红细胞膜总胆固醇联合Gensini评分对经皮冠状动脉介入术后急性冠脉综合征患者近期预后的评估价值研究

Value of Total Cholesterol of Erythrocyte Membrane Combined with Gensini Score in Evaluating the Short-term Prognosis of Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

背景经皮冠状动脉介入术(PCI)是一种公认的有效治疗急性冠脉综合征(ACS)的方法,但术后仍有患者在近期内会发生各种不良心血管事件,故采用一定的方法评估ACS患者PCI后近期预后具有实际意义。有研究提示红细胞膜总胆固醇(CEM)和Gensini评分对患者预后评估有积极意义。目的分析CEM联合Gensini评分对PCI后ACS患者近期预后的评估价值。方法本研究为回顾性研究,选取2018年6月—2019年6月在黄骅市人民医院心血管内科住院的根据冠状动脉造影首次确诊为ACS并行PCI的患者150例为研究对象。收集患者临床资料、CEM、冠状动脉病变情况(Gensini评分、多支病变发生情况)。患者出院后进行随访,随访至出院后6个月,记录患者心血管终点事件发生情况。根据PCI后6个月内心血管终点事件发生情况,将患者分为事件组与非事件组。ACS患者PCI后发生心血管终点事件的影响因素分析采用多因素Logistic回归分析;采用受试者工作特征(ROC)曲线分析CEM、Gensini评分及其联合对ACS患者PCI后发生心血管终点事件的评估价值。结果150例患者中,共34例(22.7%)发生心血管终点事件。Pearson相关分析结果显示,ACS患者CEM与Gensini评分呈正相关(r=0.345,P=0.026)。多因素Logistic回归分析结果显示,年龄≥65岁〔OR=1.131,95%CI(1.001,1.277)〕、CEM≥130μg/mg〔OR=2.649,95%CI(1.437,4.882)〕、Gensini评分≥70.0分〔OR=2.106,95%CI(1.222,3.632)〕、多支病变〔OR=1.898,95%CI(1.132,3.185)〕是ACS患者PCI后发生心血管终点事件的独立影响因素(P<0.05)。ROC曲线分析结果显示,CEM、Gensini评分及其联合评估ACS患者PCI后发生心血管终点事件的曲线下面积分别为0.942〔95%CI(0.892,0.974)〕、0.741〔95%CI(0.663,0.809)〕和0.956〔95%CI(0.909,0.982)〕。结论CEM、Gensini评分均是ACS患者PCI后发生心血管终点事件的独立预测因子,其联合应用对患者PCI后近期不良预后有重要评估价值。

Background Percutaneous coronary intervention(PCI)is recognized as an effective treatment for acute coronary syndrome(ACS),but there are still some patients who will have various adverse cardiovascular events in the near future,so it is of practical significance to use certain methods to evaluate the prognosis of ACS patients after PCI.Some studies suggest that the total cholesterol of erythrocyte membrane(CEM)and Gensini score have positive significance in evaluating the prognosis of patients.Objective To analyze the value of CEM combined with Gensini score in evaluating the short-term prognosis of ACS patients after PCI.Methods This study is a retrospective study.One hundred and fifty patients who hospitalized in the Department of Cardiology of Huanghua Municipal People's Hospital from June 2018 to June 2019 and diagnosed as ACS for the first time according to coronary angiography and treated with PCI were selected as the research objects.Clinical data,CEM and coronary artery disease status(Gensini score,occurrence of multivessel disease)were collected.Patients were followed up for 6 months after discharge,and the occurrence of cardiovascular endpoint events were recorded.According to the occurrence of cardiovascular endpoint events within 6 months after PCI,patients were divided into event group and non-event group.The influencing factors of cardiovascular endpoint events in ACS patients after PCI were analyzed by multivariate Logistic regression analysis.The evaluation values of CEM,Gensini score and their combination on cardiovascular endpoint events in ACS patients after PCI were analyzed by receiver operating characteristic(ROC)curve.Results Of the 150 patients,34 cases(22.7%)had cardiovascular endpoint events.The results of Pearson correlation analysis showed that CEM was positively correlated with Gensini score in ACS patients(r=0.345,P=0.026).The results of multivariate Logistic regression analysis showed that age≥65 years old〔OR=1.131,95%CI(1.001,1.277)〕,CEM≥130μg/mg〔OR=2.649,95%CI(1.437,4.882)〕,Gensini score≥70.0〔OR=2.106,95%CI(1.222,3.632)〕,multivessel disease〔OR=1.898,95%CI(1.132,3.185)〕were independent influencing factors of cardiovascular endpoint events in ACS patients after PCI(P<0.05).ROC curve analysis showed that the area under the curve of CEM,Gensini score and their combination for evaluating the cardiovascular endpoint events in ACS patients after PCI were 0.942〔95%CI(0.892,0.974)〕,0.741〔95%CI(0.663,0.809)〕and 0.956〔95%CI(0.909,0.982)〕,respectively.Conclusion Both CEM and Gensini score are independent predictors of cardiovascular endpoint events in patients with ACS after PCI,and their combined application has important value in evaluating poor prognosis of patients after PCI.