内源性促红细胞生成素对急性心肌梗死长期预后的预测价值

Value of endogenous erythropoietin level on predicting long-term outcome in acute myocardial infarction patients

目的探讨初发急性ST抬高型心肌梗死(STEMI)患者,直接经皮冠状动脉介入治疗(PCI)后,入院时血清内源性促红细胞生成素(EPO)水平对长期预后的预测价值。方法入选2013年9月~2014年9月于郑州大学附属洛阳中心医院初发STEMI患者163例,随访时间(19.1±2.8)月,随访终点为发生主要不良心血管事件(MACE),包括:心力衰竭再住院、心肌梗死、卒中、心源性死亡。对MACE组和无MACE组临床随访资料进行统计分析。结果 MACE组肌酸激酶(CK)峰值显著高于无MACE组,血清EPO水平和梗死前心绞痛发生率显著低于无MACE组(P均<0.05);Cox回归分析显示,血清EPO低于中位数(HR=3.504,95%CI:1.548~7.935,P=0.003)和CK峰值高于中位数(HR=7.456,95%CI:2.001~27.776,P=0.003)是MACE发生的独立危险因素;ROC曲线显示,以血清EPO切点界值17.6IU/L预测MACE,曲线下面积为0.816(95%CI:0.741~0.891,P<0.001),预测价值优于CK峰值;LogRank检验显示血清EPO与无MACE生存率有显著统计学意义(χ2=6.095,P=0.014)。结论初发STEMI患者直接PCI术后,血清内源性EPO是MACE发生的独立危险因素,对患者长期预后有一定的预测价值。

Objective To explore the value of serum endogenous erythropoietin（EPO） level on predicting long-term major adverse cardiovascular events（MACE） in patients with ST-segment elevation myocardial infarction（STEMI）. Methods We studied 183 patients with first STEMI who received successful primary percutaneous coronary intervention（PCI） within 12 h from the onset of STEMI. Incidence of MACE was observed during（20.02±0.43） months follow up. All statistic work was carried out with software of SPSS 23.0. Results The level of serum EPO was significantly higher in MACE group than in no MACE group. Cox multivariate analysis revealed that EPO（HR=3.504, 95%CI： 1.548～7.935, P=0.003） and Creatine Kinase peak（HR=7.456, 95%CI： 2.001～27.776, P=0.003） were independent prognostic risk factors of MACE. The cutoff value of EPO to predict MACE was 17.6 IU/L（AUC=0.816, 95%CI： 0.741～0.891, P0.001）. Kaplan Meier survival analysis showed that the incidence of without MACE at（19.1±2.8） months was significant difference in groups divided by the cutoff value of EPO（LogRank test, χ2=6.095, P=0.014）. Conclusion The endogenous EPO level could be used to predict long-term MACE in patients with STEMI subjected to successful primary PCI. This might be attributed to the potentially protective effect of endogenous EPO against ischemia-reperfusion injury in humans.