ST段抬高型心肌梗死病人血清淀粉样蛋白A和一氧化氮水平与预后的关系

Relationships between serum amyloid A and nitric oxide levels and prognosis in patients with ST-segment elevation myocardial infarction

目的通过测定ST段抬高型心肌梗死病人血清淀粉样蛋白A(SAA)、一氧化氮(NO)水平,探讨其与病人近期预后的关系。方法选取2016年6月至2018年9月青海省心脑血管病专科医院冠心病科病房住院的ST段抬高型心肌梗死病人134例,均行PCI治疗,根据冠脉狭窄程度积分(Gensini积分)分为轻度组59例与重度组75例,另选取同期体检健康者81例作为对照组,检测研究对象血清SAA、NO水平,分析ST段抬高型心肌梗死病人血清SAA、NO水平与Gensini积分相关性。根据随访结果将病人分为预后良好组与预后不良组,采用COX法分析影响病人预后不良的危险因素,应用受试者工作特征曲线(ROC)分析血清SAA、NO水平对病人近期预后的评估价值。结果对照组、轻度组、重度组血清SAA水平分别是(5.16±1.03)mg/L、(34.12±6.82)mg/L、(65.15±13.03)mg/L,血清NO水平分别为(72.17±14.43)μmol/L、(64.32±12.86)μmol/L、(55.27±11.05)μmol/L,轻度组与重度组Gensini积分分别为(45.26±9.05)分、(128.79±25.79)分,与对照组相比,轻度组、重度组血清SAA水平升高(P<0.05),血清NO水平降低(P<0.05);与轻度组相比,重度组血清SAA水平、Gensini积分升高(P<0.05),血清NO水平降低(P<0.05);ST段抬高型心肌梗死病人血清SAA水平与Gensini积分正相关(r=0.763,P<0.05),血清NO水平与Gensini积分负相关(r=-0.807,P<0.05);预后良好组、预后不良组血清SAA水平分别为(35.79±7.16)mg/L(63.94±12.78)mg/L,血清NO水平分别为(66.17±13.23)μmol/L(37.06±8.01)μmol/L与预后良好组相比,预后不良组血清SAA水平升高(P<0.05),血清NO水平下降(P<0.05);COX分析显示血清SAA、NO水平是影响ST段抬高型心肌梗死病人预后的独立危险因素(HR=2.099,2.355,P<0.05);ROC曲线显示,血清SAA、NO水平及二者联合检测预测ST段抬高型心肌梗死病人治疗3个月不良预后的曲线下面积为0.846(灵敏度为79.5%,特异度为82.3%),0.715(灵敏度为59%,特异度为83.6%),0.907(灵敏度为87.2%,特异度为83.6%)。结论 ST段抬高型心肌梗死病人血清SAA水平升高、NO水平降低,与冠脉病变严重程度密切相关,可能作为预估病人PCI治疗后预后不良的生物指标。

Objective To investigate the relationship between serum amyloid A(SAA) and nitric oxide(NO) levels and short-term prognosis in patients with ST-segment elevation myocardial infarction by detection of them.Methods A total of 134 patients with ST segment elevation myocardial infarction hospitalized in coronary artery disease care unit(CCU) of Qinghai Cardiovascular and Cerebrovascular Disease Hospital from June 2016 to September 2018 were treated with PCI.According to Gensini score,59 patients with mild coronary artery disease and 75 patients with coronary artery disease were assigned into two respective groups.Another 81 healthy persons were selected as control group during the same period.Serum SAA and NO levels were measured,and the correlations between serum SAA and NO levels and Gensini score in patients with ST-segment elevation myocardial infarction were analyzed.According to the follow-up results,patients were assigned into good prognosis group and poor prognosis group.COX method was used to analyze the risk factors affecting the poor prognosis of patients,and receiver operating characteristic curve(ROC) was used to analyze the values of serum SAA and NO levels in evaluating the short-term prognosis of patients.Results The levels of SAA in control group,mild group and severe group were(5.16±1.03) mg/L,(34.12±6.82) mg/L and(65.15±13.03) mg/L respectively.The levels of NO in control group,mild group and severe group were(72.17±14.43) μmol/L,(64.32±12.86) μmol/L and(55.27±11.05) μmol/L respectively.The Gensini scores in mild group and severe group were(45.26±9.05) and(128.79±25.79).Compared with control group,the serum SAA levels in mild group and severe group increased(P<0.05),while the serum NO level decreased(P<0.05).Compared with mild group,serum SAA level and Gensini score increased(P<0.05) and serum NO level decreased(P<0.05) in severe group.Serum SAA level was positively correlated with Gensini score in ST-segment elevation myocardial infarction(r=0.763,P<0.05),while serum NO level was negatively correlated with Gensini score(r=-0.807,P<0.05).The level of serum SAA was(35.79±7.16) mg/L in good prognosis group and(63.94±12.78) mg/L in poor prognosis group.The level of serum NO was(66.17±13.23) μmol/L in good prognosis group and(37.06±8.01) μmol/L in poor prognosis group.Compared with the good prognosis group,the serum SAA level in the poor prognosis group increased(P<0.05),while the serum NO level decreased(P<0.05).COX analysis showed that serum SAA and NO levels were independent risk factors affecting the prognosis of ST-segment elevation myocardial infarction(HR=2.099,2.355,P<0.05).The ROC curve showed that the areas under the curve of serum SAA and NO levels and their combined detection for predicting adverse prognosis of STsegment elevation myocardial infarction after 3 months of treatment were 0.846(sensitivity was 79.5%,specificity was 82.3%),0.715(sensitivity was 59%,specificity was 83.6%) and 0.907(sensitivity was 87.2%,specificity was 83.6%).Conclusion Serum SAA level increases and NO level decreases in patients with ST-segment elevation myocardial infarction,which are closely related to the severity of coronary artery lesions,and may be used as biological indicators to predict the poor prognosis of patients after PCI.