AMI介入治疗前后的乳酸水平变化及与冠脉微循环障碍的相关性分析

Changes in lactate levels before and after AMI intervention therapy and their correlation with coronary microcirculation disorders

摘要:

目的 观察急性心肌梗死（AMI）患者行经皮冠脉介入术（PCI）治疗前后血清乳酸（LAC）水平变化及与冠脉微循环障碍（CMD）的相关性。方法 本次研究选择焦作市第二人民医院2020年10月至2023年1月期间收治的125例AMI患者为研究对象，开展回顾性研究，所有患者均行PCI治疗，记录并比较入组患者治疗前后LAC水平变化及冠脉微循环改善情况，经Spearman相关性系数检验LAC与冠脉微循环功能的关联；根据是否合并CMD，将入组患者分为正常组、异常组，比较两组LAC水平间的差异，通过绘制受试者工作特征（ROC）曲线验证LAC对PCI术后CMD的预测效能。结果 125例AMI经PCI术治疗后24 h的LAC为（0.71±0.11）mmol/L，均低于治疗后12 h、治疗后6 h及治疗前［（1.05±0.32）mmol/L、（1.52±0.36）mmol/L、（2.26±0.34）mmol/L］（P<0.05）。125例患者治疗后冠脉血流储备（CFR）为2.55±0.37，心肌血流储备分数（FFR）为0.82±0.31，均高于治疗前（1.77±0.26、0.66±0.21），微循环阻力指数（IMR）为40.33±5.27，低于治疗前43.42±5.18（P<0.05）。经Spearman相关性系数检验，LAC水平与CFR、FFR负相关，与IMR正相关。经统计，125例患者经PCI治疗后，30例合并CMD，95例未合并CMD，异常组的LAC水平为（1.61±0.44）mmol/L，高于正常组值（0.88±0.14）mmol/L（P<0.05）。经ROC验证，LAC对预测AMI行PCI术后CMD的曲线下面积（AUC）为0.862。结论 AMI患者接受PCI术治疗后的LAC水平会随患者CFR、FFR升高而逐步下降，并会随患者的IMR降低而逐步下降；LAC对PCI术后CMD有较高预测效能。

Abstract:

Objective To observe the changes in lactic acid (LAC) levels and their correlation with coronary microvascular dysfunction (CMD) in acute myocardial infarction (AMI) patients before and after percutaneous coronary intervention (PCI) treatment.Methods This study selected 125 AMI patients admitted between October 2020 and January 2023 as the study subjects, and a retrospective study was conducted. All patients underwent PCI treatment, and the changes in LAC levels and improvement in coronary microcirculation before and after treatment were recorded and compared. The Spearman correlation coefficient was used to test the association between LAC and coronary microcirculation function. Based on whether to merge CMD, the enrolled patients were divided into a normal group and an abnormal group. The differences in LAC levels between the two groups were compared, and the predictive efficacy of LAC on postoperative CMD was verified by plotting the subject's work characteristic curve.Results The LAC of 125 AMI patients 24 hours after PCI treatment was 0.71±0.11 mmol/L, which was lower than (1.05±0.32 mmol/L, 1.52±0.36 mmol/L, 2.26±0.34 mmol/L) at 12 hours, 6 hours after treatment, and before treatment (P<0.05). After treatment, the coronary flow reserve (CFR) of 125 patients was 2.55±0.37, fractional flow reserve (FFR) was 0.82±0.31, both higher than before treatment (1.77±0.26, 0.66±0.21), the index of microcirculatory resistance (IMR) was 40.33±5.27, lower than before treatment (43.42±5.18) (P<0.05). After Spearman correlation coefficient test, LAC levels were negatively correlated with CFR and FFR, and positively correlated with IMR. According to statistics, after PCI treatment in 125 patients, 30 cases had CMD and 95 cases did not. The LAC level in the abnormal group was 1.61±0.44 mmol/L, which was higher than that in the normal group (0.88±0.14 mmol/L) (P<0.05). After ROC validation, the AUC of LAC for predicting CMD after PCI in AMI was 0.862.Conclusion The LAC level of AMI after PCI treatment will gradually decrease with the increase of CFR and FFR, and will gradually decrease with the decrease of IMR. LAC has high predictive power for postoperative CMD after PCI.