本文選題：急性心肌梗死 + 抽吸血栓��； 參考：《鄭州大學》2017年碩士論文

【摘要】：研究背景冠脈內(nèi)易損斑塊的破裂及繼發(fā)的血栓形成是急性心肌梗死的主要發(fā)病機制。病理學和影像學研究證實冠脈內(nèi)血栓包括紅色血栓和白色血栓。傳統(tǒng)的理念是急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者冠脈內(nèi)形成的是紅色血栓。然而,Yasushi等應用光學相干斷層成像(Optical coherence tomography,OCT)對40例STEMI患者的罪犯血管進行觀察,結果示78%的患者冠脈內(nèi)形成的是紅色血栓,另有22%的患者冠脈內(nèi)形成的是白色血栓;Quadros等通過肉眼分辨冠脈內(nèi)抽吸血栓,發(fā)現(xiàn)113例STEMI患者的抽吸血栓中31%為白色血栓。介于組織病理學分析是鑒別血栓類型的金標準,且冠脈內(nèi)血栓抽吸可以較為經(jīng)濟、方便地獲取血栓,因此本研究欲通過對抽吸血栓進行病理學分析來鑒別STEMI患者冠脈內(nèi)是否存在不同的血栓類型。目的探究STEMI患者冠脈內(nèi)抽吸血栓的病理類型及其構成比;分析影響STEMI患者形成不同類型血栓的相關因素。方法納入2014年3月至2016年2月在河南省人民醫(yī)院確診為STEMI并接受直接經(jīng)皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)的患者,所有患者均于發(fā)病12小時以內(nèi)接受直接PCI。對入組對象于急診冠脈造影后行血栓抽吸,并對抽吸血栓行大體病理學觀察和組織病理學分析。根據(jù)抽吸血栓的組織病理學類型將患者分為紅色/混合血栓組與白色血栓組。比較兩組患者的臨床基線資料、冠脈造影資料及血栓外觀。進行單因素及多因素Logistic回歸分析,研究影響STEMI患者形成不同血栓病理類型的相關因素。結果對137例STEMI患者于急診冠脈介入治療時行血栓抽吸,共獲得97例(70.8%)患者抽吸血栓的病理結果。其中紅色/混合血栓64例(66%),白色血栓33例(34%)。紅色/混合血栓組吸煙的患者多于白色血栓組(P=0.031);紅色/混合血栓組患者的總缺血時間明顯長于白色血栓組(P=0.013);白色血栓組患者梗死相關動脈(Infraction related artery,IRA)形成側支循環(huán)的比例高于紅色/混合血栓組(P=0.001)。紅色/混合血栓多表現(xiàn)為灰紅色、長條狀,白色血栓多表現(xiàn)為灰白色、碎屑狀(P0.001);紅色/混合血栓的直徑(P0.001)和長度(P=0.001)均明顯長于白色血栓。多因素Logistic回歸結果提示總缺血時間和IRA側支循環(huán)是影響血栓類型的相關因素,其中總缺血時間是形成紅色/混合血栓的危險因素(OR:1.741[95%CI,1.203 to 2.520];P=0.003);IRA側支循環(huán)是形成紅色/混合血栓的保護因素(OR:0.109[95%CI,0.032 to 0.376];P0.001)。結論STEMI患者冠脈內(nèi)抽吸血栓中紅色/混合血栓約占2/3,白色血栓約占1/3;總缺血時間和側支循環(huán)影響STEMI患者冠脈內(nèi)血栓類型:隨著缺血時間的延長,形成紅色/混合血栓可能性增加;無側枝循環(huán)時更容易形成紅色/混合血栓,存在側支循環(huán)時更容易形成白色血栓。
[Abstract]:Background rupture of vulnerable plaque and secondary thrombosis are the main pathogenesis of acute myocardial infarction. Pathological and imaging studies confirm that intra-coronary thrombus includes red thrombus and white thrombus. The traditional idea is that red thrombus is formed in the coronary artery of patients with ST-segment elevation myocardial infarction (ST-segment elevation myocardial inflexion) of acute ST-segment elevation myocardial infarction. However, using optical coherence tomography (Oct), Yasushi and others observed the criminal vessels in 40 patients with STEMI. The results showed that 78% of the patients had red thrombosis in their coronary arteries. In the other 22% of the patients, white thrombus was formed in the coronary artery, such as white thrombus Quadros and so on. It was found that 31% of the 113 patients with STEMI were white thrombus. Histopathological analysis is the gold standard for distinguishing the type of thrombus, and coronary artery thrombus aspiration can be more economical and convenient to obtain thrombus. Therefore, the purpose of this study is to identify the different types of thrombus in STEMI patients by pathological analysis. Objective to investigate the pathological types and composition ratio of coronary artery aspiration thrombosis in patients with STEMI, and to analyze the related factors affecting the formation of different types of thrombosis in patients with STEMI. Methods from March 2014 to February 2016, all the patients who were diagnosed as STEMI in Henan Provincial people's Hospital and received direct percutaneous coronary intervention (PCI) were treated with STEMI within 12 hours after the onset of the disease. Thrombus aspiration was performed after emergency coronary angiography, gross pathological observation and histopathological analysis were performed. Patients were divided into red / mixed thrombus group and white thrombus group according to the histopathological types of aspiration thrombus. Clinical baseline data, coronary angiography and thrombus appearance were compared between the two groups. Univariate and multivariate Logistic regression analysis was performed to study the related factors affecting the pathological types of thrombosis in patients with STEMI. Results Thrombus aspiration was performed in 137 patients with STEMI during emergency coronary intervention, and the pathological results were obtained in 97 patients (70.8%). There were 64 cases of red / mixed thrombus and 33 cases of white thrombus. The total ischemic time in red / mixed thrombus group was significantly longer than that in white thrombus group, and in white thrombus group, the infarct related artery (Infraction related artery IRA) formed collateral circulation in the white thrombus group, the total ischemic time in the red / mixed thrombus group was significantly longer than that in the white thrombus group, and the total ischemic time in the red / mixed thrombus group was significantly longer than that in the white thrombus group. The ratio was higher than that in red / mixed thrombus group. The red / mixed thrombus showed grayish red, long stripe, white thrombus was grayish white, and the diameter of red / mixed thrombus was P0.001) and the length of P0. 001) was longer than that of white thrombus. The results of multivariate Logistic regression suggested that the total ischemic time and collateral circulation of IRA were related to the type of thrombus. The total ischemic time was the risk factor for the formation of red / mixed thrombus (OR: 1.741 [95CI1.203 to 2.520] P0.003 / IRA collateral circulation was the protective factor for the formation of red / mixed thrombus (OR0.109 [95CI0.032 to 0.376] P0.001). Conclusion in patients with STEMI, red / mixed thrombus accounts for about 2 / 3, white thrombus accounts for 1 / 3, total ischemic time and collateral circulation affect the type of coronary thrombosis in patients with STEMI. The possibility of forming red / mixed thrombus was increased, and it was easier to form red / mixed thrombus without collateral circulation, and white thrombus was more easily formed in the presence of collateral circulation.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R542.22
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本文編號：1947731