急性ST段抬高型心肌梗死患者再灌注早期缺血修饰白蛋白的变化对预后的影响

Prognostic significance of the early changes of ischemia-modified albumin after mechanical reperfusion in patients with acute ST-segment elevation myocardial infarction

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者心肌缺血再灌注早期血清缺血修饰白蛋白（IMA）的变化对预后的影响.方法 对160例急性STEMI并行急诊经皮冠状动脉介入治疗（pPCI）的患者抽静脉血检测术前及术后30 min血清IMA浓度,计算IMA的变化（△IMA）,常规记录患者一般信息、手术情况、心脏危险指标及住院治疗情况,追踪住院期间及1年内主要心血管不良事件（MACE）.结果 34例患者发生MACE.以△IMA=21.175 U/ml为临界点,对预测STEMI患者行pPCI再灌注治疗后1年内发生MACE的灵敏度为76.5％,特异度为73.8％,受试者工作特征曲线下面积为0.813（95％ CI 0.735～0.891,P＜0.001）.多因素Cox回归分析显示,△IMA（P=0.024）、心功能衰竭（P=0.006）、BNP（P=0.012）、年龄（P=0.017）、病变血管数目（P=0.039）是独立预测1年内MACE的主要因素.结论 对于STEMI并行pPCI的患者,再灌注早期血清IMA变化是其1年内主要心血管不良事件的独立预测因素,具有良好的预后评估价值.

Objective To investigate the early changes of ischemia modified alhumin（IMA） after the me- chanical reperfusion in patients with acute ST-segment elevation myocardial infaretion（STEMI）, thus to investigate prognostic significance of IMA. Methods 160 patients with acute STEMI receiving pPCI were included. Serum I- MA at admission （IMA1） and 30 minutes （IMA2） were measured for calculation of the IMA change（AIMA）. Patients＇ characteristics, operation, cardiovascular risk factors and treatments were recorded. Major adverse cardio- vascular events （MACE） within one year were recorded, Results There are 34 patients occurred MACE. Setting the cutoff value of △IMA of 19.505 U/ml, the sensitivity and specificity for the adverse cardiovascular events in STEMI patients treated with pPCI within one month were 76.5% and 73.8%, respectively, with the area under the receiver operator characteristic curve was 0.813（95% CI 0.735-0.891 ,P〈0.001 ）. Multivariate Cox stcpwise regression identified the same 5 independent predictors of the one year＇s composite end point, i.e., AIMA （P=0.024）,heart failure（P=-0.006）, BNP（P=-0.012）, age（P=-0.017）, the number of lesion vessel（P=0.039）. Conclusion The early changes of IMA in STEMI patients treated with pPCI is an independent predictors for MACE within one year, having a good prognosis assessment value to those patients.