血清IL-17、Endocan及Nesfatin-1对ST段抬高型心肌梗死患者PCI术后无复流的预测价值

Predictive value of serum IL-17,Endocan and Nesfatin-1 to no-reflow in patients with STEMI after PCI

目的探讨血清白细胞介素17(IL-17)、内皮细胞特异性分子1(Endocan)及摄食抑制因子1(Nesfatin-1)在ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后无复流中的预测价值。方法选择2020年1月至2022年1月于武汉市武昌医院心内科治疗的150例STEMI患者进行研究,以PCI术后无复流作为无复流组(n=46),以正常完全灌注患者为对照组(n=104),分析STEMI患者PCI术后无复流的危险因素,检测血清IL-17、Endocan及Nesfatin-1的含量,分析IL-17、Endocan及Nesfatin-1的预测价值。结果单因素分析,两组患者在性别、吸烟、年龄、心率、高血压、糖尿病、高血脂、收缩压(SBP)、舒张压(DBP)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血小板计数(PLT)、白细胞计数(WBC)、纤维蛋白原(FIB)、肌酸激酶同工酶(CK-MB)、谷草转氨酶(AST)、药物支架、前降支闭塞比较差异无统计学意义(P>0.05);两组左心室射血分数(LVEF)、冠心病史、中性粒细胞/淋巴细胞、C反应蛋白(CRP)、肌钙蛋白T(cTnT)、发病至再灌注时间、病变长度、IL-17、Endocan及Nesfatin-1水平比较差异显著(P<0.05);两组患者总缺血时间、术前TIMI分级、支架平均直径、支架平均长度、病变血管数目及支架支数比较,差异无统计学意义(P>0.05);多因素Logistic回归分析显示,LVEF、冠心病史、中性粒细胞/淋巴细胞、CRP、cTnT、发病至再灌注时间、病变长度、IL-17、Endocan及Nesfatin-1水平均是导致STEMI患者PCI术后无复流的危险因素(P<0.05);ROC结果显示,IL-17预测STEMI患者PCI术后无复流的AUC为0.818,灵敏度为86.70%,特异度为91.20%,Endocan预测STEMI患者PCI术后无复流的AUC为0.978,灵敏度为89.60%,特异度为91.40%,Nesfatin-1预测STEMI患者PCI术后无复流的AUC为0.963,灵敏度为90.70%,特异度为91.00%。结论血清IL-17、Endocan及Nesfatin-1在STEMI患者PCI术后无复流患者中均表达异常,与患者年龄LVEF、冠心病史、中性粒细胞/淋巴细胞、CRP、cTnT、发病至再灌注时间、病变长度有关,是PCI术后无复流的独立危险因素,IL-17、Endocan及Nesfatin-1可早期预测PCI术后无复流的发生。

Objective To investigate the predictive value of serum interleukin-17(IL-17),endothelial cell specific molecule-1(Endocan)and Nesfatin-1 to no-reflow in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods STEMI patients(n=150)were chosen from Department of Cardiology in Wuchang Hospital of Wuhan City from Jan.2020 to Jan.2022.The patients with no-reflow after PCI were selected into no-reflow group(n=46),and those with normal complete perfusion were selected into control group(n=104).The risk factors for no-reflow were analyzed,levels of serum IL-17,Endocan and Nesfatin-1 were detected and predictive value of IL-17,Endocan and Nesfatin-1 were analyzed.Results The results of single-factor analysis showed that the differences in gender,smoking,age,heart rate(HR),hypertension,diabetes,hyperlipidemia,diastolic blood pressure(SBP),systolic blood pressure(DBP),triglyceride(TG),total cholesterol(TC),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C),platelet count(PLT),white blood cell count(WBC),fibrinogen(FIB),creatine kinase-MB isoenzyme(CKMB),aspertate aminotransferase(AST),drug-eluting stent(DES)and anterior descending branch infarction had no statistical significance between 2 groups(P>0.05).The differences in left ventricular ejection fraction(LVEF),history of coronary heart disease(CHD),neutrophil/lymphocyte ratio(NLR),C-reactive protein(CRP),cardiac troponin T(cTnT),time from disease onset to reperfusion,lesion length,IL-17,Endocan and Nesfatin-1 had significance between 2 groups(P<0.05).The differences in the total ischemia time,preoperative TIMI grading,mean stent diameter,mean stent length,number of diseased vessels and number of stents had no statistical significance between 2 groups(P>0.05).The multi-factor Logistic regression analysis showed that LVEF,CHD history,NLR,CRP,cTnT,time from disease onset to reperfusion,lesion length,IL-17,Endocan and Nesfatin-1 were risk factors for no-reflow in STEMI patients after PCI(P<0.05).In predicting no-reflow in STEMI patients after PCI,the results of ROC curve analysis showed that AUC of IL-17 was 0.818,sensitivity was 86.70%and specificity was 91.20%,AUC of Endocan was 0.978,sensitivity was 89.60%and specificity was 91.40%,and AUC of Nesfatin-1 was 0.963,sensitivity was 90.70%and specificity was 91.00%.Conclusion The expressions of serum IL-17,Endocan and Nesfatin-1 are abnormal in STEMI patients with no-reflow after PCI,which is related to LVEF,CHD history,NLR,CRP,cTnT,time from disease onset to reperfusion and lesion length,and they are independent risk factors for noreflow.IL-17,Endocan and Nesfatin-1 can early predict no-reflow occurrence after PCI.