血浆H-FABP、TAFI、PAI-1变化对STEMI静脉溶栓患者治疗后血管再通的预测价值

Predictive Value of Changes of Plasma H-FABP,TAFI and PAI-1 on Vascular Recanalization in Patients with STEMI after Intravenous Thrombolysis Treatment

目的:探讨血浆心型脂肪酸结合蛋白(H-FABP)、凝血酶激活的纤溶抑制物(TAFI)、纤溶酶原激活物抑制剂-1(PAI-1)的变化对ST段抬高型急性心肌梗死(STEMI)静脉溶栓患者治疗后血管再通的预测价值。方法:回顾性分析滨州医学院烟台附属医院2017年5月—2022年5月收治的150例STEMI患者的临床资料,另选取150例同期健康体检者临床资料作为对照组,STEMI患者按血管再通标准分为再通组89例和未通组61例。比较STEMI患者溶栓前与对照组血浆H-FABP、TAFI、PAI-1水平,比较再通组与未通组临床资料,比较STEMI患者溶栓前后各时间点血浆水平变化,分析上述血浆水平对患者血管再通的预测价值并绘制受试者操作特征(ROC)曲线。结果:STEMI患者溶栓前血浆H-FABP、TAFI、PAI-1均高于对照组,差异均有统计学意义(P<0.05)。与溶栓前比较,溶栓后1、3、9、12 h再通组与未通组血浆H-FABP、TAFI、PAI-1水平呈先升高,后降低趋势。溶栓后3 h再通组H-FABP水平高于未通组,溶栓后9、12 h再通组均低于未通组(P<0.05);溶栓后1、3 h再通组TAFI均高于未通组,溶栓后9、12 h再通组均低于未通组(P<0.05);溶栓后3、9、12 h再通组PAI-1水平均高于未通组(P<0.05)。H-FABP、TAFI、PAI-1联合检测预测STEMI患者血管再通的曲线下面积(AUC)值高于单项检测(P<0.05)。结论:血浆H-FABP、TAFI、PAI-1联合检测对STEMI静脉溶栓患者血管再通的预测价值较高。

Objective:To investigate the predictive value of changes of plasma heart-type fatty acid binding protein(H-FABP),thrombin activated fibrinolytic inhibitor(TAFI)and plasminogen activator inhibitor-1(PAI-1)on vascular recanalization after intravenous thrombolysis treatment in patients with ST segment elevation acute myocardial infarction(STEMI).Method:The clinical data of 150 STEMI patients admitted to Yantai Affiliated Hospital of Binzhou Medical University from May 2017 to May 2022 were retrospectively analyzed,and the clinical data of another 150 healthy medical checkups during the same period were selected as the control group.The STEMI patients were classified into 89 cases in the recanalized group and 61 cases in the uncanalized group according to the criteria of vascular recanalization.The plasma levels of H-FABP,TAFI,and PAI-1 between STEMI patients before thrombolysis and the control group were compared,the clinical data of the recanalized group and the uncanalized group were compared,the changes in plasma levels at different time points before and after thrombolysis in STEMI patients were compared,the predictive value of the above plasma levels on vascular reperfusion in patients were analyzed,and receiver operating characteristic(ROC)curves was plotted.Result:The levels of plasma H-FABP,TAFI and PAI-1 in patients with STEMI before thrombolysis were higher than those in the control group,the differences were statistically significant(P<0.05);compared with the pre-thrombolytic period,the plasma H-FABP,TAFI and PAI-1 levels in the recanalized group and the uncanalized group showed a trend of increasing first and decreasing second after thrombolysis.The level of H-FABP in the recanalized group at 3 h after thrombolysis was higher than that in the uncanalized group,and those in the recanalized group at 9,12 h after thrombolysis were lower than those in the uncanalized group(P<0.05);TAFI in the recanalized group at 1,3 h after thrombolysis were higher than those in the uncanalized group,and those in the recanalized group at 9,12 h after thrombolysis were lower than those in the uncanalized group(P<0.05);and the levels of PAI-1 in the recanalized group at 3,9 and 12 h after thrombolysis were higher than those in the uncanalized group(P<0.05).The area under the curve(AUC)value of H-FABP,TAFI and PAI-1 combined detection in predicting vascular recanalization in STEMI patients was higher than that of single detection(P<0.05).Conclusion:The combined detection of plasma H-FABP,TAFI and PAI-1 has high predictive value for vascular recanalization in patients with STEMI undergoing intravenous thrombolysis.