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目的探讨急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)且行急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者的血浆凝溶胶蛋白表达水平及其对预后的影响。方法连续入选粤北人民医院2012年1月至2014年6月发生STEMI并行急诊PCI的患者206例(STEMI组),同期148例稳定型心绞痛并行择期PCI患者(稳定型心绞痛组)及80例健康志愿者(健康对照组)。分别于入院后第1、3、5、7、9天采集患者外周静脉血,采用ELISA法检测血浆凝溶胶蛋白水平;同法取健康对照组血液行相同检测。常规记录患者一般信息、相关生化检查及手术情况、心血管疾病危险指标等,随访术后1年内主要不良心血管事件(MACE)发生情况。比较各组患者血浆凝溶胶蛋白水平,分析其与STEMI的关系。对数据进行方差分析,单因素及多因素logistic回归分析。结果 (1)STEMI组分别与稳定型心绞痛组及健康对照组比较,入院后不同时相点血浆凝溶胶蛋白水平均显著下降,差异均有统计学意义(均P<0.05);而稳定型心绞痛组与健康对照组比较,差异无统计学意义(P>0.05)。(2)根据STEMI患者随访1年内预后情况分为MACE组及非MACE组,发现MACE组入院后第1、3、5、7、9天血浆凝溶胶蛋白水平[(53.2±6.8)mg/L比(70.1±11.2)mg/L,P=0.048;(40.2±7.3)mg/L比(64.3±7.8)mg/L,P=0.033;(30.9±10.0)mg/L比(57.7±13.4)mg/L,P=0.027;(22.5±8.8)mg/L比(55.6±9.2)mg/L,P=0.012;(23.3±7.4)mg/L比(69.8±12.7)mg/L,P=0.004]均显著低于非MACE组,差异均有统计学意义。且第7天血浆凝溶胶蛋白水平降至最低值。根据1年内预后情况再将MACE组患者分为死亡组及存活组。死亡组入院后第1、3天血浆凝溶胶蛋白水平与存活组比较,差异均无统计学意义(均P>0.05),第5、7、9天[(22.8±6.0)mg/L比(40.6±9.4)mg/L,P=0.034;(14.1±6.8)mg/L比(33.5±10.1)mg/L,P=0.036;(9.3±6.8)mg/L比(35.9±11.4)mg/L,P=0.007]均显著低于存活组,差异均有统计学意义。且第7天后血浆凝溶胶蛋白水平未见回升趋势。(3)单因素logistic回归分析提示第7天血浆凝溶胶蛋白水平是STEMI患者1年内发生MACE的危险因素(P=0.014)。(4)以第7天血浆凝溶胶蛋白水平=21.7 mg/L为最佳界值,预测行PCI的STEMI患者1年内发生MACE的特异度为82.1%,敏感度为81.4%,受试者工作者特征(ROC)曲线下面积为0.854(95%CI 0.732~0.961,P<0.01)。结论推测血浆凝溶胶蛋白水平与STEMI患者预后呈负相关,可作为STEMI患者预后的预测指标,能反映病情的严重程度。
Objective To investigate the plasma levels of gelsolin in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) and its effect on prognosis. Methods A total of 206 patients (STEMI group) with STEMI concurrent PCI during January 2012 to June 2014 were enrolled in this study. 148 stable angina patients undergoing elective PCI (stable angina pectoris group) and 80 healthy controls Volunteers (healthy control group). Peripheral venous blood samples were collected on the 1st, 3rd, 5th, 7th and 9th days after admission, respectively. The levels of plasma gelsolin were measured by ELISA. The same method was used to test the blood of healthy controls. General records of patients with general information, related biochemical tests and surgical conditions, cardiovascular disease risk indicators, follow-up within 1 year after the major adverse cardiovascular events (MACE). Plasma gelsolin levels in each group were compared and their relationship with STEMI was analyzed. Data analysis of variance, univariate and multivariate logistic regression analysis. Results (1) Compared with stable angina pectoris group and healthy control group, the levels of plasma gelsolin at different time points after STEMI group were significantly decreased (all P <0.05), while those of stable angina pectoris Compared with healthy control group, there was no significant difference (P> 0.05). (2) According to the prognosis of patients with STEMI within one year of follow-up, the patients were divided into MACE group and non-MACE group. The plasma levels of gelsolin on the 1st, 3rd, 5th, 7th and 9th days after MACE were found to be (53.2 ± 6.8) mg / L L, P = 0.048; (40.2 ± 7.3) mg / L vs (64.3 ± 7.8) mg / L, P = 0.033, and (30.9 ± 10.0) mg / L vs 57.7 ± 13.4; L, P = 0.027; (22.5 ± 8.8) mg / L vs (55.6 ± 9.2) mg / L, P = 0.012; 0.004] were significantly lower than non-MACE group, the differences were statistically significant. And the level of plasma gelsolin fell to the lowest on the 7th day. Patients in MACE group were divided into death group and survival group according to the prognosis in one year. There was no significant difference in plasma levels of gelsolin between the death group and the surviving group on the 1st and 3rd days after admission (all P> 0.05), and on the 5th, 7th and 9th days (22.8 ± 6.0) mg / L 40.6 ± 9.4) mg / L, P = 0.034; (14.1 ± 6.8) mg / L vs 33.9 ± 10.1 mg / L, P = 0.036; L, P = 0.007] were significantly lower than the survival group, the difference was statistically significant. And after 7 days, the level of plasma gelsolin did not show a rising trend. (3) Univariate logistic regression analysis indicated that plasma levels of gelsolin were the risk factors of MACE within 1 year in STEMI patients (P = 0.014). (4) The optimal value of plasma gelsolin level 21.7 mg / L on day 7 was 82.1% and the sensitivity was 81.4% in 1-year STEMI patients who underwent PCI. The area under the characteristic (ROC) curve was 0.854 (95% CI 0.732-0.961, P <0.01). Conclusions It is speculated that the plasma level of gelsolin is negatively correlated with the prognosis of patients with STEMI and can be used as a predictor of prognosis in patients with STEMI and can reflect the severity of the disease.