心肌挽救指数对ST段抬高型心肌梗死患者再灌注预后的预测价值  

Predictive value of myocardial salvage index for reperfusion prognosis in patients with ST-segment elevation myocardial infarction

作　　者：徐源 仲威[2] 叶斐 夏源 凡六章 许康世 蒋明 张晓晖 XU Yuan;ZHONG Wei;YE Fei;XIA Yuan;FAN Liuzhang;XU Kangshi;JIANG Ming;ZHANG Xiaohui(Department of Cardiology,Yancheng First Hospital of Nanjing University Medicine School(Yancheng First People's Hospital),Yancheng Jiangsu 224006,China)

机构地区：[1]南京大学医学院附属盐城第一医院(盐城市第一人民医院)心内科,江苏盐城224006 [2]江苏大学附属医院心内科,江苏镇江212001 [3]江苏大学附属昆山医院(昆山市第一人民医院)心内科,江苏昆山215300

出　　处：《中国急救复苏与灾害医学杂志》2024年第5期561-564,582,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省高等学校自然科学研究面上项目(编号:20KJB320013);昆山市重点研发计划(社会发展)项目(编号:KSF202134)。

摘　　要：目的研究心肌挽救指数(MSI)对ST段抬高型心肌梗死(STEMI)患者再灌注预后的预测价值。方法回顾性分析2021年7月-2022年6月期间在盐城市第一人民医院接受再灌注治疗的102例首次STEMI患者的临床资料,通过心血管磁共振技术测量STEMI患者的MSI,根据MSI中位值将STEMI患者分为低MSI组和高MSI组,各51例。比较两组间主要不良心血管事件(MACE)临床资料、实验室指标、MACE发生率以及心功能和心室重构指标[左室射血分数(LVEF)、左心室舒张末内径(LVEDd)、左心室收缩末内径(LVESD)]。采用受试者工作特征(ROC)曲线分析术后3~7 d时MSI预测STEMI患者再灌注治疗后MACE发生的效能。结果低MSI组患者血清肌钙蛋白I(cTnI)、氨基末端-脑钠肽前体(NT-proBNP)、总胆固醇(TC)、低密度脂蛋白(LDL)显著高于高值组患者,差异有统计学意义(P<0.05)。低MSI组患者LVEF显著低于高MSI组,LVFS、LVEDd和LVESD显著高于高MSI组患者(P<0.05)。102例STEMI患者PCI术后随访1年内有27例出现MACE,MSI低值组和高值组患者各发生25例(49.02%)和2例(3.92%)MACE,低值组患者MACE发生率显著高于高值组(P<0.05)。ROC曲线分析显示术后3~7 d时MSI预测STEMI患者发生不良预后的AUC分别为0.874(95%CI:0.805~0.943),最佳诊断cut-off值为61.65,此时的灵敏度、特异度、约登指数、阳性预测和阴性预测值分别为85.18%、85.33%、70.52%、67.65%和94.12%。结论术后3~7 d MSI能够有效评估行PCI治疗的STEMI患者的预后。Objective To investigate the predictive value of myocardial salvage index(MSI)in reperfusion prognosis of patients with ST-segment elevation myocardial infarction(STEMI).Methods Clinical data of 102 patients with first time STEMI who received reperfusion therapy in Yancheng First People's Hospital from July 2021 to June 2022 were retrospectively analyzed.The MSI of STEMI patients and control group were measured by cardiovascular magnetic resonance technology,and STEMI patients were divided into low MSI group and high MSI group according to the median value of MSI,51 cases each group.major adverse cardiac events were compared between the two groups.MACE clinical data and laboratory index,the incidence of MACE and cardiac function and ventricular remodeling index[left ventricular ejection fraction left ventricular ejection fraction,LVEF,left ventricular end diastolic diameter(LVEDd),left ventricular end systolic diameter(LVESD)].Receiver operating characteristic(ROC)curve was used to analyze the efficacy of MSI in predicting the occurrence of MACE after reperfusion in STEMI patients at 3 to 7 days after surgery.Results Serum cTnI,BNP,TC and LDL in low MSI group were significantly higher than high MSI group,and the difference was statistically significant(P<0.05).LVEF in low MSI group was significantly lower than high MSI group,LVFS,LVEDd and LVESD were significantly higher than high MSI group(P<0.05).Among 102 STEMI patients,27 cases developed MACE within 1 year of follow-up after PCI,25 cases(49.02%)and 2 cases(3.92%)of MSI patients in the low value group and the high value group respectively,and the incidence of MACE in the low value group was significantly higher than high value group(P<0.05).ROC curve analysis showed that the AUC of MSI in predicting adverse prognosis of STEMI patients at 3 to 7 days after surgery was 0.874(95%CI:0.805-0.943),the optimal Cut-off value of diagnosis was 61.65,and the sensitivity,specificity,Yoden index,positive prediction and negative prediction values were 85.18%,85.33%,70.52%,6

关 键 词：ST段抬高型心肌梗死 心血管磁共振 心肌挽救指数 主要心血管不良事件 预后 

分 类 号：R542.22[医药卫生—心血管疾病]