ST段抬高型心肌梗死患者术后发生主要不良心血管事件风险标志物探索

Risk markers for MACE in STEMI patients after PCI

目的探讨择期PCI术后的血清可溶性髓样细胞触发受体样转录因子1(sTLT-1)、骨膜素水平对ST段抬高型心肌梗死(STEMI)患者发生主要不良心血管事件(MACE)的预测价值。方法选取华中科技大学协和深圳医院收治的220例首次确诊为STEMI患者,均行择期PCI,根据术后是否发生MACE将患者分为MACE组67例和无MACE组153例,比较2组患者血清sTLT-1、骨膜素水平,探讨其变化与MACE发生的关系。结果 2组Killip分级、血清sTLT-1、骨膜素水平比较有显著差异(P<0.05,P<0.01)。血清sTLT-1预测STEMI患者PCI术后发生MACE的ROC曲线下面积为0.82(95%CI:1.124~4.237),敏感性和特异性分别为75.46%和78.52%,骨膜素预测STEMI患者PCI术后发生MACE的ROC曲线下面积为0.79(95%CI:1.135~3.216),敏感性和特异性分别为72.69%和74.38%,联合检测的ROC曲线下面积为0.83(95%CI:1.146~2.235),敏感性和特异性分别为80.34%和83.45%。多因素logistic回归分析显示,Killip分级Ⅳ级、血清sTLT-1水平>0.63μg/L、骨膜素水平>40.35μg/L是STEMI患者PCI术后发生MACE的独立危险因素(P<0.05)。结论血清sTLT-1、骨膜素水平与MACE发生概率呈正比,其水平检测对于预测PCI术后MACE发生具有较高临床应用价值。

Objective To study the value of serum sTLT-1 and periostin levels for predicting MACE in STEMI patients after PCI.Methods Two hundred and twenty STEMI patients who underwent PCI in our hospital from May 2018 to May 2020 were divided into MACE group(n=67) and MACE-free group(n=153).Their serum sTLT-1 and periostin levels were measured.The relationship between serum sTLT-1 and periostin levels and MACE in STEMI patients after PCI was analyzed.Results The AUC of serum sTLT-1 level for predicting MACE in STEMI patients after PCI was 0.82(95%CI:1.124-4.237) with a sensitivity of 75.46% and a specificity of 78.52% while that of serum periostin level for predicting MACE in STEMI patients after PCI was 0.79(95%CI:1.135-3.216) with a sensitivity of 72.69% and a specificity of 74.38%.The AUC of combined serum sTLT-1 and periostin level for predicting MACE in STEMI patients after PCI was 0.83(95%CI:1.146-2.235) with a sensitivity of 80.34% and a specificity of 83.45%.Multivariate logistic regression analysis showed that Killip Ⅳ,serum sTLT-1 level>0.63 μg/L and serum periostin level>40.35 μg/L were independent risk factors for MACE in STEMI patients after PCI(P<0.05).Conclusion Serum sTLT-1 and periostin levels are closely related with MACE in STEMI patients.Measurement of serum sTLT-1 and periostin levels can thus predict MACE in STEMI patients after PCI.