血清相关指标与急性心肌梗死术后发生主要心血管不良事件的关系

Relationship Between Serum Related Indexes and Major Adverse Cardiovascular Events After Acute Myocardial Infarction Surgery

目的分析急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后脂蛋白相关磷脂酶A 2(Lp-PLA 2)、红细胞分布宽度(RDW)、超敏C反应蛋白(hs-CRP)及心肌肌钙蛋白Ⅰ(cTnⅠ)水平变化,探讨以上血清指标与患者术后主要心血管不良事件(MACE)的关系。方法前瞻性选取2021年4月至2022年4月在漯河市中医院接受PCI治疗的122例患者为研究对象,治疗后对所有患者随访6个月,记录MACE发生情况。根据MACE发生与否分为MACE组(38例)和非MACE组(84例),对比两组患者的一般资料和临床资料,并探讨血清Lp-PLA 2、RDW、hs-CRP、cTnⅠ与MACE的关系。结果MACE组患者的冠心病家族史比例以及血清Lp-PLA 2、RDW、hs-CRP、cTnⅠ水平均高于非MACE组(P<0.05)。建立相关性模型,PCI术后MACE发生与血清Lp-PLA 2、RDW、hs-CRP、cTnⅠ水平及冠心病家族史存在相关性,其中与Lp-PLA 2水平存在中等程度相关性(r=-0.449,P<0.05)。将各项血清指标纳入受试者工作特征(ROC)诊断模型,血清Lp-PLA 2、RDW、hs-CRP、cTnⅠ均对PCI术后发生MACE具有一般诊断效能,四项联合检测具有较高准确性,其诊断曲线下面积(AUC)、约登指数、灵敏度、特异度分别为0.858、0.704、89.47%、80.95%。结论血清Lp-PLA 2、RDW、hs-CRP、cTnⅠ与AMI患者PCI术后发生MACE存在密切联系,四项联合对MACE具有较高诊断和预测价值。

Objective To analyze the changes of lipoprotein-associated phospholipase A 2(Lp-PLA 2),red blood cell distribution width(RDW),hypersensitive C-reactive protein(hs-CRP)and cardiac troponinⅠ(cTnⅠ)levels in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),to explore the relationship between the above serum indicators and major adverse cardiovascular events(MACE)in patients after surgery.Methods A total of 122 patients who received PCI treatment in Luohe Hospital of Traditional Chinese Medicine from April 2021 to April 2022 were prospectively selected as the study subjects.After treatment,all patients were followed up for 6 months to record the occurrence of MACE.According to the occurrence of MACE,they were divided into MACE group(38 cases)and non-MACE group(84 cases).The general and clinical data of the two groups were compared,and the relationship between serum Lp-PLA 2,RDW,hs-CRP,cTnⅠand MACE was discussed.Results The proportion of family history of coronary heart disease and the levels of serum Lp-PLA 2,RDW,hs-CRP and cTnⅠin MACE group were higher than those in non-MACE group(P<0.05).A correlation model was established.The occurrence of MACE after PCI was correlated with the levels of serum Lp-PLA 2,RDW,hs-CRP,cTnⅠand the family history of coronary heart disease,among which there was a moderate correlation with the level of Lp-PLA 2(r=-0.449,P<0.05).Including all serum indexed into the receiver operating characteristic(ROC)diagnostic model,the serum Lp-PLA 2,RDW,hs-CRP and cTnⅠhad general diagnostic efficacy for MACE after PCI,and the four combined tests had high accuracy.The area under curve(AUC),Jordan index,sensitivity and specificity were 0.858,0.704,89.47%and 80.95%,respectively.Conclusion Serum Lp-PLA 2,RDW,hs-CRP and cTnⅠare closely related to the incidence of MACE in AMI patients after PCI.The combination of these four factors has high diagnostic and predictive value for MACE.