急性冠状动脉综合征患者PCI术前血清ICAM-1、ESM-1水平与术后冠状动脉慢血流/无复流的相关性  

Correlation between serum ICAM-1 and ESM-1 levels before PCI and postoperative coronary slow blood flow/no-reflow in patients with acute coronary syndrome

作　　者：王玉霞[1] 刘英华[1] 卢海英[2] 曾娟[2] 刘亚宁[1] 高晓丽[1] 王静[3] Wang Yuxia;Liu Yinghua;Lu Haiying;Zeng Juan;Liu Yaning;Gao Xiaoli;Wang Jing(Department of Internal Medicine Cardiovascular, General Hospital of North China Petroleum Administration,Hebei Province,Renqiu 062552,China;不详)

机构地区：[1]华北石油管理局总医院心内科,任丘062552 [2]华北石油管理局总医院功能科,任丘062552 [3]华北石油管理局总医院检验科,任丘062552

出　　处：《疑难病杂志》2022年第2期124-129,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究课题计划项目(20201256)。

摘　　要：目的探讨急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)术前血清细胞间黏附分子-1(ICAM-1)、内皮细胞特异性分子-1(ESM-1)水平与PCI术后冠状动脉慢血流/无复流(CSF/CNR)的相关性。方法选择2018年10月—2021年5月华北石油管理局总医院心内科行PCI术的ACS患者354例为研究组,根据患者PCI术后是否发生CSF/CNR,将患者分为正常血流(NCF)亚组291例和CSF/CNR亚组63例,同期选取在医院体检健康者360例为健康对照组。检测并比较健康对照组和研究组、NCF亚组和CSF/CNR亚组、研究组不同疾病类型PCI术前血清ICAM-1、ESM-1水平,Pearson法分析CSF/CNR亚组PCI术前血清ICAM-1与ESM-1的相关性,Logistic回归分析影响ACS患者PCI术后发生CSF/CNR的危险因素,受试者工作特征曲线分析PCI术前血清ICAM-1、ESM-1水平对ACS患者PCI术后发生CSF/CNR的预测价值。结果与健康对照组比较,研究组PCI术前血清ICAM-1、ESM-1水平显著升高(t/P=104.562/<0.001、52.608/<0.001);与NCF亚组比较,CSF/CNR亚组PCI术前血清ICAM-1、ESM-1水平显著升高(t/P=19.878/<0.001、21.652/<0.001);研究组中急性ST段抬高型心肌梗死(STEMI)、急性非ST段抬高型心肌梗死(NSTEMI)、不稳定型心绞痛(UAP)患者PCI术前血清ICAM-1、ESM-1水平比较差异无统计学意义(P>0.05);CSF/CNR亚组患者PCI术前血清ICAM-1与ESM-1水平呈正相关(r/P=0.484/<0.001);PCI术前血清ICAM-1、ESM-1高水平是ACS患者PCI术后发生CSF/CNR的危险因素[OR(95%CI)=3.104(1.536~6.273),3.267(1.741~6.129)];PCI术前血清ICAM-1、ESM-1水平预测ACS患者PCI术后发生CSF/CNR的曲线下面积(AUC)分别为0.744、0.775,二者联合为0.883,优于各自单独检测(Z/P=3.129/0.002、2.798/0.001)。结论ACS患者PCI术前血清ICAM-1、ESM-1水平呈高表达,二者与ACS患者PCI术后发生CSF/CNR有关,可能是临床上预测ACS患者PCI术后发生CSF/CNR的潜在生物标志物。Objective To investigate the preoperative serum intercellular adhesion molecule 1(ICAM-1)and endothelial cell specific molecule 1(ESM-1)levels in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI)and the slow coronary blood flow after PCI/No reflow(CSF/CNR)correlation.Methods From October 2018 to May 2021,354 patients with ACS who underwent PCI in the Department of Cardiology,North China Petroleum Administration General Hospital were selected as the study group.According to whether the patients had CSF/CNR after PCI,the patients were divided into normal blood flow(NCF).There were 291 cases in the subgroup and 63 cases in the CSF/CNR subgroup.Over the same period,360 cases of healthy people who had a physical examination in the hospital were selected as the healthy control group.Detect and compare the levels of serum ICAM-1 and ESM-1 before PCI in the healthy control group and the study group,NCF subgroup and CSF/CNR subgroup,and study group for different disease types.Correlation,logistic regression analysis influencing the risk factors of CSF/CNR after PCI in ACS patients,receiver operating characteristic curve analysis of pre-PCI serum ICAM-1 and ESM-1 levels in the predictive value of CSF/CNR after PCI in ACS patients.Results Compared with the healthy control group,the serum ICAM-1 and ESM-1 levels in the study group were significantly increased before PCI(t/P=104.562/<0.001,52.608/<0.001).Compared with the NCF subgroup,the serum ICAM-1 and ESM-1 levels in the CSF/CNR subgroup before PCI were significantly increased(t/P=19.878/<0.001,21.652/<0.001).There was no significant difference in serum ICAM-1 and ESM-1 levels before PCI in patients with acute ST-segment elevation myocardial infarction(STEMI),acute non-ST-elevation myocardial infarction(NSTEMI),and unstable angina(UAP)in the study group(P>0.05).There was a positive correlation between serum ICAM-1 and ESM-1 levels in the CSF/CNR subgroup before PCI(r/P=0.484/<0.001).High levels of serum ICAM-1 and ESM-1 before PC

关 键 词：急性冠状动脉综合征 细胞间黏附分子-1 内皮细胞特异性分子-1 经皮冠状动脉介入治疗 冠状动脉慢血流/无复流 

分 类 号：R541.4[医药卫生—心血管疾病]