血清胱抑素C水平对STEMI患者行PPCI术后发生心肌无复流的预测价值  

Predictive value of serum cystatin C levels in ST-segment elevation myocardial infarction patients with no-reflow after primary percutaneous coronary intervention

作　　者：曹健 郭照军 Cao Jian;Guo Zhaojun(Department of Function Diagnosis,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,Hainan,China;Department of Cardiology,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,Hainan,China)

机构地区：[1]海南医学院第二附属医院功能诊断科,海南海口570311 [2]海南医学院第二附属医院心血管内科,海南海口570311

出　　处：《中国中西医结合急救杂志》2021年第4期439-443,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：海南省自然科学资金资助项目(819MLS127)。

摘　　要：目的探讨血清胱抑素C(Cys C)水平对ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入治疗(PPCI)后发生心肌无复流的预测价值。方法纳入2018年I月至2020年8月海南医学院第二附属医院收治的230例行PPCI的STEMI患者,根据术后血流情况分为正常血流组[心肌梗死溶栓试验(TIMI)3级。184例]和无复流组(TIMI≤2级,46例)。比较两组患者的临床资料,通过多因素Logistie回归分析探讨STEMI患者行PPCI术后心肌无复流的独立危险因素,绘制受试者工作特征曲线(ROC)评价血清CysC水平对无复流的预测价值。结果无复流组的年龄,发病至球囊扩张时间(开通时间),糖尿病比例均明显高于正常血流组[年龄(岁):63.50±10.38比57.57±10.40,开通时间(h):6(4.9)比5(3.7),糖尿病比例:47.83%(22/46)比24.46%(45/184),均P<0.05].面收缩压明显低于正常[流组[mmHg(1 mmHg≈0.133 kPa):119.98±18.79比128.65±20.98,P<0.05]。与正常血流组比较,无复流组的血小板计数(PLT),D-二聚体,CysC水平以及Cys C高水平组比例均明显升高[PLT(×10^(9)/L):267.41±68.73比245.73±63.07,D-二聚体(mg/L):0.45(0.35.0.68)比0.36(0.26.0.45),Cys C(mg/L):1.15(1.04,1.46)比0.83(0.74.0.95),CysC高水平组比例:86.96%(40/46)比38.59%(71/184),均P<0.05],而估算肾小球滤过率(eGFR)和低密度脂蛋白胆固醇(LDL-C)水平均明显降低(eGFR(mL·min^(-1)·1.73 m^(-2)):90.35±23.18比106.78±22.75,LDL-C(mmo/L):2.75(2.46,3.24)比2.96(2.48,3.64),均P<0.05]。分析患者术后主要不良心血管事件(MACE)发生情况,无复流组患者住院期间的心力衰竭发生率明显高于正常血流组[36.96%(17/46)比23.91%(44/184),P<0.05]。多因素Logistie回归分析显示,Cys C≥0.88 mg/,是STEMI患者PPCI术后心肌无复流的独立预测因子[优势比(OR)=7.387.95%可信区间(95%CI)为2.756~19.803.P<0.001]。ROC曲线分析显示,Cys C截断值为1.01 mg/L时,ROC曲线下面积(AUC)为0.845(95%CI为0.791~0.889,P<0.001),预测STEMI患者行PPCI术后心肌Objeetive To explore the predictive value of senum cystatin C(Cys C)level in ST-segment elevation myorardial infarction(STEMI)patients with no-reflow after primary perutaneous coronary intervention(PPCD),Methods A total of 230 STEMI patients who underwent PPCI in the Second Afiliated Hospital of Hainan Medical Universily from January 2018 to August 2020 werr ernolled.According to the postoperative blood flow grades.the patients were divided into normal-reflow group[hrombolysis in myorardial infaretion trial(TIMI)grade 3.184 casrs|and mo-relow group(TIMI≤grade 2,46 cases).The elinical data of the Iwo groups were compared.The independent risk factors of no-reflow in STEMI patients after PPCI were explored by multivariale Logistie regression analysis.and the predictive value of serum Cys C level for no-reflow was evaluated by receiver operator characteristie curve(ROC).Results The age.time from onset to balloon dilatation(pain-to-balloon time)and proportion of diabetes mellitus in no-reflow group were higher than those in normal-reflow group lage(years):63.50±10.38 vs.57.57±10.40,pin-lo-balloon time(hours);6(4.9)vs.5(3.7).proportion of diabetes mellitus:47.83%(22/46)vs.24.46%(45/184).all P<0.05].while systolie blood pressure was lower than normal blood flow group[mmHg(1 mmHg≈0.133 kPa):119.98±18.79 vs.128.65±20.98.P<0.05].Compared with those of normal-reflow group,platelet count(PLT),D-dimer,Cys C levels and proportion of Cys C high level group in no-reflow group were signifeantly increased[PLT(×10^(9)/L):267.41±68.73 vs.245.73±63.07.D-dimer(mg/):0.45(0.35.0.68)vs.0.36(0.26.0.45),Cys C(mg/L):1.15(1.04.1.46)vs.0.83(0.74.0.95).proporion of Cys C high level group:86.96%(40/46)vs.38.59%(71/184),all P<0.05].while estimated glomerular filtration rate(eGFR)and low-density lipoprotein cholesterol(LDL-C)levels were significantly derreased in mo-renlow group[eCFR(mL·min^(-1)·1.73 m^(-2)):90.35±23.18 vs.106.78±22.75.1LDL-C(mmol/L):2.75(2.46,3.24)vs.2.96(2.48,3.64),all P<0.05].The major adverse cardiovascular eve

关 键 词：胱抑素C 直接经皮冠状动脉介入治疗 心肌无复流 ST段抬高型心肌梗死 

分 类 号：R54[医药卫生—心血管疾病]