实时三维超声心动图检测老年急性心肌梗死左心功能与实验室有关指标关联性及临床意义  

The correlation between the left ventricular function of the elderly with acute myocardial infarction and related laboratory indexes detected by real-time three-dimensional echocardiography and its clinical significance

作　　者：白丽娟 赵国强 赵恩晨 牛小虎 BAI Lijuan;ZHAO Guoqiang;ZHAO Enchen;NIU Xiaohu(Department of Utrasound Diagnosis,Cardiorascular and Cerebrouascular Disease Hospital of Qinghai Pronince,Xining 810000,China)

机构地区：[1]青海省心脑血管病专科医院超声诊断科,810000 [2]青海省心脑血管病专科医院心血管内科,810000

出　　处：《心肺血管病杂志》2021年第7期725-730,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：青海省科技支撑计划项目(090NKCA117)。

摘　　要：目的:探讨实时三维超声心动图(RT3DE)检测老年急性心肌梗死(AMI)左心功能与实验室有关指标[可溶性血凝素样氧化低密度脂蛋白受体-1(sLOX-1)、载脂蛋白CⅢ(ApoCⅢ)、心肌肌钙蛋白Ⅰ(cTnⅠ)]关联性及临床意义。方法:回顾性分析2017年5月至2020年3月,我院120例老年AMI患者临床资料,根据患者PCI术后6个月是否发生MACE分为MACE组(n=45)、N-MACE组(n=75)。对比两组RT3DE测定的左心功能指标[左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、LVEF]、血清sLOX-1、ApoCⅢ、cTnⅠ水平,观察老年AMI患者经皮冠状动脉介入治疗(PCI)术后主要不良心血管事件(MACE)发生影响因素及各指标与患者PCI术后MACE发生关联性,并分析患者左心功能指标与血清各指标关系,探讨左心功能指标与血清各指标对患者预后不良预测价值。结果:MACE组LVEDV、LVESV、血清sLOX-1、ApoCⅢ、cTnⅠ水平高于N-MACE组,LVEF水平低于N-MACE组(P<0.05);回归分析可知,年龄、发病至手术时间、心肌梗死部位、Killip分级、吸烟史、高血压、高脂血症、冠状动脉病变支数、术后ST段回落不良、LVEDV、LVESV、LVEF、血清sLOX-1、ApoCⅢ、cTnⅠ均为老年AMI患者PCI术后MACE发生影响因素(P<0.05);偏相关性分析显示,控制其他混杂因素后,LVEDV、LVESV、LVEF、血清sLOX-1、ApoCⅢ、cTnⅠ仍与老年AMI患者PCI术后MACE发生有关(P<0.05);相关性分析显示,老年AMI患者左心功能指标LVEDV、LVESV与血清sLOX-1、ApoCⅢ、cTnⅠ呈正相关,LVEF与血清sLOX-1、ApoCⅢ、cTnⅠ呈负相关(P<0.05);ROC曲线显示,左心功能指标、血清各指标对老年AMI患者PCI术后MACE均有较高预测价值,联合预测时敏感度为88.89%、特异度为76.00%。结论:RT3DE测定左心功能与老年AMI患者血清实验室有关指标sLOX-1、ApoCⅢ、cTnⅠ水平及AMI发病有关,可预测PCI后MACE发生风险,且将其与血清指标联合预测价值更高。Objective:To explore the correlation and clinical significance of left ventricular function in elderly patients with acute myocardial infarction(AMI)and related laboratory indicators[soluble hemagglutinin-like oxidized low-density lipoprotein receptor-1(sLOX-1),apolipoprotein CⅢ(ApoCⅢ),cardiac troponin I(cTnⅠ)]through real-time three-dimensional echocardiography(RT3 DE).Methods:The clinical data of 120 elderly AMI patients in our hospital from May 2017 to March 2020 were retrospectively analyzed.According to whether MACE occurred at 6 months after PCI,they were divided into MACE group(n=45)and N-MACE group(n=75).The left ventricular function indexes detected by RT3 DE[left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),LVEF],serum sLOX-1,ApoCⅢand cTnⅠlevels between the two groups were compared.The influencing factors of major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in elderly patients with AMI and the correlation between various indicators and MACE after PCI were observed.The relationship between left ventricular function indexes and serum indexes in patients was analyzed,and the predictive value of left ventricular function indexes and serum indexes for poor prognosis of patients was explored.Results:The levels of LVEDV,LVESV,serum sLOX-1,ApoCⅢ,and cTnⅠin the MACE group were higher than those in the N-MACE group,while the LVEF levels were lower than those in the N-MACE group(P<0.05);regression analysis showed that age,time from onset to operation,location of myocardial infarction,Killip grade,smoking history,hypertension,and hyperlipidemia,the number of coronary artery lesions,poor postoperative ST-segment fall,LVEDV,LVESV,LVEF,serum sLOX-1,ApoCⅢ,and cTnⅠwere all influencing factors for MACE in elderly patients with AMI after PCI(P<0.05);partial correlation analysis showed that after controlling for other confounding factors,LVEDV,LVESV,LVEF,serum sLOX-1,ApoCⅢ,cTnⅠwere still related to the occurrence of MACE in eld

关 键 词：实时三维超声心动图 左心功能 急性心肌梗死 可溶性血凝素样氧化低密度脂蛋白受体-1 载脂蛋白CⅢ 

分 类 号：R54[医药卫生—心血管疾病]