SYNTAXⅡ积分联合Lp-PLA2水平对急性心肌梗死患者行PCI后发生不良心血管事件的预测价值  

Predictive value of SYNTAXⅡscore combined with Lp-PLA2 level for adverse cardiovascular events after PCI in patients with acute myocardial infarction

作　　者：吕峰峰[1] 廉铮[2] 王钢[1] 颜利求[2] 王云飞[2] Lv Fengfeng;Lian Zheng;Wang Gang;Yan Liqiu;Wang Yunfei(Department of Cardiovascular Medicine,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院心血管内科,沧州061000 [2]沧州市中心医院心内一科,沧州061000

出　　处：《中国循证心血管医学杂志》2020年第2期197-201,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省沧州市重点研发计划指导项目(172302097)。

摘　　要：目的探讨SYNTAXⅡ积分联合脂蛋白相关磷脂酶A2(Lp-PLA2)水平对急性心肌梗死(AMI)患者行经皮冠状动脉介入治疗(PCI)后发生不良心血管事件的预测价值。方法选取2014年10月至2017年9月于沧州市中心医院心内科就诊的急性ST段抬高心肌梗死并行PCI的患者339例,患者在PCI后住院期间和出院后均给予常规联合用药治疗,出院后复查冠状动脉(冠脉)造影,评价患者SYNTAXⅡ积分,测定血浆Lp-PLA2、血浆生化指标及心动图指标,随访1年,采用多因素Logistic回归模型进行不良心血管事件的影响因素分析,ROC曲线分析SYNTAXⅡ积分和血浆Lp-PLA2值对不良心血管事件的诊断价值。结果不同SYNTAXⅡ积分患者Lp-PLA2、肌酐(Cr)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、左房内径(LAD)和左室舒张末期内径(LVEDd)指标无统计学差异(P>0.05),SYNTAXⅡ积分>31分的患者其低密度脂蛋白胆固醇(LDL-C)值均显著高于<21分和21~31分的患者(P<0.05),左室射血分数(LVEF)值均显著低于<21分和21~31分的患者(P<0.05),<21分和21~31分的患者的LDL-C值和LVEF值相比较无统计学差异(P<0.05);随着SYNTAXⅡ积分值和血浆Lp-PLA2水平增加,患者不良心血管事件发生率显著增加(P<0.05)。经多因素Logistic回归分析,血浆Lp-PLA2水平、SYNTAXⅡ积分是AMI患者经PCI后1年不良心血管事件的独立危险因素(P<0.05,OR分别为1.114和1.007)。ROC曲线分析结果显示:血浆Lp-PLA2水平和SYNTAXⅡ积分有一定的预测AMI患者PCI后不良心血管事件的诊断价值,但SYNTAXⅡ和Lp-PLA2联合应用,其诊断效率较高:敏感度和特异度分别为:0.775和0.740,约登指数较大,为0.515。结论SYNTAXⅡ积分和血浆Lp-PLA2水平是急性ST段抬高型AMI患者行PCI后远期不良心血管事件发生的独立预测因素,血浆Lp-PLA2水平、SYNTAXⅡ积分的联合运用可更好的预测AMI患者PCI后不良心血管事件发生情况。Objectives To investigate the predictive value of SYNTAXⅡpoints combined with lipoproteinassociated phospholipase A2(Lp-PLA2)levels in predicting adverse cardiovascular events in patients with acute myocardial infarction(AMI)after PCI.Methods A total of 339 patients with acute ST-elevation myocardial infarction who underwent PCI in the Department of Cardiology,Cangzhou Central Hospital from October 2014 to September 2017 were selected.Patients were given conventional combination therapy during hospitalization after PCI and after discharge.The patients were followed up for 1 year after discharge.Coronary angiography was reviewed.The patients'SYNTAXⅡscores were evaluated.Plasma Lp-PLA2,plasma biochemical indicators and cardiogram indicators were measured.Multivariate Logistic regression model was used to analyze the influencing factors of adverse cardiovascular events.ROC curve was used to analyze the diagnostic value of SYNTAXⅡscore and plasma Lp-PLA2 value.Results There was no significant difference in Lp-PLA2,creatinine(Cr),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),left atrial diameter(LAD)and left ventricular end-diastolic diameter(LVEDd)among patients with different SYNTAXⅡscore(P>0.05).The low density lipoprotein cholesterol(LDL-C)value of patients with SYNTAX II score>31 points was significantly higher than that of patients with<21 points and 21~31 points(P<0.05).Left ventricular ejection fraction(LVEF)value was significantly lower than that of patients with<21 and 21~31 points(P<0.05).There was no significant difference in LDL-C and LVEF between patients with<21 and 21~31 points(P<0.05).With the increase of SYNTAXⅡscore and plasma Lp-PLA2 level,the incidence of adverse cardiovascular events increased significantly(P<0.05).Multivariate logistic regression analysis showed that plasma Lp-PLA2 level and SYNTAXⅡscore was independent risk factor for adverse cardiovascular events in AMI patients one year after PCI(P<0.05,OR was 1.114 and 1.007 respectively).ROC

关 键 词：SYNTAXII积分 LP-PLA2 急性心肌梗死 PCI 

分 类 号：R542.22[医药卫生—心血管疾病]