h后解除,进行再灌注4 h,以建立无复流模型。通过Evens blue和硫磺素S染色,评估心肌的正常供血区、再灌注区及无复流区,并对两组大鼠心肌组织进行病理分析。结果 对照组大鼠全部存活,未出现无复流现象,心肌组织中未见细胞焦亡。手术组存活13只,形成明确的正常供血区（n=13）、再灌注区（n=13）和无复流区（n=10）。在无复流区的心肌细胞中均观察到细胞焦亡（n=10）,而正常供血区未见（n=0）,再灌注区部分出现（n=4）,差异具有统计学意义（P<0.05）。结论 细胞焦亡现象主要存在于大鼠急性心肌梗死缺血再灌注后无复流区域中,细胞焦亡可能作为一种区域特异性程序性死亡方式,在心肌无复流的发生与发展中发挥重要作用。

Objective To establish a rat model of myocardial no-reflow after acute myocardial infarction with ischemia-reperfusion injury and to preliminarily explore the occurrence of pyroptosis in the affected myocardium. Methods Twenty adult male Sprague-Dawley rats（260-320 g）were randomly divided into a control group（n=5）and a surgical group（n=15）. In the control group,the coronary artery was encircled with suture but not ligated. In the surgical group,the left anterior descending artery was ligated for 30 minutes, followed by 4 hours of reperfusion to induce the no-reflow model. Evans blue and thioflavin S staining were used to evaluate the normal perfusion area,reperfusion area,and no-reflow area of the myocardium. Histopathological analysis was conducted on myocardial tissues from both groups. Results All rats in the control group survived without evidence of no-reflow or pyroptosis in myocardial tissue. In the surgical group, 13 rats survived and showed distinct regions of normal perfusion, 13 with reperfusion, and 10 with no-reflow. Pyroptosis was observed in all no-reflow areas（n=10）, absent in the normal perfusion zones（n=0）, and partially present in the reperfusion zones（n=4）. The differences were statistically significant（P<0. 05）. Conclusions Pyroptosis predominantly occurs in the no-reflow zones following acute myocardial infarction and ischemia-reperfusion injury in rats. As a region-specific form of programmed cell death, pyroptosis may play an important role in the development of myocardial no-reflow.