作者：王璐璐，罗婷，张盈盈

单位：

430022湖北省武汉市中西医结合医院 武汉市第一医院心内科

Units：

Department of Cardiology, Wuhan Hospital of Traditional Chinese and Western Medicine/Wuhan NO.1 Hospital, Wuhan 430022, China

关键词：

ST段抬高型心肌梗死；经皮冠状动脉介入治疗；乳酸；主要不良心脑血管事件

Keywords：

ST elevation myocardial infarction; Percutaneous coronary intervention; Lactic acid; Major adverse cardiac and cerebrovascular events

CLC：

R 542.22

DOI：

10.12114/j.issn.1008-5971.2023.00.331

Funds：

湖北省卫生健康委科研项目（BF2021K4）

摘要：

目的　探讨乳酸对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后1年内发生 主要不良心脑血管事件（MACCE）的预测价值。方法　回顾性选取2019年1月—2022年1月在武汉市中西医结合医院 住院的STEMI患者 273 例为研究对象。收集患者的临床资料，根据乳酸水平三分位数将患者分为 3个组：Q1 组（乳酸 ≤1.60 mmol/L， n=91 ）， Q2组（1.60 mmol/L＜乳酸≤2.00 mmol/L，n=91）和Q3组（乳酸＞2.00 mmol/L ，n =91）。 随访1年，记录STEMI患者PCI后MACCE发生情况，采用Kaplan-Meier法绘制生存曲线，三组MACCE发生率比较采用 Log-rank检验。采用多因素Cox比例风险回归分析探讨STEMI患者PCI后1年内发生MACCE的影响因素；采用ROC曲 线分析乳酸对STEMI患者PCI后1年内发生MACCE的预测价值。结果　Q2组有糖尿病史者占比、血小板计数、总胆固 醇、三酰甘油、HDL-C、LDL-C高于Q1组，Q3组体质指数、SBP、DBP、有高血压史者占比、有糖尿病史者占比、总 胆固醇、三酰甘油、HDL-C、LDL-C、三支病变者占比高于Q1组，Q3组SBP、DBP、总胆固醇、三酰甘油高于Q2组 （P＜0.01）。生存曲线分析结果显示，Q2组和Q3组MACCE发生率高于Q1组（P＜0.01）。STEMI患者PCI后1年内发 生MACCE 100例（36.6%）。发生MACCE者年龄小于未发生MACCE者，乳酸、三酰甘油、尿酸高于未发生MACCE者 （P＜0.05）。多因素Cox比例风险回归分析结果显示，年龄、乳酸、尿酸为STEMI患者PCI后1年内发生MACCE的独立 影响因素（P＜0.05）。ROC曲线分析结果显示，乳酸预测STEMI患者PCI后1年内发生MACCE的AUC为0.636〔95%CI （0.568～0.703）〕。结论　乳酸＞1.60 mmol/L的STEMI患者PCI后1年内MACCE发生率较高，且乳酸为STEMI患者PCI 后1年内发生MACCE的独立影响因素，但其对STEMI患者PCI后1年内发生MACCE的预测价值有限。

Abstract：

Objective To explore the predictive value of lactic acid for major adverse cardiac and cerebrovascular events (MACCE) within one year after percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI) . Methods A retrospective study was conducted on 273 patients with STEMI admitted to Wuhan Hospital of Traditional Chinese and Western Medicine from January 2019 to January 2022. The clinical data of the patients were collected, and the patients were divided into Q1 group (lactic acid ≤ 1.60 mmol/L, n=91) , Q2 group (1.60 mmol/L < lactic acid ≤ 2.00 mmol/L, n=91) and Q3 group (lactic acid > 2.00 mmol/L, n=91) according to tertiles of lactic acid level. The patients were followed up for one year, and MACCE after PCI in patients with STEMI were recorded. The survival curve was drawn by Kaplan-Meier method, and MACCE incidence was compared among the three groups using Log-rank test. Multivariate Cox proportional risk regression analysis was used to explore the influencing factors of MACCE within one year after PCI in patients with STEMI. The ROC curve was used to explore the predictive value of the lactic acid for MACCE within one year after PCI in patients with STEMI. Results The proportion of patients with diabetes history, total cholesterol, triglycerides, HDL-C, LDL-C in the Q2 group were higher than those in the Q1 group, body mass index, SBP, DBP, proportion of patients with hypertension history, proportion of patients with diabetes history, platelet count, total cholesterol, triacylglycerol, HDL-C, LDL-C, and proportion of patients with three vessel lesions in the Q3 group were higher than those in the Q1 group, SBP, DBP, total cholesterol, triacylglycerol in the Q3 group were higher than those in the Q2 group (P < 0.01) . Survival curve analysis showed that MACCE incidence in the Q2 group and Q3 group was higher than that in the Q1 group (P < 0.01) . MACCE occurred in 100 STEMI patients (36.6%) within one year after PCI. The age of patients with MACCE was younger than that of those without MACCE, while lactic acid, triacylglycerol, and uric acid were higher than those without MACCE (P < 0.05) . Multivariate Cox proportional risk regression analysis showed that age, lactic acid, uric acid were the independent influencing factors of MACCE within one year after PCI in patients with STEMI (P < 0.05) . ROC curve analysis showed that the AUC of the lactic acid for predicting MACCE within one year after PCI in patients with STEMI was 0.636 [95%CI (0.568-0.703) ] . Conclusion The MACCE incidence is higher in STEMI patients with lactic acid > 1.60 mmol/L, and lactic acid is the independent influencing factors of MACCE within one year after PCI in patients with STEMI. However, the predictive value of lactic acid for MACCE within one year after PCI in patients with STEMI is limited.

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