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目的探讨急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入(primary percutaneous coronary intervention,p PCI)治疗前、后血清骨桥蛋白(osteopontin,OPN)浓度对预后的影响。方法对40例急性STEMI并行p PCI治疗的患者抽静脉血检测p PCI治疗前和治疗后3 d、治疗后5 d血清OPN浓度;常规记录患者一般信息、手术相关情况、心血管疾病危险指标等;随访住院期间及1年内主要心血管事件(major adverse cardiovascular events,MACE)。结果 18例患者发生MACE。单因素cox回归分析模型发现,p PCI治疗前OPN浓度为该类患者1年内发生MACE的危险因素(P<0.001),p PCI治疗后3 d、5 d的血清OPN浓度及平均血清OPN浓度均不是1年内发生MACE的危险因素,其统计值分别为P=0.151、P=0.417、P=0.261。多因素cox回归模型分析发现,治疗前血清OPN浓度(P=0.016)、糖尿病史(P=0.037)、左心室内射血分数(P=0.048)、心肌肌钙蛋白I(c TNI)峰值(P=0.001)为评估1年内发生MACE的主要危险因素。以血清OPN浓度=96.67μg/L为最佳cutoff值,对预测行p PCI治疗的STEMI患者1年内发生MACE的敏感度为77.8%,特异性为81.8%,受试者工作特征曲线(ROC曲线)下面积为0.808(95%置信区间0.666~0.951,P<0.01)。结论对于行p PCI治疗的STEMI患者,治疗前血清OPN浓度是其1年内发生MACE的独立危险因素。
Objective To investigate the changes of serum osteopontin (OPN) levels in patients with acute ST-segment elevation myocardial infarction (STEMI) before and after primary percutaneous coronary intervention (PCI) Effect of concentration on prognosis. Methods 40 patients with acute STEMI and concurrent PCI were enrolled in this study. Serum OPN concentrations were measured before and 3 days after PCI and at 5 days after PCI. General information, surgical information, cardiovascular risk indicators, etc. were routinely recorded Follow-up major adverse cardiovascular events (MACE) during hospitalization and within 1 year. Results MACE occurred in 18 patients. The univariate Cox regression analysis showed that the OPN concentration before PCI was a risk factor for MACE within 1 year (P <0.001), and both OPN and OPN concentrations at 3 and 5 days after PCI Not a risk factor for MACE within 1 year, the statistical values were P = 0.151, P = 0.417, P = 0.261. Multivariate Cox regression analysis showed that the serum levels of OPN (P = 0.016), diabetes mellitus (P = 0.037), left ventricular ejection fraction (P = 0.048) and cTnI peak P = 0.001) was the main risk factor for assessing the occurrence of MACE within 1 year. The optimal cutoff value of serum OPN concentration = 96.67μg / L was 77.8% and specificity of 81.8% in one-year predictive value of p PCI for STEMI patients. The receiver operating characteristic curve (ROC curve ) Was 0.808 (95% confidence interval 0.666 - 0.951, P <0.01). Conclusions Serum OPN concentrations before treatment in STEMI patients treated with p PCI are independent risk factors of MACE within 1 year.