血清髓过氧化物酶和胱抑素C水平评估AMI患者PCI术后MACEs的价值

The Clinical Value of Serum Myeloperoxidase and Cystatin C Levels in Evaluating MACEs in Patients with AMI After PCI

目的探讨急性心肌梗死(AMI)患者发病早期血清髓过氧化物酶(MPO)和胱抑素C(Cys C)水平的变化规律,以及经皮冠状动脉介入治疗(PCI)后不同随访时间段MPO和Cys C水平的变化对主要心脏不良事件(MACEs)的预测价值。方法选择2017年5月至2018年5月入我院并确诊AMI患者共126例,采用急诊或择期PCI;采用ELISA法检测入院24、48h和72h,随访1、3、6月和12月血清MPO和Cys C水平,随访12个月后,将126例患者分为MACEs组和无MACEs组,比较两组患者血清MPO和Cys C水平的差异性,采用多因素Logistic回归模型筛选MACEs的主要危险因素,受试者工作曲线(ROC)分析预测MACEs的诊断效能。结果 MACEs组19例(15.08%),MACEs组患者24、48h和72h血清MPO和Cys C水平显著高于无MACEs组(P<0.05),但两组随访1、3、6月和12月血清MPO和Cys C水平比较差异无统计学意义(P>0.05)。经Logistic回归分析筛选发现,24 h血清MPO和Cys C水平是MACEs的主要危险因素(P<0.05)。经ROC分析发现,24h血清MPO和Cys C水平预测MACEs的准确性(曲线下面积AUC值)分别为0.896和0.875(P<0.05)。结论血清MPO和Cys C水平升高参与了AMI的发生过程,并与PCI后发生MACEs有紧密联系,入院24 h血清MPO和Cys C水平可能与MACEs的发生以及预测MACEs具有较好的准确性。

Objective To explore the changing pattern of serum myeloperoxidase(MPO)and cystatin C(Cys C)levels during early onset in acute myocardial infarction(AMI)patients,as well as changes of MPO and Cys C during different follow-up periods after percutaneous coronary intervention(PCI),and their predictive values for major adverse cardiac events(MACEs).Methods A total of 126 AMI patients from May,2017 to May,2018 were enrolled for emergent or elective PCI.Serum MPO and Cys C levels at 24 h,48 h and 72 h after admission,one month,three months,six months and twelve months of follow-up were measured with ELISA.The 126 patients were divided into the MACEs group and non-MACEs group after 12-month follow-up,further to compare differences of serum MPO and Cys C levels in the two groups.We also identified main risk factors to MACEs with multivariate logistic regression model,calculated the accuracy of predicting MACEs with receiver operating curve(ROC).Results There were up to 19 cases of MACEs(15.08%) and the levels of MPO and Cys C 24 h,48 h and 72 h after admission in MACEs groups were significantly higher than non-MACEs group(P<0.05),while there were no differences for one,three,six and twelve months during follow-up(P>0.05).The MPO and Cys C levels 24 h after admission were the main risk factors to MACEs by logistic regression analysis(P<0.05).The accuracy of predicting MACEs using area under curve(AUC value)with MPO and Cys C levels 24 h after admission were 0.896 and 0.875 by ROC analysis(P<0.05).Conclusion The elevated expressions of serum MPO and Cys C are involved in AMI occurrence and closely related to MACEs after PCI.The serum levels of MPO and Cys C 24 h after admission could be associated with MACEs occurrence and can predict MACEs with better accuracy.