STEMI患者PCI术前血清NRG-1含量预测慢血流或无复流的研究

Prediction of slow blood flow or no reflow by serum NRG-1 content in patients with STEMI before PCI

目的 研究急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术前血清神经调节蛋白-1(NRG-1)含量对慢血流或无复流的预测价值。方法 选择2018年2月至2022年5月江苏扬州仪征人民医院接受急诊PCI治疗的STEMI患者,分为PCI后血流正常的观察组(15例)和慢血流或无复流的对照组(70例)。比较两组间血清NRG-1、循环血内皮微粒(EMPs)、实验室指标及冠脉造影指标的差异,采用logistic回归分析PCI后慢血流或无复流的影响因素,采用ROC曲线分析血清NRG-1对PCI后慢血流或无复流的预测价值。结果 观察组患者的血清NRG-1含量、支架后扩张比例低于对照组,EMPs水平、支架总长度、C反应蛋白水平高于对照组,差异有统计学意义(t/χ^(2)值=5.439、4.352、5.174、2.534、4.127,P<0.05);STEMI患者血清NRG-1含量与EMPs水平具有负相关关系;支架后扩张、NRG-1、EMPs是STEMI患者PCI后发生慢血流或无复流的影响因素(P<0.05);血清NRG-1含量预测STEMI患者PCI后慢血流或无复流的ROC曲线下面积为0.884,最佳截断值为11.23 pg/mL灵敏度:91.43%,特异度:80.00%。结论 血清NRG-1含量降低与STEMI患者PCI后慢血流或无复流有关,血清NRG-1是预测PCI后慢血流或无复流的标志物。

Objective To study the predictive value of serum neuregulin-1(NRG-1)contents on slow reflow or no reflow after percutaneous coronary intervention(PCI)of acute ST segment elevation myocardial infarction(STEMI)patients.Methods Patients with STEMI who received emergency PCI in Yangzhou Yizheng people's Hospital from February 2018 to May 2022 were selected and divided into the observation group with normal blood flow after PCI and the control group with slow flow or no reflow after PCI.The differences of serum NRG-1 contents,circulating endothelial microparticles(EMPs),laboratory indexes and coronary angiography indexes between the two groups were compared.Logistic regression was used to analyze the influencing factors of slow flow or no reflow after PCI.ROC curve was used to analyze the predictive value of serum NRG-1 on slow flow or no reflow after PCI.Results The serum NRG-1 content and post stent expansion ratio in the observation group were lower than those in the control group,and the EMPs level,total stent length and C-reactive protein level in the observation group were higher than those in the control group(t/x^(2)=5.439,4.352,5.174,2.534,4.127,P<0.05).There was a negative correlation between serum NRG-1 content and EMPs level in STEMI patients.Post stent dilatation,NRG-1 and EMPs were the influencing factors of slow flow or no reflow after PCI in STEMI patients(P<0.05).The area under the ROC curve of serum NRG-1 content on predicting slow flow or no reflow after PCI of STEMI patients was 0.884,and the best cutoff value was 11.23 pg/mL(sensitivity:91.43%,specificity:80.00%).Conclusion The decrease of serum NRG-1 level is related to slow flow or no reflow after PCI of STEMI patients.Serum NRG-1 is a marker for predicting slow flow or no reflow after PCI.