急性冠脉综合征患者经皮冠状动脉介入治疗前后血清和肽素及可溶性生长刺激表达基因2水平变化及其预测价值研究

Changes and Predictive Value of Serum Levels of Copeptin and sST2 in Acute Coronary Syndrome Patients Underwent Percutaneous Coronary Intervention

背景经皮冠状动脉介入治疗(PCI)是目前临床救治急性冠脉综合征(ACS)患者的重要方式,但ACS患者PCI后支架内血栓形成及主要不良心血管事件发生风险较高,而其预测指标目前尚未达成共识。目的分析ACS患者PCI前后血清和肽素及可溶性生长刺激表达基因2(sST2)水平变化及其预测价值。方法选取2016年1月-2017年6月在济南市人民医院行PCI的ACS患者106例,比较其PCI前1 d及PCI后第3天血清和肽素、sST2水平;记录所有患者随访期间支架内血栓形成、主要不良心血管事件发生情况,并比较有无支架内血栓形成、主要不良心血管事件患者PCI前Id、PCI后第3天血清和肽素、sST2水平;血清和肽素、sST2水平与ACS患者PCI后支架内血栓形成、主要不良心血管事件的相关性分析采用Spearman秩相关分析;绘制ROC曲线以分析PCI后第3天血清和肽素、sST2水平对ACS患者PCI后支架内血栓形成、主要不良心血管事件的预测价值。结果(1)PCI后第3天ACS患者血清和肽素、sST2水平低于PCI前1 d(P<0.05)。(2)随访期间发生支架内血栓形成10例(9.4%),主要不良心血管事件21例(19.8%)。有支架内血栓形成、有主要不良心血管事件患者PCI前1 d及PCI后第3天血清和肽素、sST2水平分别高于无支架内血栓形成、无主要不良心血管事件者(P<0.05)。(3)Spearman秩相关分析结果显示,PCI前1 d及PCI后第3天血清和肽素水平与ACS患者支架内血栓形成、主要不良心血管事件呈正相关(P<0.05);PCI前1 d及PCI后第3天血清sST2水平与ACS患者支架内血栓形成、主要不良心血管事件亦呈正相关(P<0.05)。(4)ROC曲线显示,PCI后第3天血清和肽素水平预测ACS患者支架内血栓形成、主要不良心血管事件的曲线下面积(AUC)分别为0.830[95%CI(0.663,0.912)]、0.910[95%CI(0.814,0.964)];PCI后第3天血清sST2水平预测ACS患者支架内血栓形成、主要不良心血管事件的AUC分别为0.777[95%CI(0.603,0.899)]、0.807[95%CI(0.682,0.894)];PCI后第3天血清和肽素联合sST2水平预测ACS患者支架内血栓形成、主要不良心血管事件的AUC分别为0.886[95%CI(0.811,0.942)]、0.952[95%CI(0.886,0.976)]。结论ACS患者PCI后血清和肽素、sST2水平明显降低,而PCI前1d及PCI后第3天血清和肽素、sST2水平均与ACS患者支架内血栓形成、主要不良心血管事件呈正相关,且PCI后第3天血清和肽素、sST2水平尤其是二者联合对ACS患者支架内血栓形成、主要不良心血管事件的预测价值较高。

Background Percutaneous coronary intervention(PCI)is an important clinical method in treating acute coronary syndrome(ACS)at present,but risk of intra-stent thrombosis and major adverse cardiovascular events(MACE)is relatively high after PCI,however there is no consensus about the predictive indicators so far.Objective To analyze the changes and predictive value of serum levels of copeptin and sST2 in ACS patients underwent PCI.Methods A total of 106 ACS patients underwent PCI were selected in Jinan People’s Hospital from January 2016 to June 2017,their serum levels of copeptin and sST2 were compared 1 day before PCI and at the third day after PCI;incidence of intra-stent thrombosis and MACE were recorded during follow-up,moreover serum levels of copeptin and sST21 day before PCI and at the third day after PCI were compared in patients complicated with intra-stent thrombosis or not,complicated with MACE or not;Spearman rank correlation was used to analyze correlations of serum levels of copeptin and sST2 with intra-stent thrombosis and MACE after PCI in patients with ACS;ROC curve was drawn to analyze the predictive value of serum levels copeptin and sST2 at the third day after PCI on intra-stent thrombosis and MACE after PCI in patients with ACS.Results(1)Compared with those 1 day before PCI,serum levels of copeptin and sST2 were statistically significantly lower in all of the 106 patients with ACS at third day after PCI(P<0.05).(2)Of the 106 patients with ACS,10 cases(9.4%)occurred intra-stent thrombosis and 21 cases(19.8%)occurred MACE during the follow-up.Serum levels of copeptin and sST2 in patients complicated with intra-stent thrombosis,complicated with MACE were statistically significantly higher than those did not complicated with intra-stent thrombosis,did not complicated with MACE(P<0.05).(3)Spearman rank correlation analysis results showed that,serum copeptin level 1 day before PCI and at the third day after PCI was positively correlated with intra-stent thrombosis and MACE in patients with ACS,respectively(P<0.05),as well as serum sST2 level 1 day before PCI and at the third day after PCI(P<0.05).(4)ROC curve showed that,AUC of serum copeptin level at the third day after PCI in predicting intra-stent thrombosis and MACE in patients with ACS was 0.830[95%CI(0.663,0912)]and 0.910[95%CI(0.814,0.964)],respectively;AUC of serum sST2 level at the third day after PCI in predicting intra-stent thrombosis and MACE in patients with ACS was 0.777[95%CI(0.603,0.899)]and 0.807[95%CI(0.682,0.894)],respectively;AUC of combination of serum levels of copeptin and sST2 at the third day after PCI in predicting intra-stent thrombosis and MACE in patients with ACS was 0.886[95%CI(0.811,0.942)]and0.952[95%CI(0.886,0.976)],respectively.Conclusion Serum levels of copeptin and sST2 are significantly decreased in postoperative ACS patients treated by PCI,both serum levels of copeptin and sST21 day before PCI and at the third day after PCI are significantly positively correlated with intra-stent thrombosis and MACE in patients with ACS,moreover serum levels of copeptin and sST2 at the third day after PCI especially the combination of the above two have relatively high predictive value on intra-stent thrombosis and MACE in patients with ACS.