入院时ADAMTS-13水平与急诊冠脉PCI术后无复流现象的相关性分析

Analysis on correlation between ADAMTS-13level at admission and no reflow after PCI

目的:探究入院时含Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶13(ADAMTS-13)水平与急诊经皮冠状动脉介入(PCI)术后无复流现象的相关性。方法:选取2014-06—2019-06期间本院收治的初发急性ST段抬高型心肌梗死(STEMI)患者209例作为研究对象(称急性STEMI组),另选取同期在本院体检显示健康者213例作为健康对照组。根据PCI术后心肌梗死溶栓(TIMI)评分将入组患者分为复流组138例和无复流组71例。采用酶联免疫吸附(ELISA)法检测血浆ADAMTS-13水平,分析其与PCI术后无复流现象发生关系。结果:与健康对照组相比,急性STEMI组患者血浆ADAMTS-13表达水平明显降低(P<0.05)。无复流组患者血浆C反应蛋白(CRP)、N末端脑利钠肽前体(NT-proBNP)、血管性血友病因子(vWF)、发病到球囊扩张时间及血栓高负荷、术前TIMI血流0级、Killip分级≥Ⅱ级比例均明显高于复流组患者(P<0.05),无复流组患者血浆ADAMTS-13水平明显低于复流组患者(P<0.05)。无复流组患者血浆ADAMTS-13水平与血浆CRP、vWF表达水平呈负相关(P<0.05)。ADAMTS-13低水平、CRP高水平、NT-proBNP高水平、vWF高水平、Killip分级≥Ⅱ级、发病到球囊扩张时间长、血栓高负荷、术前TIMI血流0级是PCI术后发生无复流的独立危险因素(P<0.05)。血浆ADAMTS-13水平预测PCI术后无复流发生的曲线下面积为0.851(95%CI:0.793~0.910),敏感度为85.90%,特异度为81.20%。结论:无复流组患者入院时血浆ADAMTS-13水平明显降低,是急性STEMI患者急诊冠脉PCI术后无复流现象发生的独立危险因素,对预测患者PCI术后发生无复流具有一定诊断价值。

Objective: To investigate the correlation between the level of a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13(ADAMTS-13) and no reflow after emergency percutaneous coronary intervention(PCI). Method: 209 patients with primary acute ST segment elevation myocardial infarction(STEMI) admitted to our hospital from June 2014 to June 2019 were selected as the study objects(called acute STEMI group), and 213 healthy people who were examined in our hospital at the same time were selected as the control group.According to the thrombolysis in myocardial infarction(TIMI) score after PCI, the patients in the group were divided into the reflow group(138 cases) and the no reflow group(71 cases).Enzyme linked immunosorbent assay(ELISA) was used to detect the level of ADAMTS-13 in plasma, and the relationship between ADAMTS-13 and no reflow after PCI was analyzed. Result: Compared with the healthy control group, the expression level of plasma ADAMTS-13 in the acute STEMI group was significantly lower(P<0.05).The levels of plasma C-reactive protein(CRP), N-terminal pro brain natriuretic peptide(NT-proBNP), von Willebrand factor(vWF), time from onset to balloon dilatation, high thrombus load, the proportions of preoperative TIMI blood flow grade 0 and Killip grade ≥ grade Ⅱ in patients in no reflow group were significantly higher than those in patients in reflow group(P<0.05), and the level of plasma ADAMTS-13 in patients in no reflow group was significantly lower than that in patients in reflow group(P<0.05).The level of plasma ADAMTS-13 was negatively correlated with the level of plasma CRP and vWF expression level(P<0.05).Low level of ADAMTS-13, high level of CRP, high level of NT-proBNP, high level of vWF, Killip grade ≥ Ⅱ, long time from onset to balloon dilatation, high burden of thrombus, and preoperative TIMI blood flow grade 0 were independent risk factors for no reflow after PCI(P<0.05).The area under the curve of plasma ADAMTS-13 level predicting no reflow after PCI was 0.851(95%CI: 0.793-0.910), the sensitivity was 85.90%, and the specificity was 81.20%.Conclusion: The level of plasma ADAMTS-13 in the patients with no reflow group is decreased significantly at the time of admission, which is an independent risk factor for no reflow after acute PCI in patients with acute STEMI, which has certain diagnostic value for predicting no reflow after PCI.