血钠对STEMI患者直接经皮冠状动脉介入治疗术后复流现象的预测价值  

The Predictive Value of Serum Sodium in Relapse After Direct Percutaneous Coronary Intervention in STEMI Patients

作　　者：张光兵[1] 杨万双 罗隽[1] 曾维艳 Zhang Guangbing;Yang Wanshuang;Luo Jun(Department of Cardiology,Mianzhu People′s Hospital,Mianzhu,Sichuan 618200,China)

机构地区：[1]绵竹市人民医院心血管内科,四川绵竹618200

出　　处：《四川医学》2022年第5期492-497,共6页Sichuan Medical Journal

摘　　要：目的分析血钠水平对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后无复流发生的预测价值。方法选择2015年5月15日至2020年8月31日在我院接受PCI手术的急性STEMI患者515例,根据术后是否复流分为复流组(403例)和无复流组(112例)。比较两组患者的一般资料及检查结果;采用Logistic回归分析筛选无复流的相关因素,采用ROC曲线判定血钠水平对无复流事件的预测价值。结果复流组和无复流组患者年龄、性别、高血压、糖尿病、收缩压、舒张压、入院时Killip分级、左心室射血分数、尿酸、空腹血糖、血钠、发病至球囊扩张时间及病变长度的差异有统计学意义(P<0.05)。多因素Logistic回归分析表明糖尿病(OR=1.156,95%CI:1.089~1.223,P=0.025)、收缩压(OR=0.962,95%CI:0.930~0.994,P=0.046)、左心室射血分数(OR=0.937,95%CI:0.902~0.972,P=0.012)、尿酸(OR=1.085,95%CI:1.027~1.143,P=0.003)、血钠(OR=0.899,95%CI:0.843~0.955,P<0.001)、发病至球囊扩张时间(OR=1.015,95%CI:1.006~1.024,P=0.005)是无复流发生的独立相关因素。血钠预测无复流的ROC曲线下面积为0.802(0.785~0.818),P<0.001;理想阈值为136.24 mmol/L,敏感度为69.14%,特异度为78.63%。结论血钠是STEMI患者PCI术后冠状动脉无复流的独立危险因素,对冠状动脉无复流具有一定的预测价值。Objective To analyze the value of serum sodium level in predicting reflow after primary percutaneous coronary intervention(PCI) in patients with ST-segment elevation acute myocardial infarction(STEMI).Methods 515 patients with acute STEMI who underwent PCI surgery in our hospital from May 15,2015 to August 31,2020 were seletcted.The subjects were divided into reflow group(403 cases) and no-reflow group(112 cases) according to whether they were reflowed after surgery.General information and examination results of the two groups of patients were compared.Logistic regression analysis was used to screen the related factors of no-reflow.ROC curve was employed to determine the predictive value of blood sodium level for no-reflow events.Results There were statistically significant differences in age,gender,hypertension,diabetes,systolic blood pressure,diastolic blood pressure,Killip classification at admission,left ventricular ejection fraction,uric acid,fasting blood glucose,blood sodium,time from onset to balloon dilation and length of lesion between the reflow group and the no-reflow group(P<0.05).Multivariate logistic regression analysis showed diabetes(OR=1.156,95%CI:1.089~1.223,P=0.025),systolic blood pressure(OR=0.962,95%CI:0.930~0.994,P=0.046),left ventricular ejection fraction(OR=0.937,95%CI:0.902~0.972,P=0.012),uric acid(OR=1.085,95%CI:1.027~1.143,P=0.003),blood sodium(OR=0.899,95%CI:0.843~0.955,P<0.001),the time from onset to balloon dilation(OR=1.015,95% CI:1.006~1.024,P=0.005) were independent related factors for the occurrence of no reflow.The area under the ROC curve of blood sodium for predicting no-reflow was 0.802,(95%CI:0.785~0.818,P<0.001);the appropriate cut-off point was 136.24 mmol/L,the sensitivity was 69.14%,and the specificity was 78.63%.Conclusion Serum sodium is an independent risk factor for coronary artery non-reflow after PCI in STEMI patients,and has certain predictive value for coronary artery non-reflow.

关 键 词：经皮冠状动脉介入治疗术 无复流现象 血钠 急性ST段抬高型心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]