血清胱抑素C水平对急性前壁心梗患者心功能有一定预测价值

Predictive Value of Serum Cystatin C Level for Cardiac Function of Patients with Acute Anterior Wall Myocardial Infarction

为了探讨影响急性前壁心肌梗死患者经皮冠状动脉介入治疗术（PCI）后心力衰竭的因素,检测血清胱抑素C水平在用PCI术治疗急性前壁心梗患者心力衰竭术后影响,本研究选择2013年1月~2017年3月在我院接受PCI治疗的急性前壁心肌梗死患者287例作为研究对象,翻阅患者病历,记录患者性别、年龄、体质量指数、合并疾病、个人史、发病至手术时间、入院时血糖、血脂、血压、白细胞、受累导联数、术前用药、罪犯血管、术前LVEF、术后TIMI血流、病变血管术、BNP水平、CysC水平,观察上述指标与术后心力衰竭的相关性。结果本研究中287例急性前壁心肌梗死患者PCI术后出现心力衰竭71例,心力衰竭发生率为24.74%。单因素分析显示,年龄、糖尿病、高血压、梗死前心绞痛、术前血糖、白细胞、术前收缩压、术前舒张压、LDL-C、术前BNP、术前CysC、术前LVEF、术后TIMI分级是影响急性前壁心肌梗死患者PCI术后心力衰竭发生的危险因素（p〈0.05）。多因素分析显示,年龄〉73.6岁、高血压、术前血糖〉8.72 mmol/L、术前CysC〉1.57 mg/L是急性前壁心肌梗死患者PCI术后心力衰竭的独立危险因素（p〈0.05）,LVEF〉48.57%、术后TIMI〉2级为急性前壁心肌梗死患者PCI术后心力衰竭的保护性因素（p〈0.05）。本研究表明,急性前壁心梗患者PCI术后心力衰竭是多种因素协同作用的结果,术前CysC水平升高对患者PCI术后心力衰竭具有一定预测价值,值得临床推广应用。

The intention of this study was to investigate the factors that influence heart failure after percutaneous coronary intervention（PCI） in patients with acute anterior wall myocardial infarction, and test the postoperative effect of serum cystatin C level on the heart failure of patients with acute anterior wall myocardial infarction after PCI. 287 patients with acute anterior wall myocardial infarction treated by PCI in our hospital from January 2013 to March 2017 were selected as the research object. We browsed through patient records, recorded gender, age,body mass index, comorbidities, personal history, duration of onset to operation, admission blood glucose, blood lipid, blood pressure, white blood cells, affected leads, premedication, culprit vessel, preoperative LVEF,postoperative TIMI blood flow, vascular lesion surgery, BNP level, CysC level, and observed the correlation between the above indexes and heart failure after operation. The results showed that among 287 patients with acute anterior wall myocardial infarction, 71 of them suffered heart failure after PCI, and the incidence of heart failure was 24.74%. Single factor analysis showed that age, diabetes, hypertension, preinfarction angina, preoperative blood glucose, white blood cells, preoperative systolic pressure, preoperative diastolic pressure, LDL-C,preoperative BNP, preoperative CysC, preoperative LVEF, postoperative TIMI classification were the risk factors for the occurrence of heart failure of patients with acute anterior wall myocardial infarction after PCI（ P〈0.05）.Multivariate analysis showed that older than 73.6 years old, hypertension, preoperative blood glucose 8.72 mmol/L, preoperative CysC 1.57 mg/L were independent risk factors for heart failure of patients with acute anterior wall myocardial infarction after PCI（P〈0.05）, while LVEF48.57%, postoperative TIMI2 level were protective factors for that（P〈0.05）. This study indicated that heart failure of patients with acute anterior wall myocardial infarction after PCI was resulted from many factors, and increased preoperative CysC level might have a certain predictive value for the heart failure of patients after PCI surgery, which could be worthy of clinical application.