脂蛋白相关磷脂酶A2、一氧化氮与内皮素-1比值对急性冠状动脉综合征患者经皮冠状动脉介入术后冠状动脉无复流的预测价值  

Predictive value of lipoprotein-associated phospholipase A2 and the ratio of nitric oxide to endothelin-1 for coronary no-reflow in patients with acute coronary syndrome after percutaneous coronary intervention

作　　者：郑朝霞 牛福英 李晴 罗静慧 李莉 Zheng Zhaoxia;Niu Fuying;Li Qing;Luo Jinghui;Li Li(Department of Cardiovascular Medicine,Fourth People's Hospital of Langfang City,Langfang 065700,China;Ultrasound Department,Fourth People's Hospital of Langfang City,Langfang 065700,China;Neurology Department,Fourth People's Hospital of Langfang City,Langfang 065700,China)

机构地区：[1]河北省廊坊市第四人民医院心血管内科,065700 [2]河北省廊坊市第四人民医院超声科,065700 [3]河北省廊坊市第四人民医院神经内科,065700

出　　处：《心脑血管病防治》2024年第9期21-25,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨脂蛋白相关磷脂酶A2(Lp-PLA2)、一氧化氮与内皮素-1比值(NO/ET-1)对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后冠状动脉无复流(CNR)的预测价值。方法选取2019年1月至2022年10月廊坊市第四人民医院行急诊PCI的ACS患者289例,根据PCI术后心肌梗死溶栓(TIMI)分级分为无复流组(TIMI分级≤2级)50例和正常血流组(TIMI分级3级)239例。收集患者临床资料,采用多因素Logistic回归分析ACS患者PCI术后CNR的影响因素,采用ROC曲线分析Lp-PLA2、NO/ET-1对ACS患者PCI术后CNR的预测价值。结果两组患者年龄、糖尿病史、吸烟史、舒张压、心功能Killip分级2~3级、术前TIMI分级、肌酸激酶同工酶峰值、心肌肌钙蛋白I峰值、氨基末端脑钠肽前体、D-二聚体、血糖、Lp-PLA2、NO、ET-1、NO/ET-1、发病至再灌注时间,差异有统计学意义(χ2/t=4.168、9.790、7.062、3.337、16.780、6.571、5.904、8.123、9.230、6.409、5.364、9.728、4.135、5.609、6.220、6.504,P<0.05)。年龄、吸烟史、血糖、发病至再灌注时间、Lp-PLA2为ACS患者PCI术后CNR的危险因素(P<0.05),NO/ET-1为ACS患者PCI术后CNR的保护因素(P<0.05)。Lp-PLA2、NO/ET-1预测ACS患者PCI术后发生CNR的曲线下面积分别为0.803、0.782,两者联合预测的曲线下面积为0.896,高于单独预测的曲线下面积(Z=4.193、4.815,P<0.05)。结论Lp-PLA2、NO/ET-1对ACS患者PCI术后发生CNR有预测价值,两者联合预测价值更佳。Objective To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2)and the ratio of nitric oxide to endothelin-1(NO/ET-1)for coronary no-reflow(CNR)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 289 ACS patients who underwent emergency PCI at the Fourth People's Hospital of Langfang City from January 2019 to October 2022 were selected.According to the thrombolysis in myocardial infarction(TIMI)flow grades after PCI,the patients were divided into the no-reflow group(TIMI≤2,50 cases)and the normal flow group(TIMI 3,239 cases).Clinical data were collected.Multivariate Logistic regression was used to analyze the factors influencing CNR in ACS patients after PCI.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of Lp-PLA2 and NO/ET-1 for CNR.Results There were statistically significant differences in age,history of diabetes,history of smoking,diastolic blood pressure(DBP),heart function grade of Killip 2-3 grade,preoperative TIMI grade,peak creatine kinase isoenzyme,peak cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-proBNP),D-Dimer,blood glucose,Lp-PLA2,NO,ET-1,NO/ET-1,and time from onset to reperfusion between the two groups(χ2/t=4.168,9.790,7.062,3.337,16.780,6.571,5.904,8.123,9.230,6.409,5.364,9.728,4.135,5.609,6.220,6.504;P<0.05).Age,smoking history,blood glucose,time from onset to reperfusion,and Lp-PLA2 were risk factors for CNR in ACS patients after PCI(P<0.05),while NO/ET-1 was a protective factor(P<0.05).The areas under the ROC curve(AUC)for predicting CNR after PCI using Lp-PLA2 and NO/ET-1 were 0.803 and 0.782,respectively.The combined predictive AUC was 0.896,which was significantly higher than the individual AUCs(Z=4.193,4.815;P<0.05).Conclusion Lp-PLA2 and NO/ET-1 have predictive value for CNR after PCI in ACS patients,and their combined predictive value is better.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入 冠状动脉无复流 脂蛋白相关磷脂酶A2 一氧化氮与内皮素-1比值 

分 类 号：R541.4[医药卫生—心血管疾病]