血浆C型凝集素样受体2水平与急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后发生主要不良心血管事件的关系

Relationship between plasma C-type lectin-like receptor 2 levels and major adverse cardiovascular events after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

目的观察急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后主要不良心血管事件(major adverse cardiovascularevents,MACEs)发生情况,探讨其与血浆C型凝集素样受体2(C-type lectin-like receptor 2,CLEC-2)水平的关系。方法行PCI治疗的165例STEMI患者,随访12个月,以随访期间MACEs为终点事件,将患者分为MACEs组39例和非MACEs组126例。PCI术后次日采用ELISA法检测患者血浆CLEC-2水平,根据CLEC-2均值(138.09 ng/L)将患者分为高水平CLEC-2(≥138.09 ng/L)组61例和低水平CLEC-2(<138.09 ng/L)组104例,采用Kaplan-Meier法分析不同术后血浆CLEC-2水平患者MACEs发生率。收集患者临床资料,采用多因素COX比例风险回归模型分析STEMI患者发生MACEs的危险因素;绘制ROC曲线,评估血浆CLEC-2水平预测STEMI患者PCI术后发生MACEs的效能。结果MACEs组患者左室射血分数[(43.48±7.10)%]低于非MACEs组[(53.29±8.02)%](P<0.05),冠状动脉病变长度[(16.05±3.26)mm]、冠状动脉狭窄率[(75.24±6.21)%]、术前Gensini评分[(95.95±13.06)分]、术前Killip心功能分级Ⅲ~Ⅳ级比率(53.85%)高于非MACEs组[(14.24±2.46)mm、(68.42±4.29)%、(71.42±9.34)分、34.92%](P<0.05),术后患者血浆CLEC-2水平[(193.26±32.46)ng/L]高于非MACEs组[(121.02±20.16)ng/L](P<0.05)。术后高水平CLEC-2组MACEs发生率(39.34%)高于低水平CLEC-2组(14.42%)(P<0.05);术前Gensini评分≥77.22分(OR=1.850,95%CI:1.714~2.261,P=0.001)、术后血浆CLEC-2水平≥138.09 ng/L(OR=2.252,95%CI:2.054~2.915,P<0.001)是STEMI患者PCI术后发生MACEs的危险因素;当血浆CLEC-2水平最佳截断值为151.05 ng/L时,预测STEMI患者PCI术后发生MACEs的AUC为0.846(95%CI:0.774~0.917,P<0.001),灵敏度为82.05%,特异度为84.92%,准确率为84.24%。结论PCI术后血浆CLEC-2水平增高与STEMI患者发生MACEs事件有关,CLEC-2可为STEMI患者MACEs风险评估提供参考。

Objective To observe the occurrence of major adverse cardiovascular events(MACEs)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI)and investigate the relationship between MACEs and plasma level of C-type lectin-like receptor 2(CLEC-2).Methods Totally 165 patients undergoing PCI for STEMI were followed up for 12 months.Taking MACEs as the endpoint event in follow-up,165 patients were divided into MACEs group(n=39)and non-MACEs group(n=126).The plasma CLEC-2 level was detected by ELISA on the second day after PCI,and according to the mean value of CLEC-2(138.09 ng/L),these patients were divided into 61 patients with CLEC-2≥138.09 ng/L(high-level CLEC-2 group)and 104 patients with CLEC-2<138.09 ng/L(low-level CLEC-2 group).Kaplan-Meier survival analysis was used to analyze the incidence of MACEs in patients with different postoperative plasma CLEC-2 levels.The clinical data were collected.Multivariate COX regression analysis was used to analyze the risk factors of MACEs.ROC was drawn to analyze the efficacy of CLEC-2 on predicting MACEs after PCI in STEMI patients.Results The left ventricular ejection fraction((43.48±7.10)%)was lower,the coronary lesion length((16.05±3.26)mm)was longer,and the rate of coronary artery stenosis((75.24±6.21)%),preoperative Gensini score(95.95±13.06)and percentage of preoperative heart function Killip class Ⅲ to Ⅳ(53.85%)were higher in MACEs group than those in no-MACEs group(53.29±8.02)%,(14.24±2.46)mm,(68.42±4.29)%,(71.42±9.34,34.92%)(P<0.05).The postoperative plasma CLEC-2 level was higher in MACEs group((193.26±32.46)ng/L)than that in no-MACEs group((121.02±20.16)ng/L)(P<0.05).The incidence of MACEs was higher in high-level CLEC-2 group(39.34%)than that in low-level CLEC-2 group(14.42%)(P<0.05).The preoperative Gensini score≥77.22(OR=1.850,95%CI:1.714-2.261,P=0.001)and postoperative plasma CLEC-2 level≥138.09 ng/L(OR=2.252,95%CI:2.054-2.915,P<0.001)were the risk factors of MACEs after PCI in STEMI patients.When the optimal cut-offvalue of CLEC-2 was 151.05 ng/L,the AUCfor predicting MACEs after PCI in STEMI patients was 0.846(95%CI:0.774-0.917,P<0.001),the sensitivity was 82.05%,the specificity was 84.92%,and the accuracy was 84.24%.Conclusion High plasma CLEC-2 level after PCI is associated with MACEs in STEMI patients,and CLEC-2 can provide a reference for MACEs risk assessment in STEMI patients.