血清KLK1、RBP4及SYNTAX-11评分预测血运重建后STEMI患者预后的临床价值

Clinical value of serum KLK1 and RBP4 and SYNTAX-11 score in predicting the prognosis of STEMI after revascularization

目的探讨血清激肽释放酶(KLK1)、视黄醇结合蛋白4(RBP4)及冠状动脉病变SYNTAX-11评分体系预测血运重建后ST段抬高型心肌梗死(STEMI)患者预后的临床价值。方法选取2016年3月—2019年6月收入万宁市人民医院的STEMI患者108例为研究对象。记录患者术前及术后1 d血清KLK1和RBP4水平及SYNTAX-11评分,并随访患者半年,观察不良心血管事件(MACE)发生情况。结果随着患者病变支数增多,KLK1逐渐降低,RBP4水平及SYNTAX-11评分逐渐升高(P<0.05)。单支病变组病变中血清KLK1及RBP4水平与SYNTAX-11评分均无相关性(P>0.05);而双支及三支病变组中,血清KLK1及RBP4水平与SYNTAX-11评分显著相关(P<0.05)。MACE组SYNTAX-11评分、RBP4水平、Hcy及cTnI等指标高于非MACE组(P<0.05),KLK1水平低于非MACE组(P<0.05)。经Logistic回归分析,得到SYNTAX-11评分、血清KLK1和RBP4水平是STEMI患者发生MACE的独立危险因素(P<0.05)。经ROC曲线分析,得到SYN⁃TAX-11评分、血清KLK1和RBP4水平均可作为预测MACE的风险因子(P<0.05)。结论血清KLK1、RBP4及SYNTAX-11评分能有效评估STEMI患者血运重建后不良心血管事件。

Objective To investigate the clinical value of serum kallikrein 1(KLK1)and retinol-binding protein 4(RBP4)and SYNTAX-11 score in predicting the prognosis of ST-segment elevation myocardial infarction(STEMI)after revascularization.Methods a total of 108 patients with STEMI admitted to Wanning people's Hospital from March 2016 to June 2019 were selected as the research objects,aged(61.83±10.46)(33~85),underwent percutaneous coronary intervention(PCI)within 12 h after onset,Peripheral venous blood samples were collected before and 1 day after PCI to test the levels of KLK1 and RBP4 by ELISA and the levels of total cholesterol(TC),triglyceride(TG),homocysteine(Hcy)and cardiac troponin I(cTnI)byautomatic biochemical analyzer.SYNTAX-11 scoreing system was used to evaluate the risks.The patients were followed up for one year and divided into 2 groups according to the occurrence of major adverse cardiovascular events(MACE):MACE group(n=23)and non-MACE group(n=85).SPSS 20.0 software was use to analyze the risk factors.Results As the number of diseased branches in patients increased,the serum KLK1 level gradually decreased,and the RBP4 level and SYNTAX-11 score gradually increased(all P<0.05).The serum KLK1 and RBP4 levels in the single-vessel disease group were not correlated with the SYNTAX-11 score(all P>0.05);while in the double-vessel and three-vessel disease groups,the serum KLK1 and RBP4 levels were significantly correlated with the SYNTAX11 score(all P<0.05).The SYNTAX-11 score,RBP4 level,Hcylevel,and cTnIlevel of the MACEgroup were all significantly higher than those of the non-MACE group(all P<0.05),whereas the KLK1 level of the MACE group was significantly lower than those of the non-MACE group(P<0.05).Logistic regression analysis showed that SYNTAX-11 score,and serum KLK1 and RBP4 levels were independent risk factors for MACE in the STEMI patients(all P<0.05).ROC curve analysis showed that SYNTAX-11 score and serum KLK1 and RBP4 levels were all risk factors for predicting MACE(all P<0.05).Conclusion Serum KLK1,RBP4 and SYNTAX-11 score can be used to effectively assess adverse cardiovascular events after revascularization in STEMI patients.