直接经皮冠状动脉介入治疗急性心肌梗死患者血清血管生成素-1和血管生成素-2与心电图ST段回落的相关性

Association of serum angiopoietin-1 and angiopoietin-2 with ST-segment resolution in acute myocardial infarction patients treated with primary percutaneous coronary intervention

目的探讨直接经皮冠状动脉介入治疗(PCI)ST段抬高急性心肌梗死(STEMI)患者的血清血管生成素-1(Ang-1)和血管生成素-2(Ang-2)与心肌再灌注的相关性。方法连续入选103例诊断为STEMI并接受直接PCI的患者,根据术后2 h心电图ST段回落(STR)分为STR≥50%组(69例)和STR<50%组(34例)。比较两组PCI术前和术后即刻、2 h、6 h、24 h的血清Ang-1、Ang-2及Ang-2和Ang-1的比值(Ang-2/Ang-1)。用多因素Logistic回归分析心电图STR不佳的危险因素。结果 STR≥50%组术前至术后6 h Ang-1显著高于STR<50%组(P<0.05),而Ang-2/Ang-1显著低于STR<50%组(P<0.01);术后24 h Ang-1和Ang-2/Ang-1及各时间点Ang-2两组间差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,术前Ang-2/Ang-1升高、发病至置入球囊时间延长、梗死相关动脉为左前降支(LAD)和术后TIMI血流<Ⅲ级是STEMI患者心电图STR不佳的独立危险因素。结论直接PCI术前Ang-2/Ang-1升高可作为STEMI患者PCI后心肌再灌注不佳的预测指标之一。

Objective To investigate the association of serum angiopoietin-1 （Ang-1） and angiopoietin-2 （Ang-2） with myocardial reperfusion in ST-segment elevation myocardial infarction （STEMI） patients treated with primary percutaneous coronary intervention （PCI）. Methods A total of 103 consecutive STEMI patients who received primary PCI were enrolled in this study. The patients were divided into two groups according to ST-segment resolution （STR） at 2 h after PCI：STR ≥ 50%group （n=69） and STR＆lt;50%group （n=34）. Serum concentrations of Ang-1, Ang-2 and Ang-2 to Ang-1 ratios （Ang-2/Ang-1） before and immediately after PCI, 2 h, 6 h, 24 h after PCI were compared. Predictors of poor STR were identiifed by multivariable logistic regression analysis. Results The patients with STR≥50%had significant higher serum Ang-1 levels （P ＆lt; 0.05） and lower Ang-2/Ang-1 ratios （P ＆lt; 0.01） from before PCI to 6 h after PCI than those with STR ＆lt; 50%;Ang-1 and Ang-2/Ang-1 at 24 h after PCI, and Ang-2 at all time points were not signiifcantly different between the two groups （P＆gt;0.05）. In multivariable＆amp;nbsp;logistic regression analysis, Ang-2/Ang-1 before PCI was independently associated with STR ＆lt; 50%;Other independent predictors were pain to balloon time, infarct related artery （LAD）, and TIMI flow grade＆lt;Ⅲafter PCI. Conclusions Higher Ang-2/Ang-1 is an independent predictor of poor myocardial reperfusion in STEMI patients after PCI.