作者：杨蓉,胡峥,高志超,魏筱,刘裴,马荣静

单位：

1.050005 河北省石家庄市，河北医科大学第二医院心内科　2.053000 河北省衡水市第四人民医院超声科

Units：

1.Department of Cardiology, the Second Hospital of Hebei Medical University, Shijiazhuang 050005, China 2.Department of Ultrasound, the No.4 People's Hospital of Hengshui, Hengshui 053000, China Corresponding author: YANG Rong, E-mail: Y18632118593@163.com

关键词：

ST段抬高型心肌梗死; 网膜素-1; 经皮冠状动脉介入治疗; 主要不良心血管事件; 预测;

Keywords：

ST-segment elevation myocardial infarction; Omentin-1; Percutaneous coronary intervention; Majoradverse cardiovascular events; Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.254

Funds：

河北省卫生健康委重点科技研究计划（20190557）

摘要：

背景ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后院内主要不良心血管事件(MACE)时有发生,MACE的早期筛查及预防是临床重点。血清网膜素-1在抑制炎性反应、稳定血管内皮细胞等方面发挥重要作用,这与STEMI患者PCI后发生MACE可能有关。目的 探讨血清网膜素-1对STEMI患者PCI后发生院内MACE的预测价值。方法 选取2019年1月至2020年6月于河北医科大学第二医院行PCI的STEMI患者180例为研究对象。统计患者临床资料、血清网膜素-1及其他生化指标。根据患者PCI后是否发生院内MACE将其分为MACE组(51例,28.3%)和非MACE组(129例,71.7%)。分析STEMI患者PCI后发生院内MACE的影响因素,绘制受试者工作特征(ROC)曲线以评估血清网膜素-1对STEMI患者PCI后发生院内MACE的预测价值。结果 MACE组患者年龄、冠状动脉病变类型为多支病变者所占比例、超敏C反应蛋白(hs-CRP)、肌酸激酶同工酶(CK-MB)高于非MACE组,支架置入数目多于非MACE组,术后心肌梗死溶栓试验(TIMI)分级、血清网膜素-1低于非MACE组(P <0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.673,95%CI(1.085,2.581)〕、支架置入数目〔OR=1.591,95%CI(1.265,2.001)〕、术后TIMI分级〔OR=0.605,95%CI(0.407,0.901)〕、血清网膜素-1〔OR=0.598,95%CI(0.464,0.771)〕是STEMI患者PCI后发生院内MACE的影响因素(P <0.05)。血清网膜素-1预测STEMI患者PCI后发生院内MACE的ROC曲线下面积为0.839〔95%CI(0.733,0.905),P <0.001〕,最佳截断值为39.21μg/L,灵敏度和特异度分别为79.87%、76.32%,约登指数为0.562。结论 血清网膜素-1降低(<39.21μg/L)对STEMI患者PCI后院内MACE具有中等预测价值,可指导临床制定有效措施以改善患者预后。

Abstract：

【Abstract】 Background Major adverse cardiovascular events (MACE) occur frequently in patients with ST segmentelevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) . The early screening and prevention ofMACE is the clinical focus. Serum omentin-1 plays an important role in inhibiting inflammatory response and stabilizing vascularendothelial cells, which may be associated with the occurrence of MACE after PCI in STEMI patients. Objective To investigatethe predictive value of serum omentin-1 for in-hospital MACE after PCI in patients with STEMI. Methods A total of 180 STEMIpatients who underwent PCI in the Second Hospital of Hebei Medical University from January 2019 to June 2020 were selected asthe research objects. The clinical data, serum omentin-1 and other biochemical indexes were counted. Patients were divided intoMACE group (51 cases, 28.3%) and non-MACE group (129 cases, 71.7%) according to whether they occurred in-hospital MACEafter PCI. The influencing factors of in-hospital MACE after PCI in STEMI patients were analyzed, and the receiver operatingcharacteristic (ROC) curve was drawn to evaluate the predictive value of serum omentin-1 for in-hospital MACE after PCI inSTEMI patients. Results The age of patients, the proportion of coronary artery disease with multivessel disease, high-sensitivityC-reactive protein (hs-CRP) , creatine kinase isoenzyme (CK-MB) in MACE group were higher than those in non-MACEgroup, the number of stents implanted was more than that of the non-MACE group, and the grade of postoperative thrombolysisin myocardial infarction (TIMI) and serum omentin-1 were lower than those of the non-MACE group (P < 0.05) . MultivariateLogistic regression analysis showed that age [OR=1.673, 95%CI (1.085, 2.581) ] , number of stents placed [OR=1.591, 95%CI(1.265, 2.001) ] , postoperative TIMI classification [OR=0.605, 95%CI (0.407, 0.901) ] , serum omentin-1 [OR=0.598, 95%CI(0.464, 0.771) ] were the influencing factors of in-hospital MACE after PCI in STEMI patients (P < 0.05) . The area under the ROCcurve of serum omentin-1 for predicting the in-hospital MACE after PCI in STEMI patients was 0.839 [95%CI (0.733, 0.905) ,P <0.001] , the best cut-off value was 39.21μg/L, and the sensitivity and specificity were 79.87%, 76.32%, respectively, andthe Youden index was 0.562.Conclusion The decrease of serum omentin-1 ( < 39.21μg/L) has medium predictive valuefor in-hospital MACE after PCI in STEMI patients, and can guide the clinical development of effective measures to improve theprognosis of patients.

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