血清鸢尾素水平与急性心肌梗死合并射血分数保留型心力衰竭患者PCI术后心源性猝死的相关性研究

The correlation between serum irisin level and sudden cardiac death after PCI in patients with acute myocardial infarction and ejection fraction preserving heart failure

目的:探讨血清鸢尾素水平与急性ST段抬高型心肌梗死(STEMI)合并射血分数保留型心力衰竭(HFpEF)患者PCI术后心源性猝死的相关性。方法:本研究入组164例STEMI患者,通过ELISA法检测患者PCI术后血清鸢尾素水平,以PCI术后N末端B型利钠肽前体(NT-proBNP)水平及入院3 d内心脏彩超结果筛选出HFpEF患者,最终根据鸢尾素水平对入选患者进行分层,评估STEMI合并HFpEF患者行直接PCI术后1年内心源性猝死风险。评估指标包括埋藏式心律转复除颤器(ICD)植入指征达标率、恶性心律失常及心源性猝死率。结果:164例STEMI患者PCI术后血清鸢尾素水平为(0.48±0.29)μg/ml。患者基线血清鸢尾素水平呈偏态分布,根据中位数和四分位间距分为4组:Q1组(42例,鸢尾素<0.33μg/ml),Q2组(40例,0.33μg/ml≤鸢尾素<0.43μg/ml)、Q3组(40例,0.43μg/ml≤鸢尾素<0.55μg/ml)、Q4组(42例,鸢尾素≥0.55μg/ml)。其中Q4组ICD植入指征达标率及心源性猝死率明显高于其他组(均P<0.05),但恶性心律失常差异无统计学意义。在校正相关因素后,多因素Cox回归分析显示,PCI术后Killip分级(HR=3.35,95%CI:1.32~8.49,P=0.011)和血清鸢尾素等级(HR=3.97,95%CI:1.32~11.92,P=0.014)是心源性猝死的主要危险因素。结论:STEMI合并HFpEF患者血清鸢尾素水平升高与PCI术后心源性猝死风险增加相关,是心源性猝死的独立危险因素。

Objective:To investigate the correlation between serum irisin levels and sudden cardiac death after PCI in patients with acute ST-segment elevation myocardial infarction(STEMI)complicated with ejection fraction preserving heart failure(HFpEF).Method:A total of 164 patients with STEMI were enrolled.The serum irisin levels after PCI were detected by ELISA.Patients with HFpEF were screened based on NT-proBNP levels after PCI and results of cardiac ultrasound within three days after admission.According to irisin levels,stratification was performed to assess the risk of sudden cardiac death within one year after PCI in patients with STEMI complicated with HFpEF.Evaluation indicators included the rate of implantable cardioverter defibrillator(ICD)implantation indication compliance,malignant arrhythmias,and sudden cardiac death.Result:The serum irisin levels in 164 STEMI patients after PCI were(0.48±0.29)μg/ml.Baseline serum irisin levels in patients with STEMI showed a skewed distribution,and all patients were divided into four groups based on the median and interquartile range,namely Q1(n=42,irisin levels<0.33μg/ml),Q2(n=40,0.33μg/ml≤irisin levels<0.43μg/ml),Q3(n=40,0.43μg/ml≤irisin levels<0.55μg/ml),and Q4 group(n=42,irisin levels≥0.55μg/ml).the rate of ICD implantation indication compliance and the rate of sudden cardiac death in the Q4 group were significantly higher than those in other groups(all P<0.05),but there was no significant difference in malignant arrhythmias.After adjusting for related factors,multivariate Cox regression analysis showed that Killip grade(HR=3.35,95%CI:1.32-8.49,P=0.011),and serum irisin grade(HR=3.97,95%CI:1.32-11.92,P=0.014)were the main risk factors for sudden cardiac death.Conclusion:The increased serum irisin level in patients with HFpEF and STEMI is related to the increased risk of sudden cardiac death after PCI,which can be used as an effective predictor of sudden cardiac death.