血清指标联合超声心动图检查对老年急性心肌梗死后心力衰竭的预测价值  

Predictive value of serum indicators combined with echocardiography for heart failure in elderly patients after acute myocardial infarction

作　　者：严晓燕 曾卓华 李凯 谢杨 吴静 石波 Yan Xiaoyan;Zeng Zhuohua;Li Kai;Xie Yang;Wu Jing;Shi Bo(Department of Ultrasonography,Second Affiliated Hospital of Chengdu Medical College·Nuclear Industry 416 Hospital,Chengdu 610051,Sichuan Province,China)

机构地区：[1]成都医学院第二附属医院核工业四一六医院超声医学科,610051

出　　处：《中华老年心脑血管病杂志》2024年第11期1272-1276,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：四川省卫生和计划生育委员会科研课题(17PJ437)。

摘　　要：目的 分析血清孤独G蛋白偶联受体配体12(Apelin-12)联合超声心动图室壁运动积分(wall motion score, WMS)、左心室整体纵向应变(left ventricular global longitudinal strain, LV-GLS)对老年急性心肌梗死(acute myocardial infarction, AMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后心力衰竭(heart failure, HF)的预测价值。方法 回顾性收集2021年1月至2023年12月核工业四一六医院收治的老年AMI患者98例,根据PCI术后随访3个月HF发生情况分为HF组39例及非HF组59例。入院12 h内完成PCI,并在出院时完成血液标本采集与超声心动图检查,使用ROC曲线评估Apelin-12、WMS及LV-GLS对老年AMI患者发生HF的预测价值,使用Kappa一致性检验评估3项指标联合检测对老年AMI患者HF预测的准确性。结果 HF组血清Apelin-12水平明显低于非HF组,WMS及LV-GLS明显高于非HF组,差异有统计学意义(P<0.01)。ROC曲线分析显示,Apelin-12、WMS、LV-GLS预测老年AMI患者PCI术后HF的曲线下面积分别为0.931、0.745、0.749,截断值分别为1.55μg/L、20.50分、-12.90%。多因素logistic回归分析显示,血清Apelin-12<1.55μg/L、WMS>20.50分、LV-GLS>-12.90%为老年AMI患者PCI术后HF的独立危险因素(OR=3.508,95%CI:2.002~6.147;OR=2.818,95%CI:1.479~5.371;OR=2.841,95%CI:1.505~5.363)。上述3项联合检查应用串联,即Apelin-12+WMS+LV-GLS为血清Apelin-12<1.55μg/L且WMS>20.50分且LV-GLS>-12.90%时预测HF阳性,特异性提升至94.92%,Kappa值为0.714(P<0.01)。结论 老年AMI患者PCI术后检测Apelin-12及WMS、LV-GLS对预测HF发生有利,可为临床诊疗开辟新方向。Objective To analyze the predictive value of serum solitary G protein-coupled receptor ligand-12(Apelin-12)combined with echocardiographic parameters,wall motion score(WMS)and left ventricular global longitudinal strain(LV-GLS)for heart failure(HF)in elderly patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).MethodsA total of 98 elderly AMI patients undergoing PCI in our hospital from January 2021 to December 2023 were enrolled,and according to the occurrence of HF or not at 3 months after PCI,they were divided into HF group(39 cases)and non-HF group(59 cases).PCI procedure was completed within 12 h after admission,and the blood samples were collected and echocardiography was performed at discharge.ROC curve was plotted to evaluate the predictive value of Apelin-12,WMS and LV-GLS for HF in elderly AMI patients.Kappa consistency test was conducted to assess the accuracy of combined the three indicators in predicting HF in the patients.Results The HF group had significantly lower serum Apelin-12 level,and higher WMS and LV-GLS than the non-HF group(P<0.01).ROC curve analysis showed that the AUC value of Apelin-12,WMS and LV-GLS in predicting HF after PCI in elderly AMI patients was 0.931,0.745 and 0.749,respectively,and their cut-off values was 1.55μg/L,20.50 and-12.90%,respectively.Multivariate logistic regression analysis revealed that serum Apelin-12<1.55μg/L,WMS>20.50 points,and LV-GLS>-12.90%were independent risk factors for postoperative HF in elderly AMI patients(OR=3.508,95%CI:2.002-6.147);(OR=2.818,95%CI:1.479-5.371;OR=2.841,95%CI:1.505-5.363).When the three indicators combined in tandem,that is,when serum Apelin-12<1.55μg/L,WMS>20.50 and LV-GLS>-12.90%,HF was predicted to be positive,with a specificity increasing to 94.92%and a Kappa value of 0.714(P<0.01).Conclusion Detection of serum Apelin-12,WMS and LV-GLS is beneficial for elderly AMI patients after PCI in predicting the occurrence of HF,and can open up a new direction for clinical diagnosis and treatment.

关 键 词：心肌梗死 心力衰竭 超声心动描记术 预测 孤独G蛋白偶联受体配体12 

分 类 号：R541.6[医药卫生—心血管疾病] R542.22[医药卫生—内科学]