血清ANGPTL4联合Nesfatin-1对急性ST段抬高型心肌梗死患者PCI术后无复流的预测价值研究

The Predictive Value Study of Serum ANGPTL4 Combined with Nesfatin-1in Patients with Acute ST-Segment Elevation Myocardial Infarction Non-Reflux after PCI

目的:探讨血清血管生成素样蛋白4(ANGPTL4)联合摄食抑制因子1(Nesfatin-1)对急性ST段抬高型心肌梗死(ASTEMI)患者经皮冠状动脉介入(PCI)术后无复流的预测价值。方法:选择2017年2月至2020年10月我院收治的339例ASTEMI患者,根据术后心肌梗死溶栓治疗(TIMI)分级将患者分为无复流组(TIMI血流0~2级,61例)和正常血流组(TIMI血流3级,278例)。比较两组患者基线资料、血清ANGPTL4和Nesfatin-1水平、实验室指标。多因素Logistic回归分析ASTEMI患者PCI术后发生无复流的影响因素,受试者工作特征(ROC)曲线分析血清ANGPTL4、Nesfatin-1预测ASTEMI患者PCI术后发生无复流的效能。结果:无复流组年龄、PCI术前心率、左室重量指数(LVMI)、休克指数、冠脉痉挛、血糖、冠脉病变长度、冠脉病变支数、白细胞计数、中性粒细胞计数、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)高于正常血流组(P<0.05),收缩压、左心室射血分数(LVEF)、血清ANGPTL4和Nesfatin-1水平低于正常血流组(P<0.05)。低水平Nesfatin-1、低水平ANGPTL4、高休克指数、冠脉痉挛是ASTEMI患者PCI术后发生无复流的危险因素(P<0.05)。联合ANGPTL4、Nesfatin-1预测ASTEMI患者PCI术后发生无复流的曲线下面积(AUC)为0.885,高于ANGPTL4、Nesfatin-1单独预测的0.751、0.725。结论:PCI术后无复流ASTEMI患者血清ANGPTL4、Nesfatin-1水平降低,且血清Nesfatin-1、ANGPTL4水平降低与ASTEMI患者PCI术后无复流的发生密切相关,对ASTEMI患者PCI术后无复流具有一定的预测价值。

Objective:To investigate the predictive value of serum angiopoietin-like 4(ANGPTL4)combined with Nesfatin-1 in patients with acute ST-segment elevation myocardial infarction(ASTEMI)non-reflux after percutaneous coronary intervention(PCI).Methods:A total of 339 patients with ASTEMI who were admitted to our hospital from February 2017 to October 2020 were selected,and they were divided into no reflow group(TIMI blood flow level 0~2,61 cases)and normal blood flow group(TIMI blood flow level3,278 cases)according to the classification of thrombolytic therapy(TIMI)for postoperative myocardial infarction.The baseline data,serum levels of ANGPTL4 and Nesfatin-1 and laboratory indexes were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of patients with ASTEMI no reflow after PCI.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of serum ANGPTL4 and Nesfatin-1 in predicting patients with ASTEMI no reflow after PCI.Results:The age,heart rate before PCI,left ventricular mass index(LVMI),shock index,coronary artery spasm,blood glucose,length of coronary artery lesions,number of coronary artery lesions,leukocyte count,neutrophil count,creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI)in the no reflow group were higher than those in the normal blood flow group(P<0.05),systolic blood pressure,left ventricular ejection fraction(LVEF),the levels of serum ANGPTL4 and Nesfatin-1 were lower than those in normal blood flow group(P<0.05).Low level of Nesfatin-1,low level of ANGPTL4,high shock index and coronary artery spasm were the risk factors of patients with ASTEMI no reflow after PCI(P<0.05).The area under the curve(AUC)of patients with ASTEMI no reflow after PCI predicted by ANGPTL4 and Nesfatin-1 was 0.885,which was higher than 0.751 and 0.725 predicted by ANGPTL4 and Nesfatin-1 alone.Conclusion:The levels of serum ANGPTL4 and Nesfatin-1 decreased in patients with no reflow after PCI,and the decreased levels of serum Nesfatin-1 and ANGPTL4 are closely related to the occurrence of patients with ASTEMI no reflow after PCI,which had a certain predictive value for patients with ASTEMI no reflow after PCI.