血清ADAMTS13、IL-18对急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术后患者预后的预测价值  

Predictive value of serum ADAMTS13 and IL-18 in prognosis of patients after percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

作　　者：严宪才[1] 黄书哲 吴志光[1] 刘锦文 周耀辉[1] YAN Xiancai;HUANG Shuzhe;WU Zhiguang;LIU Jinwen;ZHOU Yaohui(Department of Emergency,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,China;不详)

机构地区：[1]中山市中医院急诊科,广东中山528400 [2]中山市中医院危重病医学科

出　　处：《山东医药》2022年第4期6-10,共5页Shandong Medical Journal

基　　金：广东省中医药局科研项目(20201374)。

摘　　要：目的探讨血清含1型血小板结合蛋白基序的去整合素样金属蛋白酶成员13(ADAMTS13)、IL-18对急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)术后患者预后的预测价值。方法213例STEMI患者,根据PCI术后1年是否发生主要不良心血管事件(MACE)分为MACE组(n=52)和非MACE组(n=161)。采用酶联免疫吸附法测定血清ADAMTS13、IL-18,Spearman相关性分析Killip分级与血清ADAMTS13、IL-18水平的相关性,多因素Logistic回归分析STEMI患者PCI术后MACE发生的影响因素,受试者工作特征(ROC)曲线分析血清ADAMTS13、IL-18水平对STEMI患者PCI后MACE发生的预测价值。结果MACE组发病至入院时间、支架长度长于非MACE组,Killip分级≥Ⅱ级比例、支架数目高于非MACE组(P均<0.05)。Killip分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者血清ADAMTS13水平依次降低,IL-18水平依次升高;Killip分级与ADAMTS13水平呈负相关,与IL-18水平呈正相关(r_(s)分别为-0.740、0.797,P均<0.001)。发病至入院时间、Killip分级≥Ⅱ级、IL-18水平为STEMI患者PCI术后MACE发生独立危险因素,ADAMTS13水平为独立保护因素(P均<0.05)。ADAMTS13+IL-18预测STEMI患者PCI术后MACE发生的曲线下面积大于ADAMTS13、IL-18单独预测(P均<0.05)。结论血清ADAMTS13水平降低和IL-18水平升高与STEMI患者心功能降低和MACE发生有关,二者联合能提升PCI术后MACE发生预测价值。Objective To investigate the predictive value of serum a disintegrin and metalloproteinase with thrombospondin type 1 motif,member 13(ADAMTS13)and interleukin-18(IL-18)on the prognosis of patients after percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI).Methods Two hundred and thirteen patients with STEMI were divided into the MACE group(n=52)and the non-MACE group(n=161)according to whether they had major adverse cardiovascular event(MACE)1 year after PCI.The enzyme-linked immunosorbent assay was used to determine the serum ADAMTS13 and IL-18 levels,and the correlation between Killip classification and serum ADAMTS13 and IL-18 levels was analyzed by Spearman correlation.Factors influencing the occurrence of MACE after PCI in STEMI patients were analyzed using multifactorial Logistic regression,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum ADAMTS13 and IL-18 levels in the occurrence of MACE after PCI in STEMI patients.Results Compared with the non-MACE group,the MACE group had longer time from onset to admission,longer stent length,increased proportion of Killip classification≥gradeⅡ,increased number of stents,lower serum ADAMTS13 levels and higher serum IL-18 levels(all P<0.05).Patients with Killip gradeⅠ,Ⅱ,ⅢandⅣhad sequentially lower serum ADAMTS13 levels and sequentially higher IL-18 levels;Killip grade was negatively correlated with ADAMTS13 levels and positively correlated with IL-18 levels(r s=-0.740,0.797,both P<0.001).Time from onset to admission 3,Killip classification≥Ⅱand IL-18 level were independent risk factors for the development of MACE after PCI in STEMI patients,and ADAMTS13 level was an independent protective factor(all P<0.05).The area under curve(AUC)of ADAMTS13+IL-18 in predicting the occurrence of MACE after PCI in STEMI patients was greater than that predicted by ADAMTS13 or IL-18 alone(both P<0.05).Conclusion Decreased serum ADAMTS13 levels and increased IL-18 levels are

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 含1型血小板结合蛋白基序的去整合素样金属蛋白酶成员13 白细胞介素18 主要不良心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病]