FXⅢa活性与急性心肌梗死PCI术后心功能的相关性分析

Correlation between coagu1ation factor XⅢactivity and heart function in patients with acute myocardial infarction after PCI

目的探讨凝血因子XⅢ(FXⅢa)活性与急性心肌梗死行经皮冠状动脉介入治疗(PCI)后心功能的相关性。方法选取2017年6月至2019年6月于秦皇岛市第一医院就诊的120例心肌梗死并行PCI的患者为研究对象,入院后测定患者FXⅢa活性,并根据FXⅢa活性的中位数109%分为低活性组(FXⅢa活性<109%)和高活性组(FXⅢa活性≥109%),每组各60例,收集患者临床资料及心功能指标。采用Spearman的相关系数对FXⅢa活性与急性心肌梗死PCI后心功能的相关性进行分析。结果截止末次随访时间2020年6月25日,共117例患者完成随访,其中2例高活性组失访,1例低活性组于术后2周死亡。术后12个月后高活性组左室舒张末容积[(126.34±6.57)ml/m^(2)vs.(130.84±6.23)ml/m^(2),P<0.05]、左室收缩末容积[(71.65±5.89)ml/m^(2)vs.(76.56±4.81)ml/m^(2),P<0.05]、肌酸激酶同工酶[(29.23±5.84)μg/L vs.(35.74±6.35)μg/L,P<0.05]、N末端脑钠肽前体[(300.12±60.11)pg/ml vs.(384.57±50.91)pg/ml,P<0.05]、左室质量[(301.89±15.43)g vs.(320.79±16.75)g,P<0.05]低于低活性组;左室搏出量[(65.32±8.42)ml vs.(52.64±11.87)ml,P<0.05]、左室射血分数[(71.73±7.38)%vs.(65.82±7.12)%,P<0.05]高于低活性组。Spearman的相关分析提示FXⅢa活性与LVSV呈正相关(R^(2)=0.3549,P<0.05),与LVM呈负相关(R^(2)=0.7446,P<0.05)。结论心肌梗死后FXⅢa活性与LVSV呈正相关,与LVM呈负相关,在急性心肌梗死后应评估FXⅢa的临界值,并根据患者FXⅢa活性予以FXⅢa替代治疗,以改善预后。

Objective To discuss the correlation between activity of coagu1ation factor XⅢ(FXⅢa)and heart function in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods AMI patients(n=120)undergone PCI were chosen from the First Hospital of Qinhuangdao City from June 2017 to June 2019.According to the median of FXⅢa activity(109%),all patients were divided into low activity group(FXⅢa activity<109%)and high activity group(FXⅢa≥109%,each n=60).The clinical materials and indexes of heart function were collected from all patients,and correlation between FXⅢa activity and heart function after AMI and PCI was analyzed by using Spearman correlation coefficient.Results The closing time of the last follow-up was June 25,2020.There were totally 117 patients with completed follow-up,2 cases missed in high activity group and 1 case died in low activity group 2 weeks after PCI.After PCI for 12 months,the levels of left ventricular end-diastolic volume[LVEDV,(126.34±6.57)ml/m^(2)vs.(130.84±6.23)ml/m^(2),P<0.05],left ventricular end-systolic volume[LVESV,(71.65±5.89)ml/m^(2)vs.(76.56±4.81)ml/m^(2),P<0.05],creatine kinase-MB isoenzyme[CK-MB,(29.23±5.84)μg/L vs.(35.74±6.35)μg/L,P<0.05],N-terminal pro-brain natriuretic peptide[NT-proBNP,(300.12±60.11)pg/ml vs.(384.57±50.91)pg/ml,P<0.05]and left ventricular mass[LVM,(301.89±15.43)g vs.(320.79±16.75)g,P<0.05]were lower in high activity group than those in low activity group,and levels of left ventricular stroke volume[LVSV,(65.32±8.42)ml vs.(52.64±11.87)ml,P<0.05]and left ventricular ejection fraction[LVEF,(71.73±7.38)%vs.(65.82±7.12)%,P<0.05]were higher in high activity group than those in low activity group.The results of Spearman correlation coefficient analysis showed that FXⅢa activity was positively correlated to LVSV(R^(2)=0.3549,P<0.05)and negatively correlated to LVM(R^(2)=0.7446,P<0.05).Conclusion FXⅢa activity is positively correlated to LVSV and negatively correlated to LVM after AMI.The critical value of FXⅢa should be reviewed after AMI,and patients can be given FXⅢa replacement therapy according to FXⅢa activity for improving prognosis.