血清ACSL4、SII水平对急性ST段抬高型心肌梗死合并HFpEF患者PCI术中无复流的预测价值  

Predictive value of serum ACSL4 and SII levels for no-reflow phenomenon during PCI in patients with acute ST-segment elevation myocardial infarction complicated by HFpEF

作　　者：张庆龙[1] 何婷 杨琦 王锦波 何雪松 潘孝东 Zhang Qinglong;He Ting;Yang Qi;Wang Jinbo;He Xuesong;Pan Xiaodong(Department of Emergency Medicine,The Second Affiliated Hospital of Anhui Medical University,Anhui,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院急诊内科,合肥230601

出　　处：《疑难病杂志》2025年第4期428-433,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：安徽省医疗卫生重点专科建设项目(皖卫科教发[2021]273号)。

摘　　要：目的探讨血清酰基辅酶A合成酶长链家族成员4(ACSL4)、系统免疫炎性指数(SII)水平对急性ST段抬高型心肌梗死(ASTEMI)合并射血分数保留的心力衰竭(HFpEF)患者经皮冠状动脉介入(PCI)术中无复流的预测价值。方法选取2019年10月—2024年6月于安徽医科大学第二附属医院接受PCI术的ASTEMI合并HFpEF患者135例(观察组)和同期医院健康体检志愿者70例(健康对照组),根据PCI术中血流情况将ASTEMI合并HFpEF患者分为无复流亚组(33例)和复流亚组(102例)。比较各组血清ACSL4、SII水平;多因素非条件Logistic回归确定ASTEMI合并HFpEF患者PCI术中无复流的危险因素;绘制受试者工作特征(ROC)曲线分析血清ACSL4、SII水平对ASTEMI合并HFpEF患者PCI术中无复流的预测价值。结果与健康对照组比较,观察组血清ACSL4、SII水平升高(t/P=21.858/<0.001、13.649/<0.001);135例ASTEMI合并HFpEF患者PCI术中无复流率为24.44%(33/135)。与复流亚组比较,无复流亚组血清ACSL4、SII水平升高(t/P=5.877/<0.001、5.324/<0.001),无复流亚组年龄更大,KILLIP分级Ⅳ级比例、NT-proBNP和低密度脂蛋白胆固醇(LDL-C)水平升高(χ^(2)/t/P=3.610/<0.001、2.993/0.003、3.782/0.005、2.109/0.037);Logistic回归分析结果显示,年龄大、ACSL4高、SII高为ASTEMI合并HFpEF患者PCI术中无复流的独立危险因素[OR(95%CI)=1.123(1.022~1.235)、1.207(1.082~1.346)、1.003(1.002~1.005)];ROC曲线分析结果显示,血清ACSL4、SII水平及二者联合预测ASTEMI合并HFpEF患者PCI术中无复流的曲线下面积(AUC)分别为0.786、0.797、0.879,二者联合优于各自单独预测价值(Z/P=2.474/0.010、2.726/0.004)。结论血清ACSL4、SII水平升高与ASTEMI合并HFpEF患者PCI术中无复流密切相关,血清ACSL4、SII水平联合检测对其预测价值较高。Objective To investigate the predictive value of serum acyl-CoA synthetase long-chain family member 4(ACSL4)and systemic immune-inflammation index(SII)levels for no-reflow phenomenon during percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(ASTEMI)complicated by heart failure with preserved ejection fraction(HFpEF).Methods This study included 135 ASTEMI patients with HFpEF(observation group)who underwent PCI at The Second Affiliated Hospital of Anhui Medical University from October 2019 to June 2024,and 70 healthy volunteers(control group).The ASTEMI patients were further divided into no-reflow subgroup(n=33)and reflow subgroup(n=102)based on coronary flow during PCI.Serum ACSL4 and SII levels were compared among groups.Multivariate unconditional Logistic regression was used to identify risk factors for no-reflow.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of serum ACSL4 and SII levels for no-reflow.Results Compared with controls,the observation group showed higher serum ACSL4 and SII levels(t/P=21.858/<0.001,13.649/<0.001).The no-reflow rate during PCI was 24.44%(33/135).The no-reflow subgroup had higher ACSL4 and SII levels than the reflow subgroup(t/P=5.877/<0.001,5.324/<0.001).Patients in no-reflow subgroup were older,with higher proportions of KILLIP class IV,NT-proBNP and LDL-C levels(χ^(2)/t/P=3.610/<0.001,2.993/0.003,3.782/0.005,2.109/0.037).Advanced age,high ACSL4,and high SII were independent risk factors for no-reflow[OR(95%CI)=1.123(1.022-1.243),1.207(1.082-1.346),1.003(1.002-1.005)].The AUC values for predicting no-reflow using ACSL4,SII,and their combination were 0.786,0.797,and 0.879 respectively,with combined detection showing superior predictive value(Z/P=2.474/0.010,2.726/0.004).Conclusion Elevated serum ACSL4 and SII levels are closely associated with no-reflow during PCI in ASTEMI patients with HFpEF.Combined detection of these biomarkers shows high predictive value.

关 键 词：急性ST段抬高型心肌梗死 射血分数保留的心力衰竭 酰基辅酶A合成酶长链家族成员4 系统免疫炎性指数 经皮冠状动脉介入术 无复流 预测价值 

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