三维心脏超声参数联合血UA、ApoA1/ApoB对AMI患者PCI术后并发心力衰竭的预测价值

Prediction value of three-dimensional cardiac ultrasound parameters combined with blood UA,ApoA 1/ApoB in patients with AMI complicated with heart failure after PCI

目的 探讨三维心脏超声参数联合血尿酸(UA)、载脂蛋白A1 (ApoA1)/载脂蛋白B (ApoB)对急性心肌梗死(AMI)患者经皮冠脉介入术(PCI)术后并发心力衰竭的预测价值。方法 选取郑州市第七人民医院2020年6月至2022年1月收治的107例行PCI的AMI患者记作AMI组,另招募107例健康志愿者记作对照组。采用三维心脏超声评估两组受试者心功能并比较,包括左室收缩末容积(LVESV)、左心室舒张末期容积(LVEDV)、左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、左心室射血分数(LVEF);检测两组受试者外周血UA、ApoA1、ApoB水平,并计算ApoA1/ApoB。随访1年,统计AMI组患者PCI术后并发心力衰竭的发生率。比较AMI组患者PCI术后并发心力衰竭与未发生者三维心脏超声参数及外周血UA、ApoA1/ApoB水平;采用Logistic回归分析探讨AMI组患者PCI术后并发心力衰竭的影响因素;绘制受试者工作特征(ROC)曲线分析三维心脏超声参数,外周血UA、ApoA1/ApoB水平单独与联合对AMI患者PCI术后并发心力衰竭的预测价值。结果 AMI组患者LVESV、LVEDV、LVESD、LVEDD、血清UA高于对照组(P<0.05),LVEF及血清ApoA1/ApoB低于对照组(P<0.05);AMI患者心力衰竭发生率为28.28%,发生心力衰竭患者发病至PCI时间长于未发生者(P<0.05),Gensini评分>60分占比、LVESV、LVEDV、血清UA均高于未发生者(P<0.05),LVEF及血清ApoA1/ApoB低于未发生者(P<0.05);发病至PCI时间、Gensini评分、LVESD、LVEDD、LVEF、UA、ApoA1/ApoB均是AMI患者PCI术后并发心力衰竭的影响因素(OR=3.127、2.833、3.327、3.554、0.596、3.056、0.575,P<0.05);三维心脏超声参数LVESD、LVEDD、LVEF,血清UA、ApoA1/ApoB联合预测AMI患者PCI术后并发心力衰竭的灵敏度均高于单独预测(P<0.05),AUC均高于单独预测(P<0.05),特异度均与单独预测差异无统计学意义(P>0.05)。结论 三维心脏超声参数,血清UA、ApoA1/ApoB均是AMI患者PCI术后并发心力衰竭的影响因素,三者联合预测AMI患者PCI术后并发心力衰竭的效能高于单独预测。

【Objective】To explore the predictive value of three-dimensional cardiac ultrasound parameters combined with blood uric acid(UA)and apolipoprotein A1/apolipoprotein B(ApoA1/ApoB)for heart failure after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).【Methods】A total of 107 patients with AMI who underwent PCI in our hospital from June 2020 to January 2022 were selected as AMI group,and 107 healthy volunteers were recruited as control group.The cardiac function of subjects in 2 groups was evaluated and compared by three-dimensional cardiac ultrasound,including left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF).UA,ApoA1 and ApoB levels in peripheral blood of subjects in 2 groups were detected,and ApoA1/ApoB were calculated.After 1-year follow-up,the incidence of heart failure after PCI in patients in the AMI group was calculated.Three-dimensional cardiac ultrasound parameters and peripheral blood UA,ApoA1/ApoB levels between patients with and without heart failure after PCI in the AMI group.Logistic regression analysis was used to investigate the influencing factors of heart failure after PCI in AMI group.Receiver operating characteristic(ROC)curve was drawn to analyze three-dimensional cardiac ultrasound parameters,and the value of peripheral blood UA,ApoA1/ApoB levels alone and in combination for predicting heart failure in AMI patients after PCI.【Results】LVESV,LVEDV,LVESD,LVEDD,and serum UA in AMI group were higher than those in control group(P<0.05),while LVEF and serum ApoA1/ApoB were lower than those in control group(P<0.05).The incidence of heart failure in AMI patients was 28.28%.The time from onset to PCI in patients with heart failure was longer than that in patients without heart failure(P<0.05),the proportion of Gensini score>60,LVESV,LVEDV and serum UA were higher than those without heart failure(P<0.05),and LVEF and serum ApoA1/ApoB were lower than those without heart failure(P<0.05).The time from onset to PCI,Gensini score,LVESD,LVEDD,LVESV,LVEDV,LVEF,UA,ApoA1/ApoB were all the influencing factors of heart failure after PCI in AMI patients(OR=3.127,2.833,3.327,3.554,0.596,3.056,0.575,P<0.05).The sensitivity of three-dimensional cardiac ultrasound parameters LVESD,LVEDD,LVEF,serum UA,ApoA1/ApoB in combination with the prediction of AMI patients complicated with heart failure after PCI was higher than that predicted alone(P<0.05),and the area under curve(AUC)was higher than that of single prediction(P<0.05).There was no significant difference in specificity between combined predition and single prediction(P>0.05).【Conclusion】Three-dimensional echocardiography parameters,serum UA and ApoA1/ApoB levels are all factors affecting heart failure after PCI in AMI patients.The combined prediction of the three factors is more effective than the single prediction in predicting heart failure after PCI in AMI patients.