摘要
[目的]探讨血清信号肽-CUB-表皮生长因子结构域包含蛋白1(SCUBE1)、内皮细胞特异性分子1(Endocan)水平与急性ST段抬高型心肌梗死(ASTEMI)患者经皮冠状动脉介入治疗(PCI)后冠状动脉无复流的关系。[方法]将海南省三亚市人民医院急诊科收治的120例经急诊PCI治疗的ASTEMI患者纳入观察组,根据PCI术后心肌梗死溶栓试验(TIMI)血流分级,将ASTEMI患者分为无复流组和再灌注组,另选取60例健康体检者纳入对照组,采集血液标本,测定并比较ASTEMI患者PCI术前、术后即刻、术后48 h、对照组体检时的血清SCUBE1、Endocan水平。采用多因素Logistic回归分析无复流的危险因素,采用ROC曲线分析PCI术前SCUBE1、Endocan预测PCI术后冠状动脉无复流的临床价值。[结果]与对照组比较,观察组患者PCI术前、术后即刻、术后48 h血清SCUBE1及Endocan水平均较高(P<0.05)。无复流组与再灌注组的左心室射血分数、冠心病病史占比、C反应蛋白、中性粒细胞/淋巴细胞、肌钙蛋白T、发病至再灌注时间、病变长度差异均有显著性(P<0.05)。与再灌注组比较,无复流组患者PCI术前、术后即刻、术后48 h的血清SCUBE1及Endocan水平均较高(P<0.05)。多因素Logistic回归分析显示:冠心病病史、左心室射血分数、PCI术前SCUBE1和Endocan是影响术后冠状动脉无复流发生的显著影响因素(P<0.05)。PCI术前SCUBE1联合Endocan预测PCI术后冠状动脉无复流的ROC曲线下面积为0.870(95%CI:0.785~0.955)。[结论]PCI术前高血清SCUBE1、Endocan水平是影响ASTEMI患者PCI术后冠状动脉无复流的危险因素,术前联合检测SCUBE1、Endocan有助于预测PCI术后冠状动脉无复流的发生风险。
Aim To investigate the relationship between serum signal peptide-CUB-epidermal growth factor domain containing protein 1(SCUBE1), endothelial cell specific molecule-1(Endocan) levels and no coronary reflow after percutaneous coronary intervention(PCI) in patients with acute ST-segment elevation myocardial infarction(ASTEMI).Methods 120 ASTEMI patients treated by emergency PCI in the Emergency Department of Sanya People’s Hospital of Hainan Province were included in observation group. According to the blood flow classification of thrombolysis in myocardial infarction(TIMI) after PCI, ASTEMI patients were divided into no-reflow group and reperfusion group. Another 60 healthy subjects were selected into control group. Blood samples were collected to measure and compare the levels of serum SCUBE1 and Endocan in patients with ASTEMI before PCI, immediately after PCI, 48 hours after PCI and in control group. Multivariate Logistic regression was used to analyze the risk factors of no-reflow. ROC curve was used to analyze the clinical value of SCUBE1 and Endocan before PCI in predicting no-reflow of coronary artery after PCI. Results Compared with control group, the levels of serum SCUBE1 and Endocan in observation group were increased before PCI, immediately after PCI and 48 hours after PCI(P<0.05). There were significant differences in left ventricular ejection fraction, proportion of history of coronary heart disease, C-reactive protein, neutrophil/lymphocyte, troponin T, time from onset to reperfusion and lesion length between no-reflow group and reperfusion group(P<0.05). Compared with the reperfusion group, the levels of serum SCUBE1 and Endocan in no-reflow group were increased before PCI, immediately after PCI and 48 hours after PCI(P<0.05). Multivariate Logistic regression analysis showed that the history of coronary heart disease, left ventricular ejection fraction, SCUBE1 and Endocan levels before PCI were significant factors affecting the occurrence of no-reflow of coronary artery after PCI(P<0.05). The area under the ROC curve predicted by SCUBE1 combined with Endocan before PCI was 0.870(95%CI:0.785~0.955). Conclusion The high serum levels of SCUBE1 and Endocan before PCI are risk factors affecting no-reflow of coronary artery after PCI in patients with ASTEMI.The combined detection of SCUBE1 and Endocan before PCI is helpful to predict the risk of no-reflow of coronary artery after PCI.
作者
林晓伟
邓明尧
吉晓理
李涛
袁金堂
LIN Xiaowei;DENG Mingyao;JI Xiaoli;LI Tao;YUAN Jintang(Department of Emergency,Sanya Peoples Hospital of Hainan Province,Sanya,Hainan 572000,China)
出处
《中国动脉硬化杂志》
CAS
2023年第1期56-62,共7页
Chinese Journal of Arteriosclerosis
基金
海南省卫生计生行业科研项目(1802330169A2001)。
