摘要
目的探讨急性心肌梗死患者行经皮冠状动脉介入(PCI)治疗后血清高迁移率族蛋白B1(HMGB1)、可溶性髓样细胞触发受体样转录因子-1(sTLT-1)水平变化,以及对预后评估的影响。方法选取2013年3月—2017年6月在潍坊医学院附属益都中心医院心内科因急性心肌梗死(AMI)行PCI治疗的241例患者。采用酶联免疫吸附试验检测血清HMGB1、sTLT-1水平,记录住院及出院后12个月主要不良心血管事件(MACE)的发生情况。结果PCI治疗后63例(26.14%)患者发生MACE(MACE组),178例患者未发生MACE(非MACE组)。MACE组患者病变支数3支比例、血清HMGB1和sTLT-1水平、Gensini评分高于非MACE组(P<0.05);血清HMGB1水平预测MACE发生的ROC曲线显示,当血清HMGB1为64.73 pg/ml时,曲线下面积为0.868(95%CI:0.820,0.916),敏感性为0.873(95%CI:0.768,0.937),特异性为0.758(95%CI:0.698,0.811);血清sTLT-1水平预测MACE发生的ROC曲线显示,当血清sTLT-1为620.84 pg/ml时,曲线下面积为0.753(95%CI:0.683,0.823),敏感性为0.810(95%CI:0.703,0.886),特异性为0.629(95%CI:0.570,0.685);两者联合时,曲线下面积为0.895(95%CI:0.849,0.941),敏感性为0.873(95%CI:0.768,0.937),特异性为0.798(95%CI:0.738,0.848)。Cox比例风险模型结果显示,甘油三酯[RR=1.629(95%CI:1.137,2.334)]、Gensini评分[RR=1.052(95%CI:1.033,1.070)]、HMGB1[RR=1.081(95%CI:1.049,1.113)]及sTLT-1水平[RR=1.008(95%CI:1.003,1.013)]是影响AMI患者接受PCI治疗后发生MACE的危险因素。结论AMI患者接受PCI治疗后12月内MACE的发生与血清HMGB1、sTLT-1水平有关,是患者预后的危险因素,可作为患者远期预后的预测指标。
Objective To investigate the changes of serum levels of HMGB1 and sTLT-1 in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),and the impact on prognosis assessment.Methods A total of 241 cases of patients with AMI undergoing PCI treatment in our hospital were selected from March 2013 to June 2017.Clinical data were collected.The serum levels of HMGB1 and sTLT-1 were detected by enzyme-linked immunosorbent assay(ELISA).All patients were follow-up after surgery.The incidence of major adverse cardiovascular events(MACE)during hospitalization and 12 months after discharge were recorded.Results Among 241 cases of patients,63(26.14%)cases of patients occurred MACE after PCI(MACE group),and 178 cases did not occur MACE(non-MACE group).The proportion of lesions involving the three vessels,the serum levels of HMGB1 and sTLT-1,and the Gensini score of patients in the MACE group were higher than in the non-MACE group(P<0.05).The ROC curve analysis showed that,when the serum level of HMGB1 in predicting the occurrence of MACE,the serum level of HMGB1 was 64.73 pg/ml,the area under the curve was 0.868(95%CI:0.820,0.916),the sensitivity was 87.3%(95%CI:0.768,0.937)and the specificity was 75.84%(95%CI:0.698,0.811);when the serum level of sTLT-1 in predicting the occurrence of MACE,the serum level of sTLT-1 was 620.84 pg/ml,the area under the curve was 0.753(95%CI:0.683,0.823),the sensitivity was 81.0%(95%CI:0.703,0.886)and the specificity was 62.9%(95%CI:0.570,0.685);and when the two were combined,the area under the curve was 0.895(95%CI:0.849,0.941),the sensitivity was 87.3%(95%CI:0.768,0.937),and the specificity was 79.8%(95%CI:0.738,0.848).Cox proportional hazard model analysis showed that TG[RR=1.629(95%CI:1.137,2.334)],Gensini score[RR=1.052(95%CI:1.033,1.070)],the serum levels of HMGB1[RR=1.081(95%CI:1.049,1.113)]and sTLT-1[RR=1.008(95%CI:1.003,1.013)]were the risk factors for MACE in patients with AMI after PCI treatment.Conclusions The occurrence of MACE in patients with AMI after PCI is related to serum levels of HMGB1 and sTLT-1,which are risk factors for prognosis of patients.They could be used as predictors of longterm prognosis of patients.
作者
孟萌
魏佳丽
潘红
孙彬
Meng Meng;Jia-li Wei;Hong Pan;Bin Sun(Affiliated Yidu Central Hospital of Weifang Medical College,Weifang,Shandong 262500,China)
出处
《中国现代医学杂志》
CAS
2019年第24期38-43,共6页
China Journal of Modern Medicine
基金
潍坊市科学技术发展计划(No:2019YX098)
关键词
心血管疾病
心肌梗塞
超声检查
介入性
预后
cardiovascular diseases
myocardial infarction
ultrasonography,interventional
prognosis
