组蛋白去乙酰化酶3用于急性心肌梗死经皮冠状动脉介入治疗后慢血流或无复流风险评估  

Evaluation of histone deacetylase 3 as a risk marker for slow/no reflow in acute myocardial infarction after PCI

作　　者：穆怀彬 林琳 李静 李燕 王海荣 卢峰 Mu Huaibin;Lin Lin;Li Jing;Li Yan;Wang Hairong;Lu Feng(Fourth Department of Cardiology,Tangshan Workers'Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]唐山市工人医院心内四科,063000

出　　处：《中华老年心脑血管病杂志》2024年第1期21-24,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河北省医学科学研究重点课题计划(20181254)。

摘　　要：目的探讨术前组蛋白去乙酰化酶3(HDAC3)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后慢血流/无复流风险的评估价值。方法选取2020年6月至2022年6月在唐山市工人医院接受PCI的AMI患者280例,根据PCI术后心肌灌注分级(TIMI)血流分级分为慢血流/无复流组(TIMI≤Ⅱ级)54例和正常血流组(TIMI>Ⅱ级)226例。比较2组人口学特征、基础疾病、入院时基线资料、术前冠状动脉造影结果及术前实验室指标。采用多因素logistic回归分析确定AMI患者PCI术后慢血流/无复流的影响因素,绘制ROC曲线分析相关指标对慢血流/无复流的预测价值。结果慢血流/无复流组吸烟史、Killip分级Ⅱ级比例、心率、再灌注时间、血清低密度脂蛋白胆固醇、中性粒细胞计数/淋巴细胞比值(NLR)、D-二聚体及HDAC3水平高于正常血流组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,再灌注时间、NLR、HDAC3是AMI患者PCI术后慢血流/无复流的影响因素(P<0.05,P<0.01)。再灌注时间+NLR预测AMI患者PCI术后慢血流/无复流的ROC曲线下面积为0.798(95%CI:0.664~0.922,P=0.002),敏感性与特异性分别为0.87、0.73;再灌注时间+NLR联合血清HDAC3预测AMI患者PCI后慢血流/无复流的ROC曲线下面积为0.903(95%CI:0.790~0.922,P<0.01),敏感性与特异性分别为0.93、0.84。结论术前HDAC3水平是AMI患者PCI术后慢血流/无复流的影响因素,在再灌注时间和NLR的基础上检测术前血清HDAC3可为慢血流/无复流的评估提供额外的预测价值。Objective To investigate the value of histone deacetylase 3(HDAC3)in evaluating the risk of slow/no reflow in AMI patients after PCI.Methods A total of 280 AMI patients undergoing PCI in our hospital from June 2020 to June 2022 were recruited,and according to TIMI blood flow grading,they were divided into slow/no reflow group(TIMI≤gradeⅡ,n=54)and normal flow group(TIMI>gradeⅡ,n=226).The demographic characteristics,underlying diseases,baseline data at admission,and preoperative results of coronary angiography and laboratory tests were compared between the two groups.Multivariate logistic regression analysis was used to determine the influencing factors for slow/no reflow in AMI patients after PCI,and ROC curve was drawn to analyze the predictive value of related indicators for slow/no reflow.Results Obviously larger proportions of smoking history and Killip gradeⅡ,higher heart rate,longer reperfusion time,and higher serum levels of LDL-C,NLR,D-D and HDAC3 were observed in the slow/no reflow group than the normal flow group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that reperfusion time,NLR and HDAC3 were influencing factors for slow/no reflow in AMI patients after PCI(P<0.05,P<0.01).The AUC value of reperfusion time+NLR in predicting the slow/no reflow after PCI in AMI patients was 0.798(95%CI:0.664-0.922,P=0.002),with a sensitivity and specificity of 0.87 and 0.73,respectively.And when serum HDAC3 level was combined in the prediction,the AUC value was 0.903(95%CI:0.790-0.922,P<0.01),with a sensitivity and specificity of 0.93 and 0.84,respectively.Conclusion Preoperative HDAC3 level is an influencing factor for slow/no reflow in AMI patients after PCI.Based on reperfusion time and NLR,combination of the 3 indicators can provide additional predictive value for slow/no reflow in these patients.

关 键 词：心肌梗死 经皮冠状动脉介入治疗 组蛋白脱乙酰基酶类 血流速度 影响因素分析 慢血流 

分 类 号：R542.22[医药卫生—心血管疾病]