三种血清指标对老年急性ST段抬高型心肌梗死患者介入术后院内康复期间事件的预测效能  

Predictive efficacy of three serum indicators for MACE during in-hospital rehabilitation in elderly with acute STEMI after PCI

作　　者：张文雅 苏文刚[1] 李春燕 Zhang Wenya;Su Wengang;Li Chunyan(Department of Cardiovascular Diseases,Nanyang First People'sHospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳市第一人民医院心血管内科,473000

出　　处：《中华老年心脑血管病杂志》2023年第9期918-922,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190555)。

摘　　要：目的 探讨血清微小RNA-499(miR-499)、可溶性fms样酪氨酸激酶1(sFlt-1)、血小板微颗粒(PMP)对老年急性ST段抬高型心肌梗死(STEMI)患者PCI术后院内康复期间主要不良心脏事件(MACE)的预测效能。方法 选取2019年3月至2022年6月南阳市第一人民医院心血管内科住院的STEMI患者106例,根据PCI术后院内康复期间发生MACE情况分为MACE组21例和对照组85例。比较2组PCI术前、术后即刻血清miR-499、sFlt-1、PMP水平及TIMI血流分级,分析各血清指标与TIMI血流分级的相关性,评价各血清指标对MACE的预测效能。结果 MACE组发病至入院时间、Gensini评分、KillipⅣ级比例明显高于对照组(P<0.05,P<0.01)。2组PCI术后即刻血清miR-499、sFlt-1、PMP水平明显低于PCI术前(P<0.01);MACE组PCI术前和术后即刻血清miR-499、sFlt-1、PMP水平明显高于对照组,差异有统计学意义(P<0.01)。MACE组PCI术前、术后即刻TIMI血流分级状况明显低于对照组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,PCI术前和术后即刻血清miR-499、sFlt-1、PMP水平与TIMI血流分级呈负相关(r=-0.510,r=-0.558,r=-0.486,P<0.01;r=-0.603,r=-0.572,r=-0.615,P<0.01)。ROC曲线分析显示,PCI术前和术后即刻血清miR-499、sFlt-1、PMP联合预测MACE的曲线下面积高于miR-499、sFlt-1、PMP单一指标预测。结论 血清miR-499、sFlt-1、PMP可作为预测老年STEMI患者PCI术后院内康复期间MACE的重要指标,PCI术后即刻联合检测预测效能更为可靠。Objective To investigate the predictive efficacy of serum microRNA-499(miR-499),soluble fms-like tyrosine kinase-1(sFlt-1),and platelet microparticles(PMP)for major adverse cardiac events(MACE)during in-hospital rehabilitation in the elderly with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods One hundred and six patients with acute STEMI admitted in our department from March 2019 to June 2022 were enrolled and then divided into a MACE group(21 cases)and a control group(85 cases)according to whether MACE occurred during in-hospital rehabilitation after PCI.Their serum miR-499,sFlt-1 and PMP levels,and TIMI flow grade before and immediately after PCI were compared between the two groups,and the correlations of each serum indicator with TIMI flow grade were analyzed to evaluate the predictive efficacy of the indicators for MACE.Results The MACE group had significantly longer time from onset to admission,higher Gensini score,and larger proportion of Killip class IV than the control group(P<0.05,P<0.01).The serum miR-499,sFlt-1 and PMP levels were obviously declined in both groups immediately after PCI(P<0.01),and the levels in the MACE group were statistically increased than those in the control group at the two time points(P<0.01).Notable worse TIMI blood flow grade was also observed in the MACE group than the control group both at before and immediately after PCI(P<0.05).Spearman correlation analysis indicated that the serum miR-499,sFlt-1 and PMP levels before and immediately after PCI were negatively correlated with TIMI blood flow grade(r=-0.510,-0.558,-0.486,P<0.01;r=-0.603,-0.572,-0.615,P<0.01).ROC curve analysis showed that the AUC of the three indicators combined together before and immediately after PCI was larger than the value of each indicator alone at the corresponding time points in predicting the occurrence of MACE.Conclusion Serum miR-499,sFlt-1 and PMP levels can be important predictors for MACE during in-hospital rehabilitation after PCI

关 键 词：心肌梗死 经皮冠状动脉介入治疗 预测 微小RNA-499 可溶性fms样酪氨酸激酶 主要不良心脏事件 

分 类 号：R542.22[医药卫生—心血管疾病]