急性心肌梗死患者PCI术后近期预后不良的高危因素及Hcy、CysC、AngⅡ、ALD、BNP的预测价值  

High-risk factors for short-term poor prognosis in patients with acute myocardial infarction after percutaneous coronary intervention and the predictive values of Hcy,CysC,AngⅡ,ALD,and BNP in them

作　　者：何春松 吴方婷 何小伍 HE Chunsong;WU Fangting;HE Xiaowu(Department of Laboratory,AnQing 116 Hospital,China RongTong Medical Healthcare Group Co.Ltd.,Anhui,Anqing 246003,China;不详)

机构地区：[1]中国融通医疗健康集团有限公司安庆一一六医院检验科,安徽省安庆市246003 [2]中国融通医疗健康集团有限公司安庆一一六医院心血管内科,安徽省安庆市246003

出　　处：《河北医药》2024年第12期1791-1795,共5页Hebei Medical Journal

基　　金：中国健康促进基金会(编号:XM_2019_011_0112_01)。

摘　　要：目的探讨急性心肌梗死(AMI)患者皮冠状动脉介入治疗(PCI)术后近期预后不良的高危因素及血清同型半胱氨酸(Hcy)、胱抑素(CysC)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、脑钠肽(BNP)对其预测价值。方法回顾性分析2020年6月至2023年1月收治的214例AMI患者临床资料,患者出院后随访6个月,根据随访后患者预后情况分为预后良好组(n=170)和预后不良组(n=44例)。比较2组临床资料,采用单因素及多因素分析法分析AMI患者PCI术后近期预后不良的高危因素;分别采用酶循环法、乳胶免疫比浊法、化学发光法、直接化学发光法检测血清Hcy、CysC、AngⅡ、ALD、BNP表达水平;采用受试者工作特征曲线(ROC)分析Hcy、CysC、AngⅡ、ALD、BNP单独及联合检测对AMI患者PCI术后近期预后不良的诊断价值。结果AMI患者PCI术后近期预后不良44例,发生率为20.56%(44/214)。多因素Logistic回归分析结果显示,心功能分级≥Ⅱ级、术前心搏骤停、病变血管有3支、血浆胆红素水平高均是AMI患者PCI术后近期预后不良的高危因素(OR=2.113,2.008,2.273,2.143,P<0.05)。预后不良组血清Hcy、CysC、AngⅡ、ALD、BNP水平均显著高于预后良好组(P<0.05)。绘制ROC曲线获得Hcy、CysC、AngⅡ、ALD、BNP单独及联合检测诊断AMI患者PCI术后近期预后不良的曲线下面积(AUC)分别为0.777、0.765、0.656、0.721、0.756、0.943;其中,联合诊断的AUC高于各项单独检测,Hcy高于AngⅡ,且联合检测的敏感度和特异度为93.20%,80.00%。结论AMI患者PCI术后近期预后不良发生率较高,AMI患者PCI术后近期预后不良的Hcy、CysC、AngⅡ、ALD、BNP呈高表达,联合检测Hcy、CysC、AngⅡ、ALD、BNP有助于诊断AMI患者PCI术后近期预后不良,且AMI患者PCI术后近期预后不良的发生与心功能分级、术前心搏骤停、病变血管有3支、血浆胆红素水平密切相关。Objective To investigate the high-risk factors for short-term poor prognosis of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI)and the predictive values of serum homocysteine(Hcy),cystatin(CysC),angiotensinⅡ(AngⅡ),aldosterone(ALD)and brain natriuretic peptide(BNP)in them.Methods The clinical data of 214 AMI patients admitted to our hospital from June 2020 to January 2023 were retrospectively analyzed.They were followed up for 6 months after discharge.According to the follow-up data,patients were assigned into the good prognosis group(n=170)and the poor prognosis group(n=44).The clinical data of the two groups were compared,and univariate and multivariate analysis were used to analyze the risk factors for the short-term poor prognosis in AMI patients after PCI.Serum Hcy,CysC,AngⅡ,ALD and BNP were detected by enzyme cycling,latex immunoturbidimetry,chemiluminescence and direct chemiluminescence,respectively.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of Hcy,CysC,AngII,ALD,and BNP alone and their combination detection in the short-term poor prognosis of AMI patients after PCI.Results There were 44(20.56%)AMI patients with poor prognosis after PCI.Multivariate Logistic regression analysis showed that cardiac function≥gradeⅡ,preoperative cardiac arrest,3 diseased blood vessels,and high levels of plasma bilirubin were the risk factors for poor prognosis after PCI in AMI patients(OR=2.113,2.008,2.273 and 2.143,respectively;P<0.05).Serum Hcy,CysC,AngⅡ,ALD and BNP in the poor prognosis group were significantly higher than those of the good prognosis group(P<0.05).The area under the curve(AUC)of Hcy,CysC,AngⅡ,ALD,and BNP and their combination detection for predicting poor prognosis in AMI patients after PCI was 0.777,0.765,0.656,0.721,0.756,and 0.943,respectively.The AUC of the combination detection was significantly higher than that of the single detection,and that of Hcy was significantly higher than AngⅡ.The sensitiv

关 键 词：心肌梗死 皮冠状动脉介入治疗 同型半胱氨酸 胱抑素 血管紧张素Ⅱ 醛固酮 脑钠肽 高危因素 诊断价值 

分 类 号：R542.22[医药卫生—心血管疾病]