作者：崔玉梅，董蕾

单位：

1.100700北京市第六医院急诊科 2.100700北京市第六医院心内科 通信作者：董蕾，E-mail：donglei0424@126.com

Units：

1.Department of Emergency, Beijing Sixth Hospital, Beijing 100700, China 2.Department of Cardiology, Beijing Sixth Hospital, Beijing 100700, China Corresponding author: DONG Lei, E-mail: donglei0424@126.com

关键词：

ST段抬高型心肌梗死; 经皮冠状动脉介入术; 支架内血栓形成; 白介素17; 脂蛋白(a;

Keywords：

ST-segment elevation myocardial infarction; Percutaneous coronary intervention; In-stent thrombosis;Interleukin-17; Lipoprotein (a)

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.070

Funds：

摘要：

背景经皮冠状动脉介入术(PCI)后仍有部分ST段抬高型心肌梗死(STEMI)患者发生支架内血栓形成,进而威胁患者的身体健康。因此,寻找可以预测STEMI患者PCI后支架内血栓形成的临床指标至关重要。目的分析血清白介素17(IL-17)、脂蛋白(a)〔Lp(a)〕水平与STEMI患者PCI后支架内血栓形成的关系。方法 回顾性选取2016年2月至2020年12月于北京市第六医院行PCI的256例STEMI患者,根据患者PCI后1年内是否发生支架内血栓形成将其分为血栓组和无血栓组。查阅患者病历资料,收集其基线资料和实验室检查指标;STEMI患者PCI后支架内血栓形成的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价血清IL-17、Lp(a)水平及二者联合对STEMI患者PCI后支架内血栓形成的预测价值;采用R 4.1.0统计分析软件中“rmda”软件包绘制决策曲线,以分析血清IL-17、Lp(a)水平及二者联合在临床决策中的应用价值。结果 256例STEMI患者PCI后1年内支架内血栓形成发生率为19.5%(50/256)。血栓组患者血浆脑钠肽、血清IL-17、血清Lp(a)水平高于无血栓组(P<0.05)。多因素Logistic回归分析结果显示,血浆脑钠肽〔OR=1.038,95%CI(1.002,1.075)〕、血清IL-17〔OR=1.297,95%CI(1.164,1.445)〕、血清Lp(a)〔OR=1.036,95%CI(1.020,1.052)〕水平是STEMI患者PCI后支架内血栓形成的独立影响因素(P<0.05)。ROC曲线分析结果显示,血清IL-17、Lp(a)水平及二者联合预测STEMI患者PCI后支架内血栓形成的AUC分别为0.745〔95%CI(0.667,0.822)〕、0.748〔95%CI(0.677,0.819)〕、0.777〔95%CI(0.711,0.842)〕。决策曲线分析结果显示,在0.01～0.41的阈值概率区间,血清IL-17、Lp(a)水平联合评估STEMI患者PCI后支架内血栓形成的净收益率优于单一血清IL-17、Lp(a)水平。结论 血清IL-17、Lp(a)水平升高会增加STEMI患者PCI后支架内血栓形成发生风险,血清IL-17、Lp(a)水平及二者联合对STEMI患者PCI后支架内血栓形成具有一定预测价值;在0.01～0.41的阈值概率区间,血清IL-17、Lp(a)水平联合在临床决策中具有更高的应用价值。

Abstract：

【Abstract】　Background After percutaneous coronary intervention (PCI) , in-stent thrombosis still occurs in somepatients with ST segment elevation myocardial infarction (STEMI) , threatening their health. Therefore, it is very important to seekrelevant indicators that can predict the in-stent thrombosis of STEMI patients after PCI. Objective To analyze the relationshipbetween serum interleukin 17 (IL-17) , lipoprotein (a) [Lp (a) ] levels and in-stent thrombosis in STEMI patients after PCI.MethodsA total of 256 patients with STEMI who underwent PCI in Beijing Sixth Hospital from February 2016 to December2020 were retrospectively selected. According to whether there was in-stent thrombosis within 1 year after PCI, they were dividedinto thrombosis group and non-thrombosis group. The patient's medical records were consulted and their baseline data andlaboratory examination indexes were collected. Multivariate Logistic regression analysis was used to analyze the influencing factorsof in-stent thrombosis in patients with STEMI after PCI; ROC curve was drawn to evaluate the predictive value of serum IL-17,LP (a) levels and their combination for in-stent thrombosis after PCI in STEMI patients; the "rmda" software package in R 4.1.0statistical analysis software was used to draw the decision curve and to analyze the application value of serum IL-17, Lp (a) levelsand their combination in clinical decision-making. Results The incidence of in-stent thrombosis in 256 patients with STEMIwithin 1 year after PCI was 19.5% (50/256) . The levels of plasma brain natriuretic peptide (BNP) , serum IL-17 and serum Lp (a)in thrombotic group were higher than those in non-thrombotic group (P < 0.05) . Multivariate Logistic regression analysis resultsshowed that plasma BNP [OR=1.038, 95%CI (1.002, 1.075) ] , serum IL-17 [OR=1.297, 95%CI (1.164, 1.445) ] and serum Lp (a)[OR=1.036, 95%CI (1.020, 1.052) ] levels were independent influencing factors of in-stent thrombosis in patients with STEMI afterPCI (P < 0.05) . ROC curve analysis results showed that the AUC of serum IL-17, Lp (a) levels and their combination in predictingin-stent thrombosis in patients with STEMI after PCI were 0.745 [95%CI (0.667, 0.822) ] , 0.748 [95%CI (0.677, 0.819) ]and 0.777 [95%CI (0.711, 0.842) ] , respectively. Decision curve analysis results showed that in the threshold probability intervalof 0.01-0.41, the net benefit rate of combined of serum IL-17 and Lp (a) levels for evaluating in-stent thrombosis in patientswith STEMI after PCI was better than that of the single serum IL-17 and Lp (a) level. Conclusion The increase of serum IL-17and Lp (a) levels will increase the risk of in-stent thrombosis in patients with STEMI after PCI. The levels of serum IL-17, Lp (a)and their combination have a certain predictive value for in-stent thrombosis in patients with STEMI after PCI; in the thresholdprobability interval of 0.01-0.41, the combination of serum IL-17 and Lp (a) levels has higher application value in clinicaldecision-making.

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