STEMI再灌注后微血管阻塞与心肌内出血： 从CMR表型到预后与干预
Microvascular Obstruction and Intramyocardial Hemorrhage after Reperfusion in ST-Segment Elevation Myocardial Infarction: From CMR Phenotypes to Prognosis and Management Strategies
摘要: 急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗后，心外膜血流虽可恢复至TIMI 3级，但组织水平仍常存在再灌注不足及无复流现象。微血管阻塞(MVO)与心肌内出血(IMH)是再灌注后微循环损伤的核心影像表型，与左心室不良重构、心功能恢复受限及主要不良心血管事件等风险增高密切相关。心脏磁共振(CMR)技术具有无创、高空间分辨率及多参数成像等优势，可精准识别和评估MVO及IMH，为缺血/再灌注损伤的关键病理过程提供一体化的表征，并有助于进行风险分层。本文围绕MVO与IMH，综述其发生机制、CMR判读要点、预后意义及干预策略，并展望表型驱动的精准治疗方向。
Abstract: In patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergent percutaneous coronary intervention (PCI), epicardial coronary flow may be restored to Thrombolysis in Myocardial Infarction (TIMI) grade 3; however, inadequate myocardial tissue reperfusion and the no-reflow phenomenon often persist at the microvascular level. Microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) are hallmark CMR phenotypes of post-reperfusion microvascular injury and are strongly associated with adverse left ventricular remodeling, limited recovery of ventricular function, and an increased risk of major adverse cardiovascular events. Cardiac magnetic resonance, a noninvasive high-spatial-resolution multiparametric imaging modality, enables robust detection and quantification of MVO and IMH, provides an integrated assessment of key pathological processes underlying ischemia-reperfusion injury, and supports risk stratification. Here, we review the mechanisms of MVO and IMH, highlight practical considerations for CMR acquisition and interpretation, summarize prognostic evidence, and discuss current and emerging therapeutic strategies, with an outlook toward phenotype-driven precision therapy.
文章引用：莫可儿, 李丽. STEMI再灌注后微血管阻塞与心肌内出血： 从CMR表型到预后与干预[J]. 临床医学进展, 2026, 16(3): 3886-3893. https://doi.org/10.12677/acm.2026.1631198

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