外周血Apelin水平对急性ST段抬高型心肌梗死病情及预后评估价值

Value of Apelin levels in peripheral blood to the assessment of the condition and prognosis of acute ST-segment elevation myocardial infarction

目的探讨外周血Apelin水平对急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者病情及预后评估价值。方法 90例STEMI患者,45例直接行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)者为直接PCI组,45例择期接受PCI治疗者为择期PCI组;选择同期45例稳定型心绞痛患者为对照组。检测STEMI患者入院时、PCI术后、出院及随访1a时外周血Apelin水平,并与对照组进行比较;分析Apelin水平与STEMI患者左室射血分数(left ventricular ejection fraction,LVEF)水平和终点事件的关系。结果直接PCI组及择期PCI组患者入院时Apelin水平[(423.6±11.0)、(425.8±10.9)pmol/L)]均低于对照组[(521.5±10.8)pmol/L](P<0.05);术后、出院及随访1a时,直接PCI组Apelin水平[(481.2±10.9)、(480.5±10.5)、(468.9±11.6)pmol/L]较入院时增高(P<0.05),但仍低于对照组(P<0.05);择期PCI组术后、出院时、随访1a时[(431.9±11.2)、(432.5±10.8)、(431.5±11.0)pmol/L]与入院时比较差异无统计学意义(P>0.05);低水平LVEF患者外周血Apelin水平[(400.6±10.1)pmol/L]低于正常水平LVEF患者[(459.8±11.2)pmol/L],差异有统计学意义(P<0.05);随访1a,择期PCI组心血管不良事件发生率(17.8%)高于直接PCI组(13.3%)和对照组(4.4%)(P<0.05)。结论外周血Apelin水平与急性STEMI患者病情及预后有关。

Objective To explore the value of Apelin in peripheral blood to the assessment of the condition and prognosis of acute ST-segment elevation myocardial infarction （STEMI）. Methods Ninety patients with STEMI were divided into direct percutaneous coronary intervention （PCI） group receiving direct PCI and elective PCI group receiving elective PCI, with 45 patients in each group. Another 45 patients with stable angina were as controls （control group）. The Apelin levels were detected at admission, after PCI, at discharge and after 1-year follow-up in direct and elective PCI groups, and were compared with control group. The relationship of Apelin level with left ventricular ejection fraction （LVEF） and end point events was analyzed. Results The level of Apelin was significantly lower in direct PCI group （（423. 6 ± 11.0） pmol/L） and elective PCI group （（425.8± 10. 9） pmol/L） than that in control group （（521. 5± 10.8） pmol/L） at admission （P〈0.05）. And the level of Apelin was signifiacantly higher after operation （（481.2± 10.9） pmol/L）, at discharge （（480.5±10.5） pmol/L）, and in 1-year follow-up （（468.9 ± 11.6） pmol/L） than that at admission in direct PCI group （P〈0.05）, which were lower than those in control group （P〈0.05）. There were no significant differences in the Apelin levels after operation （（431. 9 ±11. 2） pmol/L）, at discharge （（432. 5 ± 10. 8） pmol/L） and in 1-year follow-up （（431. 5±11.0） pmol/L） in comparison with that at admission in elective PCI group （P〉0.05）. The level of peripheral Apelin was significantly lower in STEMI patients with lower LVEF （（400. 6±10. 1） pmol/L） than that in STEMI patients with normal LVEF （（459. 8± 11. 2） pmol/L） （P〈0.05）. The one-year follow-up result showed the incidence of cardiovascular adverse events was signifiacantly higher in elective PCI group （17.8 %） than that in direct PCI group （13. 3%） and control group （4. 4%） （P〈0.05）. Conclusion Peripheral Apelin level is correlated with the severity and prognosis of STEMI.