急性冠脉综合征患者经皮冠脉介入术后Lp-PLA2、hs-CRP、NT-proBNP水平对预后的评估价值

Evaluation Value of Lp-PLA2, Hs-CRP and NT-proBNP Levels in the Prognosis of ACS Patients after PCI

目的探讨急性冠脉综合征(ACS)患者经皮冠脉介入术(PCI)后脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏C反应蛋白(hs-CRP)、N末端B型钠尿肽原(NT-proBNP)对预后的评估价值。方法选取2017年3月至2019年10月接受PCI治疗的ACS患者187例,术后进行6个月随访,根据是否发生主要不良心血管事件(MACE)分为无MACE组(126例)和MACE组(61例)。分别于介入手术前和介入手术后3d,检测两组患者Lp-PLA2、hs-CRP、NT-proBNP,以及左心室射血分数(LVEF)、心脏每搏量(SV)、心脏指数(CI)。采用多因素Logistic逐步回归分析MACE的危险因素,采用ROC曲线下面积(AUC)评价不同指标对MACE发生的诊断效能。结果两组患者介入治疗后3d的Lp-PLA2、hs-CRP、NT-proBNP水平与介入治疗前比较明显下降(P<0.05),MACE组介入治疗后3d的Lp-PLA2、hs-CRP、NT-proBNP水平高于无MACE组(P<0.05)。两组患者在介入治疗后3d的LVEF、SV、CI与介入治疗前比较明显增高(P<0.05),MACE组介入治疗后3d的LVEF、SV、CI水平低于无MACE组(P<0.05)。Lp-PLA2、hs-CRP、NT-proBNP为MACE发生的独立危险因素(P<0.05),LVEF为MACE发生的独立保护因素(P<0.05)。Lp-PLA2、hs-CRP、NT-proBNP预测MACE的AUC均明显高于LVEF(Z=6.035、5.061、4.983,P<0.001)。结论Lp-PLA2、hs-CRP、NT-proBNP与MACE的发生独立相关,有可能成为ACS患者PCI术后预后的良好监测指标。

Objective To investigate the evaluation value of lipoprotein-associated phospholipase A2(Lp-PLA2),hypersensitive C-reactive protein(hs-CRP)and N end of B-type natriuretic peptide original(NT-proBNP)levels in the prognosis of acute coronary syndrome(ACS)patients after percutaneous coronary intervention(PCI).Methods A total of 187 ACS patients admitted to our hospital from March 2017 to October 2019 who received PCI were selected.The patients were followed up for 6 months after the operation.According to the occurrence of major adverse cardiovascular events(MACE),126 patients in non-MACE group and 61 patients in MACE group were divided.Lp-PLA2,hsCRP,NT-proBNP,left ventricular ejection fraction(LVEF),stroke volume(SV),and cardiac index(CI)were measured before interventional therapy and on the 3 rd day after interventional therapy,respectively.Multivariate Logistic stepwise regression was used to analyze the risk factors of MACE,and the area under ROC curve(AUC)was used to evaluate the diagnostic efficacy of different indicators for MACE.Results Lp-PLA2,hs-CRP and NT-proBNP levels after interventional therapy in the two groups were significantly decreased(P<0.05),and Lp-PLA2,hs-CRP and NT-proBNP levels after interventional therapy in the MACE group were higher than those in the non-MACE group(P<0.05).LVEF,SV and CI on the 3 rd day after interventional therapy in the two groups were significantly higher than those before interventional therapy(P<0.05),and LVEF,SV and CI on the 3 rd day after interventional therapy in the MACE group were lower than those in the non-MACE group(P<0.05).Lp-PLA2,hs-CRP and NT-proBNP were the independent risk factors for MACE(P<0.05),and LVEF was the independent protective factor for MACE(P<0.05).AUC of Lp-PLA2,hs-CRP and NT-proBNP for predicting MACE occurrence was significantly higher than that of LVEF(Z=6.035,5.061,4.983,P<0.001).Conclusion Lp-PLA2,hs-CRP and NT-proBNP are independently correlated with the occurrence of MACE,and may be good indicators for monitoring the prognosis of ACS patients after PCI.