摘要
目的观察行经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)的急性心肌梗死(acute myocardial infarction, AMI)患者术前血清凝集蛋白-1(intelectin-1, ITLN-1)和可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1, sICAM-1)水平,探讨其对AMI患者PCI术后心肌无复流的预测价值。方法行直接PCI术的AMI患者412例,根据术后心肌血流情况分为无复流组92例和正常血流组320例,比较2组临床资料。采用ELISA法检测2组患者术前血清ITLN-1、sICAM-1水平;采用多因素logistic回归分析AMI患者直接PCI术后心肌无复流的影响因素;绘制ROC曲线,评估AMI患者术前血清ITLN-1和sICAM-1水平对PCI术后心肌无复流的预测效能。结果 412例AMI患者PCI术后发生心肌无复流92例,发生率为22.33%。无复流组患者术前血清sICAM-1水平[(614.67±84.63)ng/L]、年龄[(69.13±10.14)岁]、多支血管病变比率(70.65%)、支架置入数[(3.17±1.43)个]明显高于正常血流组[(402.59±81.66)ng/L、(64.58±9.49)岁、34.69%、(2.04±1.12)个](P<0.05),术前血清ITLN-1水平[(269.57±59.67)mg/L]明显低于正常血流组[(398.59±78.56)mg/L](P<0.05)。术前血清sICAM-1水平>449.95 ng/L(OR=1.972,95%CI:1.218~3.048,P=0.005)、年龄>65岁(OR=1.609,95%CI:1.023~2.531,P=0.019)、双支血管病变(OR=1.669,95%CI:1.034~2.692,P=0.013)是AMI患者PCI术后心肌无复流的危险因素,术前血清ITLN-1水平>369.78 mg/L(OR=0.603,95%CI:0.426~0.853,P=0.022)是AMI患者PCI术后心肌无复流的保护因素。术前血清ITLN-1、sICAM-1水平最佳截断值分别为297.43μg/L、466.27 mg/L时,单独及联合检测预测AMI患者直接PCI术后心肌无复流的AUC分别为0.835(95%CI:0.783~0.886,P<0.001)、0.882(95%CI:0.848~0.916,P<0.001)、0.927(95%CI:0.902~0.953,P<0.001),灵敏度分别为73.47%、77.21%、81.60%,特异度分别为92.25%、90.92%、93.66%;二者联合检测预测AMI患者PCI术后心肌无复流的AUC高于ITLN-1和sICAM-1单独检测(P<0.05)。结论术前血清ITLN-1>369.78 mg/L是AMI患者直接PCI术后心肌无复流的保护因素,sICAM-1>449.95 ng/L是其危险因素,二者联合检测有助于患者心肌无复流的早期识别。
Objective To observe the serum levels of intelectin-1(ITLN-1) and soluble intercellular adhesion molecule-1(sICAM-1) before percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI), and to investigate their values to the prediction of myocardial no reflow in AMI patients after PCI. Methods Totally 412 AMI patients undergoing primary PCI were divided into no reflow group(n=92) and normal blood flow group(n=320) according to postoperative myocardial blood flow. The clinical data were compared between two groups. The serum levels of ITLN-1 and sICAM-1 were detected by ELISA before PCI. The influencing factors of myocardial no reflow in AMI patients after PCI were analyzed by multivariate logistic regression. ROC was drawn to evaluate the predictive efficacies of preoperative serum ITLN-1 and sICAM-1 on myocardial no reflow in AMI patients after PCI. Results In 412 patients with AMI after PCI, myocardial no reflow occurred in 92 patients, with the incidence of 22.33%. No reflow group had higher level of preoperative serum sICAM-1((614.67±84.63) ng/L), older age of the patients((69.13±10.14) years), higher proportion of multi-vessel lesions(70.65%) and more stents(3.17±1.43) than normal blood flow group((402.59±81.66) g/L,(64.58±9.49) years, 34.69%, 2.04±1.12)(P<0.05). The preoperative serum ITLN-1 level was significantly lower in no reflow group((269.57±59.67) mg/L) than that in normal blood flow group((398.59±78.56) mg/L)(P<0.05). The preoperative serum sICAM-1 level >449.95 ng/L(OR=1.972, 95%CI:1.218-3.048,P=0.005),age>65 years(OR=1.609,95%CI:1.023-2.531,P=0.019),and double vessel lesions(OR=1.669,95%CI:1.034-2.692,P=0.013)were the risk factors,while the preoperative ITLN-1 >369.78 mg/L(OR=0.603,95%CI:0.426-0.853,P=0.022)was the protective factor of myocardial no reflow after PCI in patients with AMI. When the optimal cut-off values of the preoperative ITLN-1 and sICAM-1 were 297.43 μg/L and466.27 mg/L,the AUCs of ITLN-1,sICAM-1 and ITLN-1+sICAM-1 for predicting no reflow after primary PCI were0.835(95%CI:0.783-0.886,P<0.001),0.882(95%CI:0.848-0.916,P<0.001),and 0.927(95%CI:0.902-0.953,P<0.001),the sensitivities were 73.47%,77.21% and 81.60%,and the specificities were 92.25%,90.92% and 93.66%,respectively.The AUCof combined detection was higher than that of either ITLN-1 or sICAM-1(P<0.05).Conclusion The preoperative serum ITLN-1 >369.78 mg/L is a protective factor and sICAM-1 >449.95 ng/L is a risk factor of myocardial no reflow after primary PCI in patients with AMI.The combined detection of ITLN-1 and sICAM-1 is helpful for early identification of myocardial no reflow in AMI patients.
作者
杨飞
肖纯
YANG Fei;XIAO Chun(Department of Cardiology,the Third People's Hospital of Huizhou,Huizhou,Guangdong 560001,China)
出处
《中华实用诊断与治疗杂志》
2021年第2期163-166,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
广东省自筹经费类科技计划项目(2017ZC0046)。
作者简介
通信作者:肖纯,E-mail:chun_6903@163.com。
