ox-LDL联合心电图缺血分级对STEMI患者PCI术后发生MACE的预测价值  

Predictive value of ox-LDL combined with ECG ischaemia grading for MACE after PCI in STEMI patients

作　　者：孙亚召 李刚 张书研 孙培 李海林 张凌晓 刘斌 刘东升 SUN Ya-zhao;LI Gang;ZHANG Shu-yan;SUN Pei;LI Hai-lin;ZHANG Ling-xiao;LIU Bin;LIU Dong-sheng(Department of Cardiology,Cangzhou People's Hospital,Cangzhou,Hebei,061000,China)

机构地区：[1]沧州市人民医院心内科,河北沧州061000 [2]沧州市人民医院超声科,河北沧州061000 [3]沧州市人民医院检验科,河北沧州061000

出　　处：《心血管康复医学杂志》2025年第2期199-204,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：沧州市科技计划项目(23244102020)。

摘　　要：目的:通过回顾性队列研究设计评估血清氧化型低密度脂蛋白(ox-LDL)及心电图缺血分级对急性ST段抬高型心肌梗死(STEMI)患者经皮冠脉介入治疗(PCI)术后并发主要不良心血管事件(MACE)的预测价值。方法:选择2019年10月至2022年5月沧州市人民医院收治的336例STEMI患者,通过医院病历系统获取病历信息,所有患者均接受PCI及医师推荐的基础治疗。以随访12个月内发生MACE作为评价指标,将患者分为MACE组(n=65)和无MACE组(n=271)。采用多因素Logistic回归模型研究STEMI患者PCI术后MACE的影响因素,采用Spearman检验分析ox-LDL水平、心电图缺血分级与PCI术后MACE的相关性,采用ROC曲线评估ox-LDL、心电图缺血分级以及两者联合对PCI术后MACE的预测效能。结果:MACE总发生率为19.35%。与无MACE组比较,MACE组ox-LDL水平[46.34(29.46,66.29)U/L比33.00(23.02,50.03)U/L]、心电图III级缺血比例(64.62%比42.80%)显著升高(P均<0.01)。多因素Logistic回归分析显示,ox-LDL(OR=1.022,95%CI 1.011~1.033,P=0.001)和心电图III级缺血(OR=1.878,95%CI 1.007~3.504,P=0.048)是STEMI患者PCI术后MACE的独立危险因素。Spearman检验显示,ox-LDL、心电图III级缺血均与PCI术后MACE呈正相关(r=0.209、0.173,P均<0.001)。ROC曲线分析表明,ox-LDL、心电图III级缺血以及两者联合预测PCI术后MACE的AUC分别为0.653(95%CI 0.599~0.704)、0.609(95%CI 0.555~0.662)和0.758(95%CI 0.709~0.803),其中两者联合的预测价值显著高于任一单独检测(Z=2.030、3.097,P=0.042、0.002)。结论:ox-LDL联合心电图缺血分级对STEMI患者PCI术后12个月发生MACE具有较高的预测价值。Objective:The predictive value of oxidized low density lipoprotein(ox-LDL)and electrocardiogram(ECG)ischaemia grade for major adverse cardiovascular events(MACE)in patients with ST elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI)was assessed by a retrospective cohort study design.Methods:A total of 336 STEMI patients admitted to Cangzhou People's Hospital between October 2019 and May 2022 were selected,and the medical record information was obtained through the hospital medical record system,and all patients received PCI and physician-recommended basic treatment.With occurrence of MACE with in 12-month follow-up as the evaluation index,they were divided into MACE group(n=65)and no MACE group(n=271).Multifactorial Logistic regression model was used to study the influencing factors of MACE after PCI in STEMI patients,and Spearman test for association of ox-LDL level,ECG ischaemia grade with MACE after PCI.ROC curve was used to evaluate the predictive efficacy of ox-LDL,ECG ischaemia grade and their combination for MACE after PCI.Results:The overall MACE incidence was 19.35%.Compared with patients in no MACE group,those in MACE group had significant higher ox-LDL level[46.34(29.46,66.29)U/L vs.33.00(23.02,50.03)U/L]and proportion of ECG grade III ischaemia(64.62%vs.42.80%)(P<0.01 all).Multifactorial Logistic regression analysis showed that ox-LDL(OR=1.022,95%CI 1.011~1.033,P=0.001)and ECG grade III ischaemia(OR=1.878,95%CI 1.007~3.504,P=0.048)were the independent risk factors of post-PCI MACE in STEMI patients.Spearman test showed that ox-LDL and ECG grade III ischaemia were positively correlated with post-PCI MACE(r=0.209,0.173,P<0.001 all).ROC curve analysis showed that the AUCs of ox-LDL,ECG grade III ischaemia and their combination in predicting post-PCI MACE were respectively 0.653(95%CI 0.599~0.704),0.609(95%CI 0.555~0.662)and 0.758(95%CI 0.709~0.803),in which the predictive value of the combination of the two was significantly higher than any single detection(Z=2.030,3.097,P

关 键 词：心肌梗死 脂蛋白类 LDL 心电描记术 

分 类 号：R542.22[医药卫生—心血管疾病]