血浆sCD40L水平对急性STEMI患者PCI术后发生无复流的预测价值

Predictive value of plasma sCD40L level for no reflow in acute STEMI patients after PCI

目的:探讨血浆sCD40L水平对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后发生无复流(NR)的预测价值.方法:根据NR诊断标准,于我院行急诊PCI的82例急性STEMI患者被分为非NR组(40例)与NR组(42例).另选择同期健康者39例作为健康对照组.观察比较三组一般资料与实验室检查指标,并分析上述指标与NR的关系.结果:与健康对照组比较,NR组甘油三酯水平显著降低(P=0.001);非NR组、NR组年龄、白细胞计数(WBC)、红细胞沉降率(ESR)、血浆sCD40L水平显著升高(P均=0.001),且NR组年龄、WBC、血浆sCD40L水平升高更显著(P均=0.001).与非NR组比较,NR组Gensi-ni评分显著升高(P=0.001).Spearman相关分析显示,血浆sCD40L水平与年龄、Gensini评分、ESR及WBC呈显著正相关(r=0.181~0.401,P<0.05或<0.01).多因素Logistic回归分析显示,年龄、sCD40L是STEMI患者PCI术后发生NR的独立危险因素(OR=1.032、1.042,P=0.025,0.001).ROC曲线显示,sCD40L水平预测NR的敏感性为84%,特异性为90%,最佳截断值为243pg/ml,曲线下面积为0.895,95%CI为0.826~0.969,P=0.001.结论:血浆sCD40L水平对急性STEMI患者PCI术后发生NR具有一定预测价值,值得推广.

Objective:To explore predictive value of plasma sCD40 L level for no reflow(NR) in patients with acute ST elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI). Methods:According to diagnostic criteria of NR, a total of 82 acute STEMI patients undergoing emergency PCI in our hospital were divided into no NR group(n=40) and NR group(n=42). Another 39 healthy people were enrolled as healthy control group simultaneously. General data and laboratory indexes were observed and compared among three groups, and relationship among above indexes and NR were observed. Results:Compared with healthy control group, there was significant reduction in triglyceride level in NR group(P=0.001);significant rise in age, white blood cell count(WBC), erythrocyte sedimentation rate(ESR) and plasma sCD40 L level in no NR group and NR group(P=0.001 all), and age, WBC and plasma sCD40 L level of NR group higher than those of no NR group(P=0.001 all). Compared with no NR group, there was significant rise in Gensini score in NR group(P=0.001). Spearman correlation analysis indicated that plasma sCD40 L level was significant positively correlated with age, Gensini score, ESR and WBC(r=0.181~0.401, P<0.05 or <0.01). Multifactor Logistic regression analysis indicated that age and sCD40 L were independent risk factors for NR after PCI in STEMI patients(OR=1.032, 1.042, P=0.025, 0.001). ROC curve of sCD40 L predicting NR indicated that the sensitivity and specificity of sCD40 L level was 84% and 90% respectively, the optimal cutoff point was 243 pg/ml, area under the curve(AUC) was 0.895, and 95%CI was 0.826~0.969, P=0.001. Conclusion:Plasma sCD40 L level possesses certain predictive value for NR after PCI in acute STEMI patients, which is worth extending.