血清PAPP-A、CysC水平对老年AMI患者PCI后不良心血管事件的预测分析  

Levels of serum PAPP-A and CysC for predicting adverse cardiovascular events in elderly patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：李艳艳 安书杰 Li Yanyan;An Shujie(Department of General Medicine,First Affiliated Hospital of Air Force Medical University,Xi`an 710032,China;不详)

机构地区：[1]空军军医大学第一附属医院综合诊疗科,西安710032

出　　处：《中国循证心血管医学杂志》2021年第12期1449-1452,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家重点研发计划冠心病队列建设项目(2016YFC090903)。

摘　　要：目的探讨血清中妊娠相关蛋白-A(PAPP-A)和胱抑素C(CysC)水平对老年急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后不良心血管事件发生的预测价值。方法回顾性分析2017年8月至2019年3月于空军军医大学第一附属医院收治行PCI的老年AMI患者129例,均于术后24 h内检测血清PAPP-A、CysC水平,严密随访3月,根据不良心血管事件发生情况分为发生组(26例)与未发生组(103例)。对比两组患者的血清PAPP-A、CysC水平,采用多变量Logistic回归分析法分析PAPP-A、CysC水平与老年AMI患者PCI后近期不良心血管事件发生的关系,采用工作曲线(ROC)评价PAPP-A和CysC对不良心血管事件的预测价值。结果老年AMI患者PCI后24 h血清PAPP-A水平为(36.52±4.73)mIU/ml,CysC水平为(1.62±0.31)mg/L;PCI后随访3个月,不良心血管事件发生率为20.16%(26/129);发生组PCI后24 h血清PAPP-A、CysC水平均高于未发生组,差异有统计学意义(P<0.05);发生组PCI后24 h血清PAPP-A水平≥8.5 mIU/ml、血清CysC水平≥1.1 mg/L的占比均高于未发生组,差异均有统计学意义(P<0.05);经多变量Logistic回归分析,高血压史、糖尿病史、PCI后24 h血清PAPP-A水平≥8.5 mIU/ml及CysC水平≥1.1 mg/L均是老年AMI患者PCI后近期发生不良心血管事件的危险因素(OR=2.472、2.440、2.787、2.737,P<0.05);PCI后24 h血清PAPP-A水平、CysC水平单项及联合预测老年AMI患者PCI后近期发生不良心血管事件的灵敏度分别为88.46%、84.62%、92.31%,特异度分别为81.55%、84.62%、91.26%,曲线下面积(AUC)分别为0.861、0.834、0.935。结论血清PAPP-A、CysC水平对PCI后发生不良心血管事件具有较高预测价值,临床中可据此制定对应性预防措施,以减少术后不良心血管事件的发生。Objective To investigate the predictive value of levels of serum pregnancy-associated plasma protein A(PAPP-A)and cystatin C(Cys C)to incidence of adverse cardiovascular events in elderly patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods AMI patients(n=129)undergone PCI were retrospectively analyzed in the First Affiliated Hospital of Air Force Medical University from Aug.2017 to Mar.2019.The levels of PAPP-A and CysC were detected within 24 h after PCI,and all patients were followed up for 3 months.All patients were divided,according to incidence status of adverse cardiovascular events,into incidence group(n=26)and non-incidence group(n=103).The levels of PAPP-A and CysC were compared between 2 groups.The correlation between levels of PAPP-A and CysC and short-term incidence of adverse cardiovascular events was analyzed by using Logistic regression analysis.The predictive value of PAPP-A and CysC to adverse cardiovascular events was reviewed by using receiver operating characteristic(ROC)curve.Results The level of PAPP-A was(36.52±4.73)mIU/ml and level of CysC was(1.62±0.31)mg/L in elderly AMI patients after PCI for 24 h.The incidence rate of adverse cardiovascular events was 20.16%(26/129)after followed up for 3 months after PCI.The levels of PAPP-A and CysC were higher in incidence group than those in non-incidence group after PCI for 24 h(P<0.05).The percentages of patients with PAPP-A≥8.5 mIU/ml and CysC≥1.1 mg/L were higher in incidence group than those in non-incidence group after PCI for 24 h(P<0.05).The results of Logistic regression analysis showed that history of hypertension and diabetes,PAPP-A≥8.5 mIU/ml and CysC≥1.1 mg/L after PCI for 24 h were risk factors of short-term adverse cardiovascular events(OR=2.472,2.440,2.787,2.737,P<0.05).The sensitivity of PAPP-A,CysC or PAPP-A combined with CysC was,respectively,88.46%,84.62%and 92.31%,specificity was,respectively,81.55%,84.62%and 91.26%,and AUC of ROC curve was,respectively,0.861,0.834 and 0

关 键 词：妊娠相关蛋白-A 胱抑素C 急性心肌梗死 经皮冠状动脉介入治疗 不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]