急性前壁ST段抬高型心肌梗死患者介入治疗前血清血管内皮生长因子与左心室重构的关联性研究  

Relationship between serum VEGF on admission and left ventricular remodeling in patients with acute anterior ST-segment elevation myocardial infarction undergoing emergency PCI

作　　者：杨洋 李楠[1] 赖红梅[1] YANG Yang;LI Nan;LAI Hong-mei(Department of Cardiology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院心血管内科,新疆乌鲁木齐市830001

出　　处：《中国心血管病研究》2021年第9期818-823,共6页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区自然科学基金项目(2017D01C115)。

摘　　要：目的分析急性前壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI患者入院血清血管内皮生长因子(vascular endothelial growth factor,VEGF)水平与急诊经皮冠状动脉内介入术(percutaneous coronary intervention,PCI)后6个月左心室重构(left ventricular remodeling,LVR)的关联性。方法纳入2016年1月至2017年12月在新疆自治区人民医院心血管内科行急诊PCI的急性前壁STEMI患者,收集其入院时临床资料和血液样本,采用酶联免疫吸附实验检测血清VEGF水平。在住院3天内和PCI后6个月分别对患者进行超声心动图检查,根据左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)变化情况将患者分为LVR组(n=43)和非LVR组(n=156),其中LVR定义为随访6个月时LVEDV较基线水平增加≥20%。比较两组患者的临床变量,并采用logistic回归方程分析各变量与发生LVR的关联性。结果LVR组患者高血压(39.5%)、2型糖尿病(30.2%)、多支血管病变(46.5%)和PCI后慢血流(18.6%)的比例以及症状出现至球囊通过时间[(5.63±2.66)h]显著高于非LVR组患者[23.7%、13.5%、28.2%、6.4%、(4.39±2.14)h],差异有统计学意义(P均<0.05)。LVR组患者入院后肌钙蛋白I峰值水平显著高于非LVR组患者[(30.72±17.06)ng/ml比(23.61±15.95)ng/ml],而入院VEGF水平低于非LVR组患者[(113.23±39.44)pg/ml比(133.05±43.75)pg/mL],差异有统计学意义(P均<0.05)。Logistic回归分析显示,校正年龄、高血压、症状出现至球囊通过时间、多支血管病变、术后慢血流等因素后,2型糖尿病(OR=2.518,95%CI 1.02~6.175,P=0.044)与肌钙蛋白I峰值(OR=1.032,95%CI 1.002~1.063,P=0.034)是STEMI患者PCI后6个月出现LVR的独立危险因素,而入院时血清VEGF水平(OR=0.987,95%CI 0.967~0.999,P=0.037)是其保护性因素。结论入院血清VEGF水平与急性前壁STEMI患者PCI后6个月发生LVR密切相关,有助于对STEMI患者进行危险分层和评估预后。Objective The aim of this study was to investigate the usefulness of admission vascular endothelial growth factor(VEGF)in predicting adverse left ventricular remodeling relationship between serum vascular endothelial growth factor(VEGF)on admission and left ventricular remodeling in the patients with acute anterior ST-segment elevation myocardial infarction(STEMI)undergoing emergency PCI.Methods Patients with acute anterior STEMI who received percutaneous coronary intervention within 12 h fome symptom onset were included(n=199).Echocardiograms were performed during hospitalization(24-72 h)and after 6 months.Patients were divided into two groups according to the presence of left ventricular remodeling(LVR).LVR was defined as a≥20%increase in LV end-diastolic volume at 6-month post-infarct.Results 43(21.6%)of the patients demonstrated remodeling in the 6 months of follow-up.Patients in the LVR group had more symptom onset to balloon time[(5.63±2.66)h]with higher prevalence of hypertension(39.5%),diabetes mellitus type 2(30.2%),multivessel disease(46.5%)and slow coronary flow post-PCI(18.6%)in comparison to participants without LVR[(4.39±2.14)h,23.7%,13.5%,28.2%and 6.4%](all P<0.05).Meanwhile,patients in the LVR group had higher peak c Tn I[(30.72±17.06)ng/m L]and lower level of VEGF[(113.23±39.44)pg/ml]in comparison to participants without LVR[(23.61±15.95)ng/ml and(133.05±43.75)pg/ml](all P<0.05).Multivariate logistic regression analysis demonstrated that DM(OR=2.518,95%CI 1.027~6.175,P=0.044)and peak c Tn I(OR=1.032,95%CI1.002~1.063,P=0.034)were the independent predictors of LVR after PCI,while VEGF level on admission was a protective factor for LVR(OR=0.987,95%CI 0.967~0.999,P=0.037).Conclusion EVGF on admission is an independent predictor of LVR in patients with acute anterior STEMI undergoing PCI and it can be used as an indicator for risk stratification and prognosis.

关 键 词：急性前壁ST段抬高型心肌梗死 左心室重构 血管内皮生长因子 

分 类 号：R542.22[医药卫生—心血管疾病]