血浆脂蛋白相关磷脂酶A_(2)联合CHA_(2) DS_(2)-VASc评分对STEMI患者PCI术后无复流的预测价值

Predictive Value of Plasma Lipoprotein Associated Phospholipase A_(2) Combined with CHA_(2) DS_(2)-VASc Score for No-reflow in STEMI Patients after PCI

目的分析血浆脂蛋白相关磷脂酶A 2(Lp-PLA 2)联合CHA 2DS 2-VASc评分对ST段抬高型急性心肌梗死(STEMI)患者经皮冠脉介入(PCI)术后无复流的预测价值。方法选取2018年1月至2019年12月于河南中医药大学第一附属医院行直接PCI术的STEMI患者208例作为研究对象,根据术后心肌血流情况将患者分为无复流组(58例)和正常血流组(150例),比较两组患者术前血浆Lp-PLA 2水平、CHA 2DS 2-VASc评分及一般临床资料的差异,应用logistic回归分析STEMI患者直接PCI术后无复流的影响因素,使用受试者工作特征曲线(ROC)曲线检验Lp-PLA 2联合CHA 2DS 2-VASc评分对无复流的预测效能。结果无复流组患者的血浆Lp-PLA 2水平、CHA 2DS 2-VASc评分、年龄、多支血管病变占比、支架置入数目高于正常血流组(P<0.05)。logistic多因素回归分析显示,Lp-PLA 2(OR=1.851)、CHA 2DS 2-VASc(OR=1.883)、年龄(OR=1.692)、病变血管数(OR=1.745)均是STEMI患者直接PCI术后无复流的危险因素(P<0.05)。血浆Lp-PLA 2水平、CHA 2DS 2-VASc评分预测STEMI患者直接PCI术后无复流的ROC曲线下面积(AUC)分别为0.831、0.885,二者联合检测的AUC可达0.929,高于任一单项指标(P<0.05)。结论血浆Lp-PLA 2水平联合CHA 2DS 2-VASc评分对STEMI患者直接PCI术后无复流的发生具有较高的预测价值,且准确性高于二者任一单项指标。

Objective To analyze the predictive value of plasma lipoprotein associated phospholipase A 2(Lp-PLA 2)combined with CHA 2DS 2-VASc score in predicting no-reflow after percutaneous coronary intervention(PCI)in patients with ST-segment elevation acute myocardial infarction(STEMI).Methods A total of 208 STEMI patients who underwent primary PCI in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2018 to December 2019 were selected as the research objects.The patients were divided into no-reflow group(58 cases)and normal blood flow group(150 cases)that according to the postoperative myocardial blood flow.The levels of plasma Lp-PLA 2,CHA 2DS 2 VASc score and general clinical data were compared between the two groups.Logistic regression was used to analyze the influencing factors of no-reflow in STEMI patients after PCI.Receiver operating characteristic(ROC)curve was used to test the predictive effect of Lp-PLA 2 combined with CHA 2DS 2 VASc score on no-reflow.Results The plasma Lp-PLA 2 level,CHA 2DS 2-VASc score,age,the proportion of multi vessel disease and the number of stents in no-reflow group were higher than those in normal blood flow group(P<0.05).Logistic regression analysis showed that Lp-PLA 2(OR=1.851),CHA 2DS 2-VASc(OR=1.883),age(OR=1.692),and number of diseased vessels(OR=1.745)were the risk factors for no-reflow after primary PCI in STEMI patients(P<0.05).The area under ROC curve(AUC)of plasma Lp-PLA 2 level and CHA 2DS 2-VASc score in predicting no-reflow after primary PCI in STEMI patients were 0.831 and 0.885.The AUC of combined detection of Lp-PLA 2 level and CHA 2DS 2-VASc score was 0.929,which was higher than any single index(P<0.05).Conclusion The plasma Lp-PLA 2 level combined with CHA 2DS 2-VASc score has a high predictive value for the occurrence of no-reflow after primary PCI in STEMI patients,and the accuracy is higher than either of the two indexes.