2026 年第 5 期 第 21 卷

血清学指标与急性ST段抬高型心肌梗死急诊介入治疗后慢血流/无复流的关系研究

Study on the relationship between serological markers and slow flow/no-reflow after emergency percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作者：何洁1邱世香1蒲嘉骐1王红2

英文作者：He Jie1 Qiu Shixiang1 Pu Jiaqi1 Wang Hong2

单位：1首都医科大学附属北京安贞医院南充医院·南充市中心医院介入医学科，南充637000；2成都医学院第一附属医院心血管内科，成都610500

英文单位：1Department of Interventional Medicine Nanchong Hospital of Beijing Anzhen Hospital Capital Medical University Nanchong Central Hospital Nanchong 637000 China; 2Department of Cardiovascular Medicine The First Affiliated Hospital of Chengdu Medical College Chengdu 610500 China

关键词：ST段抬高型心肌梗死；细胞间黏附分子；低密度脂蛋白胆固醇；高密度脂蛋白胆固醇；经皮冠状动脉介入

英文关键词：ST-segmentelevationmyocardialinfarction;Intercellularadhesionmolecules;Low-densitylipoproteincholesterol;High-densitylipoproteincholesterol;Percutaneouscoronaryintervention

• 摘要：

• 目的 探讨可溶性细胞间黏附分子1（sICAM-1）及低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值（LDL-C/HDL-C）与急性ST段抬高型心肌梗死（STEMI）急诊介入治疗后慢血流/无复流的关系。方法 选取2022年1月至2025年1月南充市中心医院急诊科收治的急性STEMI患者286例进行前瞻性研究。将术后即刻心肌梗死溶栓试验（TIMI）血流分级≤2级的患者纳入异常血流组，TIMI分级为3级的患者纳入正常血流组。比较2组术前一般临床资料及实验室指标；使用Logistic回归方法分析影响STEMI患者术后慢血流/无复流的因素；采用受试者工作特征（ROC）曲线分析血清sICAM-1、LDL-C/HDL-C对STEMI患者术后慢血流/无复流的预测价值。结果 本研究正常血流组231例、异常血流组55例。异常血流组患者发病至经皮冠状动脉介入（PCI）时间长于正常血流组，白细胞计数、中性粒细胞计数高于正常血流组（均P＜0.05）。异常血流组患者血清sICAM-1、LDL-C/HDL-C水平均高于正常血流组［（410±55）μg/L比（361±49）μg/L、（2.9±0.8）比（2.3±0.6）］（t=6.583、5.526，均P＜0.001）。Logistic回归分析结果显示sICAM-1、LDL-C/HDL-C、发病至PCI时间、白细胞计数、中性粒细胞计数升高均是影响STEMI患者PCI术后慢血流/无复流的危险因素（均P＜0.05）。ROC曲线分析结果显示，sICAM-1、LDL-C/HDL-C单独及联合预测STEMI患者PCI术后慢血流/无复流的曲线下面积分别为0.769、0.763、0.868，二者联合预测的曲线下面积显著大于单独检测（Z=2.528，P=0.012；Z=2.926，P=0.003）。结论 血清sICAM-1、LDL-C/HDL-C水平异常升高是STEMI患者术后慢血流/无复流的独立危险因素，且二者联合对慢血流/无复流有较高的预测效能。

• Objective To investigate the relationship between soluble intercellular adhesion molecule-1 (sICAM-1), low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and slow flow/no-reflow after emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A prospective study was performed on 286 patients with acute STEMI admitted to Department of Emergency, Nanchong Central Hospital from January 2022 to January 2025. Patients with thrombolysis in myocardial infarction (TIMI) flow grade ≤2 after operation were assigned to the abnormal blood flow group, and those with TIMI grade 3 to the normal blood flow group. Clinical and laboratory data were compared between the two groups. Logistic regression analysis was used to identify risk factors for slow flow/no-reflow after PCI. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum sICAM-1 and LDL-C/HDL-C for slow flow/no-reflow. Results Among the 286 patients, 231 were in the normal blood flow group and 55 in the abnormal blood flow group. The time from symptom onset to PCI was longer, and white blood cell count and neutrophil count were higher in the abnormal blood flow group than those in the normal blood flow group (all P<0.05). Serum levels of sICAM-1 and LDL-C/HDL-C were significantly higher in the abnormal blood flow group than those in the normal blood flow group ［(410±55)μg/L vs (361±49)μg/L, (2.9±0.8) vs (2.3±0.6)］(t=6.583, 5.526, both P<0.001). Logistic regression analysis showed that elevated sICAM-1, LDL-C/HDL-C, time from onset to PCI, white blood cell count and neutrophil count were independent risk factors for slow flow/no-reflow after PCI (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) of sICAM-1, LDL-C/HDL-C alone and in combination was 0.769, 0.763 and 0.868, respectively. The AUC of the combined detection was significantly higher than that of single detection (Z=2.528, P=0.012; Z=2.926, P=0.003). Conclusion Abnormally elevated serum sICAM-1 and LDL-C/HDL-C are independent risk factors for slow flow/no-reflow in STEMI patients after PCI, and their combination has high predictive efficiency for slow flow/no-reflow.