血清SDC-1、THBS-1水平与急性STEMI患者PCI术后无复流发生的相关性

Correlation between serum SDC-1 and THBS-1 levels with no-reflow after PCI in patients with acute STEMI

目的探究血清多配体蛋白聚糖-1(SDC-1)、血小板反应蛋白1(THBS-1)水平与急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后无复流发生的相关性。方法纳入2020年1月—2023年12月江苏省昆山市第一人民医院心血管内科诊治急性STEMI患者394例为病例组,根据PCI术后血液是否复流分为复流亚组(n=308)和无复流亚组(n=86),另纳入体检健康人群402例为健康对照组。采用酶联免疫吸附法(ELISA)测定血清SDC-1、THBS-1表达水平;采用Pearson/Spearman法分析血清SDC-1、THBS-1表达与发生无复流患者临床资料的相关性;Logistic回归分析PCI术后无复流发生的影响因素;绘制受试者工作特征曲线(ROC)分析血清SDC-1、THBS-1水平预测急性STEMI患者PCI术后无复流发生的价值。结果与健康对照组比较,病例组血清SDC-1、THBS-1水平升高(t/P=170.052/<0.001、62.118/<0.001)。与复流亚组比较,无复流亚组患者冠状动脉病变长、冠状动脉病变支数多(t/χ^(2)/P=9.035/<0.001、11.443/0.001),无复流亚组血清SDC-1、THBS-1水平均升高(t/P=8.885/<0.001、8.754/<0.001);急性STEMI经PCI术后无复流患者血清SDC-1、THBS-1与冠状动脉病变长度、冠状动脉多支病变均呈正相关(SDC-1:r/r s/P=0.412/<0.001、0.539/<0.001;THBS-1:r/r s/P=0.457/<0.001、0.582/<0.001);急性STEMI患者冠状动脉病变长、冠状动脉多支病变及血清SDC-1高、THBS-1高均为PCI术后无复流发生的危险因素[OR(95%CI)=3.363(1.450~7.794)、3.625(1.783~7.370)、4.391(2.722~7.084)、5.146(3.695~7.167),P均<0.001];血清SDC-1、THBS-1及二者联合预测急性STEMI患者PCI术后无复流发生的AUC分别为0.812、0.770、0.882,二者联合优于各自单独预测效能(Z/P=2.046/0.041、3.274/0.001)。结论PCI术后发生无复流的急性STEMI患者血清SDC-1、THBS-1水平均升高,是无复流发生的危险因素,二者联合具有较高的预测价值。

Objective To investigate the correlation between serum levels of syndecan-1(SDC-1)and thrombospondin-1(THBS-1)and the no-reflow after percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(STEMI).Methods A total of 394 patients with acute STEMI diagnosed and treated in the Cardiovascular Department of the First People's Hospital of Kunshan City,Jiangsu Province from January 2020 to December 2023 were selected as the study group.They were grouped into a reflow subgroup(n=308)and a no-reflow subgroup(n=86)based on whether blood flow was restored after PCI.Additionally,402 healthy individuals who underwent physical examination were included as the control group.Enzyme linked immunosorbent assay(ELISA)was applied to measure the expression levels of serum SDC-1 and THBS-1 in different groups.Pearson/Spearman methods were applied to analyze the correlation between serum SDC-1 and THBS-1 expression and clinical data of patients with no-reflow.Logistic regression was applied to analyze the influencing factors of no-reflow occurrence after PCI surgery.Receiver operating characteristic(ROC)curves were plotted to analyze the potential value of serum SDC-1 and THBS-1 expression in predicting no-reflow occurrence after PCI in acute STEMI patients.Results Compared with the control group,the research group showed high expression of serum SDC-1 and THBS-1(t/P=170.052/<0.001,62.118/<0.001).There were obvious differences in the length and number of coronary artery lesions between the no-reflow group and the reflow group(t/χ^(2)/P=9.035/<0.001,11.443/0.001).Compared with the reflow subgroup,the expression of serum SDC-1 and THBS-1 increased in the no-reflow subgroup(t/P=8.885/0.000,8.754/0.000).The expression of serum SDC-1(r/r s/P=0.412/<0.001,0.539/<0.001)and THBS-1 in acute STEMI patients with no-reflow after PCI was positively correlated with the length of coronary artery lesions and multi vessel coronary artery lesions(r/r s/P=0.457/<0.001,0.582/<0.001).The length of coronary artery lesions,multi vessel coronary artery lesions,serum SDC-1,and THBS-1 in patients with acute STEMI were all risk factors for no-reflow after PCI[OR(95%CI)=3.363(1.450-7.794),3.625(1.783-7.370),4.391(2.722-7.084),5.146(3.695-7.167)].The area under the curve(AUC)for predicting no-reflow after PCI in acute STEMI patients based on the expression levels of serum SDC-1,THBS-1 and combined was 0.812,0.770 and 0.882,respectively.The combined prediction efficiency of the two was better than that of each(Z/P=2.046/0.041,3.274/0.001).Conclusion The expressions of serum SDC-1 and THBS-1 are elevated in acute STEMI patients with no-reflow after PCI,they are risk factors for the no-reflow.The combination of the two has a high predictive value for the occurrence of no-reflow.