STEMI患者急诊PCI术前H-FABP水平与预后的关系

The relationship between serum level of H-FABP before PCI and prognosis in patients with STEMI

目的观察急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗(p PCI)术前血清心型脂肪酸结合蛋白(H-FABP)水平与预后的关系。方法入组患者104例,于发病12 h内行p PCI术,术前检测H-FABP浓度。所有患者冠状动脉造影后按Gensini积分系统计算积分,分为3组:A组(8分≤Gensini积分<41分)34例,B组(41分≤Gensini积分<64分)34例,C组(Gensini积分≥64分)36例。对各组的收缩压(SBP)、舒张压(DBP)、吸烟史、H-FABP、左室射血分数(LVEF)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、合并糖尿病(DM)比例、合并高血压病比例等指标进行统计学分析。术后随访12个月,按是否发生主要不良心血管事件(MACE)分为MACE组和非MACE组,对2组相关因素进行统计学分析;对有统计学意义的单因素指标应用Logistic回归分析筛选STEMI患者p PCI术后发生MACE的危险因素。结果 A组、B组及C组TC呈依次增高趋势(P<0.05);B、C组LVEF值低于A组(P<0.05)。3组间的SBP、DBP、吸烟史、H-FABP、TG、HDL-C、LDL-C、空腹血糖、合并DM比例、合并高血压病比例等指标差异均无统计学意义。随访12个月,MACE组合并DM比例、发病至p PCI时间、TC、术前H-FABP水平、Gensini积分均高于非MACE组(P<0.05);Logistic回归分析显示,合并DM,术前较高的血清H-FABP水平是术后12个月内发生MACE的独立危险因素(P<0.05)。结论对于合并DM、术前血清H-FABP水平升高的急性ST段抬高型心肌梗死患者p PCI术后12个月内要警惕MACE的发生。

Objective To observe the relationship between serum level of H-FABP before percutaneous coronary intervention(PCI)and prognosis in patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of104cases were recruited in this study.PCI was performed12h after onset.The concentration of H-FABP was detected before operation.Gensini score system was used to calculate the integral of all patients after coronary angiography.According to Gensini score,patients were divided into three groups,34cases in group A(8≤Gensini scores<41),34cases in group B(41≤Gensini scores<64)and36cases in group C(Gensini scores≥64).Indicators were analyzed statistically including systolic blood pressure(SBP),diastolic blood pressure(DBP),smoking history,H-FABP,left ventricular ejection fraction(LVEF),total cholesterol(TC),triglycerides(TG),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),fasting blood sugar,diabetes(DM)and hypertension.The patients were followed up for12months after operation.According to the occurrence of major adverse cardiovascular events(MACE),patients were divided into MACE group and non-MACE group.The related factors of two groups were statistically analyzed.The multivariate Logistic regression analysis was used to screen the risk factors of MACE for patients with STEMI after emergency PCI.Results There is a gradually increasing tendency in total cholesterol levels among three A,B and C groups(P<0.05).LVEF values were lower in B group and C group than that of A group(P<0.05).There were no significant differences in levels of SBP,DBP,H-FABP,TG,HDL-C,LDL-C,fasting plasma glucose and smoking history,DM,and hypertension between three groups(P>0.05).In12-month follow-up,the proportion of STEM combined with DM,the time from onset to PCI,the level of TC,the level of H-FABP before operation and Gensini score were significantly higher in MACE group than those of non-MACE group(P<0.05).Logistic regression analysis showed that STEM combined with DM,higher serum level of H-FABP before operation were risk factors of MACE in12-month after operation(P<0.05).Conclusion For patients with acute STEM combined with diabetes and elevated preoperative serum level of H-FABP,be alert to the occurrence of MACE in12-month after PCI.