血清HMGB1、SAA水平及CAMI-STEMI评分对STEMI患者PCI术后生存状况的预测价值  

Predictive value of serum HMGB1, SAA level and CAMI-STEMI score for survival in patients with STEMI after PCI

作　　者：李亚男 王倩[2] LI Ya-nan;WANG Qian(Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050,China;Cardiothoracic Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050 [2]首都医科大学附属北京安贞医院心外科,北京100029

出　　处：《中国医学前沿杂志（电子版）》2019年第7期162-166,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨血清高迁移率族蛋白B1(high mobility group box 1 protein,HMGB1)、血清淀粉蛋白A(serum amyloid Aprotein,SAA)水平及中国心肌梗死注册登记研究-ST段抬高型心肌梗死(China acute myocardial infarction registry-ST segmentelevation myocardial infarction,CAMI-STEMI)评分对ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后生存状况的预测价值。方法选取2015年1月至2017年12月于首都医科大学附属北京友谊医院行PCI的269例STEMI患者为研究对象,根据PCI术后6个月内有无发生主要不良心脏事件(major adverse cardiovascular events,MACE)将其分为预后不良组和预后良好组。比较两组患者术前血清HMGB1、SAA水平及CAMI-STEMI评分,采用ROC曲线下面积(area under curve,AUC)评价三者对PCI术后MACE的预测价值,采用多因素COX回归分析探讨患者PCI术后出现MACE的独立预测因素。结果269例患者PCI术后6个月内共有51例(19.0%)出现MACE,包括支架内再发血栓28例,再发心肌梗死10例,恶性心律失常7例,心力衰竭5例,心源性死亡1例。预后不良组患者年龄显著大于预后良好组(P<0.05),术前血白细胞、空腹血糖、尿酸、超敏C反应蛋白、血清HMGB1、SAA水平、CAMI-STEMI评分、血管梗死位于近段的比率均显著高于预后良好组(均P<0.05),发病至心肌再灌注时间显著长于预后良好组(P<0.05)。术前血清HMGB1、SAA水平、CAMI-STEMI评分对MACE发生具有中等预测价值(AUC分别为0.786、0.760、0.853),三者联合对STEMI患者PCI术后MACE发生的预测价值更高。多因素COX回归分析结果表明,梗死位于血管近段、发病至心肌再灌注时间、术前血清HMGB1、SAA水平、CAMI-STEMI评分均为STEMI患者PCI术后MACE出现的独立预测因素(均P<0.05)。结论术前血清HMGB1、SAA水平及CAMI-STEMI评分均为STEMI患者PCI术后生存状况的独立预测因素,其中CAMObjective To investigate the predictive value of serum high mobility group box 1 protein (HMGB1), serum amyloid A protein (SAA) level and China acute myocardial infarction registry-ST segment elevation myocardial infarction (CAMI-STEMI) score for survival in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Method 268 patients with STEMI received PCI in Beijing Friendship Hospital, Capital Medical University from January 2015 to December 2017 were enrolled for the study and divided into poor prognosis group and good prognosis group according to the occurrence of major adverse cardiovascular events (MACE) within 6 months after PCI. Preoperative serum HMGB1, SAA levels and CAMI-STEMI score were compared between two groups. Area under curve (AUC) of receiver operating curve (ROC) was perfomed to evaluate the predictive value of three factors for MACE after PCI. Multivariate COX regression was used to analyze the independent predictors of MACE after PCI. Result A total of 51 patients (19.0%) suffered from MACE within 6 months after PCI, included 28 cases with recurrent stent thrombosis, 10 cases with recurrent myocardial infarction, 7 cases with malignant arrhythmia, 5 cases with heart failure and 1 case with cardiac death. The age of patients in poor prognosis group was significantly older than that in good prognosis group (P < 0.05), and preoperative white blood cells, fasting blood sugar, uric acid, high-sensitivity C-reactive protein, serum levels of HMGB1, SAA, CAMI-STEMI score and the ratio of infarction located in the proximal segment of blood vessel were significantly higher in good prognosis group (all P < 0.05), and the duration from onset to myocardial reperfusion was significantly longer than that in good prognosis group (P < 0.05). Preoperative serum HMGB1, SAA level and CAMI-STEMI score had moderate predictive value for occurrence of postoperative MACE (AUC were 0.786, 0.760, 0.853 respectively), and combination of these three factors had hi

关 键 词：ST段抬高型心肌梗死 高迁移率族蛋白B1 血清淀粉蛋白A CAMI-STEMI评分 经皮冠状动脉介入治疗 主要不良心脏事件 

分 类 号：R542.22[医药卫生—心血管疾病]