急诊经皮冠状动脉介入治疗前、后血清骨桥蛋白浓度对急性ST段抬高型心肌梗死患者预后的影响  

Plasma osteopontin concentrations before and after primary percutaneous coronary intervention in prediction of prognosis in patients with acute ST-segment elevation myocardial infarction

作　　者：梁家荣[1] 唐良秋[1] 陈云宪 张社兵[1] 范文茂[1] 陈锦锋[1] 龙秀环 林义轩 刘相应 佟文娟[1] 

机构地区：[1]粤北人民医院心血管内科,广东韶关512000

出　　处：《岭南心血管病杂志》2015年第5期601-605,共5页South China Journal of Cardiovascular Diseases

摘　　要：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。Objectives To investigate the concentrations of plasma osteopontin before and after primary percutaneous coronary intervention（p PCI） in prediction of prognosis in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods In this study, 40 patients with acute STEMI were recruited. Blood samples were taken before p PCI and on the 3rdday and 5thday after p PCI. Patients ＇ characteristics, operation information, cardiovascular risk factors were recorded. Major adverse cardiovascular events（MACE） within one year were recorded. Results There were18 patients occurred MACE. Univariate Cox regression analysis showed that plasma concentration of osteopontin before p PCI was the independent risk factor of MACE within one year（P〈0.001）. Plasma concentrations of osteopontin on the3 rdand 5thday after p PCI or t he average plasma concentration of osteopontin were not the independent risk factors of MACE（P =0.151,P =0.417,P =0.261）. Multivariate Cox regression analysis revealed that plasma concentration of osteopontin before p PCI（P=0.016）, diabetes（P=0.037）, 1eft ventricular ejection fraction（P=0.048） and peak cardiac troponin I（c TNI）（P=0.001） were the major risk factors of MACE within one year. Setting the cutoff value of osteopontin before p PCI of 96.67 μg / L, the sensitivity and specificity for MACE in patients with STEMI treated with p PCI within one year were 77.8% and 81.8%, respectively, with the area under the receiver operating characteristic curve（ROC） of0.808（95% confidence interval： 0.666-0.951,P〈0.01）. Conclusions Plasma osteopontin concentration before p PCI is the independent risk factor of MACE within one year in patients with STEMI treated with p PCI.

关 键 词：心肌梗死 骨桥蛋白 血管成形术 经腔 经皮冠状动脉 预后 

分 类 号：R542.22[医药卫生—心血管疾病]