急性心肌梗死患者血清sLOX-1、hs-CRP水平及CHA2 DS2-VASc评分与术后无复流现象的相关性  

Correlation analysis of serum sLOX-1, hs-CRP levels, and CHA2 DS2-VASc score with no-reflow phenomenon after acute myocardial infarction surgery

作　　者：陈红伟 曹军 张继伟 任俊燕 侯子旻 CHEN Hong-wei;CAO Jun;ZHANG Ji-wei;REN Jun-yan;HOU Zi-min(Department of Emergency,the Fourth Clinical College of Xinxiang Medical College,Xinxiang Central Hospital,Xinxiang 453000,Henan,China)

机构地区：[1]新乡医学院第四临床学院、新乡市中心医院急诊科,河南新乡453000

出　　处：《广东医学》2023年第12期1542-1547,共6页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210907)。

摘　　要：目的 探究急性心肌梗死(acute myocardial infarction, AMI)患者血清可溶性凝集素样氧化低密度脂蛋白受体-1(soluble lectin-like oxidized low density lipoprotein receptor-1,sLOX-1)、超敏-C反应蛋白(high-sensitivity C-reactive protein, hs-CRP)水平及CHA2DS2-VASc评分与经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)后无复流现象的关系。方法 选取2021年7月至2023年3月期间收治的500例AMI患者为研究对象,根据患者术后心肌梗死溶栓(TIMI)分级,将500例患者分为无复流组(n=92)和复流组(n=408)。收集患者临床资料并采用酶联免疫吸附试验(ELISA)检测血清sLOX-1水平和采用免疫比浊法检测hs-CRP水平;比较无复流组和复流组患者临床资料以及血清sLOX-1、hs-CRP水平、CHA2DS2-VASc评分。多因素logistic回归分析法分析AMI患者术后无复流的影响因素;受试者工作特征(ROC)曲线分析血清sLOX-1、hs-CRP水平和CHA2DS2-VASc评分对AMI患者术后无复流现象的预测价值。结果 单因素分析表明,病灶血管长度、发病至血管再通时间、入院时TIMI分级、糖尿病史、心力衰竭史与术后无复流有关(P<0.05)。与复流组比较,无复流组血清sLOX-1、hs-CRP水平和CHA2DS2-VASc评分均明显升高(P<0.05)。多因素logistic回归分析结果显示,sLOX-1、hs-CRP、CHA2DS2-VASc评分、病灶血管长度、术前血流TIMI分级、心力衰竭史和糖尿病史均是AMI患者术后无复流现象的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清sLOX-1水平单独预测AMI患者术后无复流现象的ROC曲线下面积(AUC)为0.817(95%CI:0.780~0.850),最佳截断值为301.7 ng/L;血清hs-CRP水平单独预测的AUC为0.840(95%CI:0.805~0.871),最佳截断值为14.93 mg/L;CHA2DS2-VASc评分单独预测的AUC为0.821(95%CI:0.785~0.854),最佳截断值为3分;三者联合预测的AUC为0.925(95%CI:0.898~0.946),显著大于血清sLOX-1单独预测的AUC(Z=4.408,P=0.000),hs-CRP单独预测的AUC(Z=3.742,P=0.000)�Objective To investigate the correlations between serum soluble lectin-like oxidized low-density lipoprotein receptor-1(sLOX-1),high-sensitivity C-reactive protein(hs-CRP)levels,CHA2 DS2-VASc score,and the occurrence of no-reflow phenomenon after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods A total of 500 AMI patients from July 2021 to March 2023 were selected.According to the postoperative thrombolysis in myocardial infarction(TIMI)grading,the 500 patients were divided into no-reflow group(n=92)and reflow group(n=408).Clinical data were collected,and serum sLOX-1 levels were measured using enzyme-linked immunosorbent assay(ELISA),while hs-CRP levels were measured using immunoturbidimetric assay.Clinical data,serum sLOX-1 and hs-CRP levels,and CHA2 DS2-VASc scores were compared between the two groups.Multifactor logistic regression analysis was used to analyze the influencing factors of no-reflow after PCI in AMI patients.Receiver operating characteristic(ROC)curve analysis performed to evaluate the predictive value of serum sLOX-1,hs-CRP levels,and CHA2 DS2-VASc score for no-reflow phenomenon after PCI in AMI patients.Results Univariate analysis indicated that the length of the lesion vessel,time from onset to vessel recanalization,TIMI grading at admission,history of diabetes,and history of heart failure were significantly correlated to no-reflow after PCI(P<0.05).Compared with the reflow group,the no-reflow group had significantly higher serum sLOX-1 levels,hs-CRP levels,and CHA2 DS2-VASc scores(P<0.05).Multivariate logistic regression analysis revealed that sLOX-1,hs-CRP,CHA2 DS2-VASc score,lesion vessel length,preoperative TIMI flow grading,history of heart failure,and history of diabetes were independent risk factors for no-reflow phenomenon after PCI in AMI patients(P<0.05).ROC curve analysis showed that the individual area under ROC curve(AUC)of serum sLOX-1,hs-CRP,and CHA2 DS2-VASc score in predicting no-reflow phenomenon after PCI in AMI patients were

关 键 词：急性心肌梗死 可溶性凝集素样氧化低密度脂蛋白受体-1 超敏-C反应蛋白 

分 类 号：R542.22[医药卫生—心血管疾病] R541[医药卫生—内科学]