血清CCL7、CTHRC1水平与急性心肌梗死患者直接PCI术后无复流现象的关系

Correlation of serum CCL7 and CTHRC1 levels with no-reflow phenomenon after primary PCI in patients with acute myocardial infarction

目的检测急性心肌梗死(AMI)患者血清趋化因子配体7(CCL7)、胶原蛋白三螺旋重复蛋白1(CTHRC1)水平,分析其与直接经皮冠状动脉介入治疗(PCI)术后无复流现象的关系。方法选取2022年1月-2023年10月期间沧州市人民医院医专院区心内二区收治的127例AMI患者作为研究对象,行直接PCI术后根据是否发生无复流现象分为无复流组(n=21)、正常血流组(n=106)。采用酶联免疫吸附法检测血清CCL7、CTHRC1水平;采用受试者工作特性(ROC)曲线评估血清CCL7、CTHRC1对AMI患者直接PCI术后无复流现象的预测价值;采用多因素logistic逐步回归分析AMI患者直接PCI术后无复流现象的影响因素。结果无复流组血清CCL7、CTHRC1水平高于正常血流组,差异均有统计学意义(t=6.838、11.244,P均<0.05)。血清CCL7、CTHRC1预测AMI患者直接PCI术后无复流现象的曲线下面积(AUC)(95%CI)分别为0.773(0.751~0.825)、0.859(0.807~0.911);两项指标联合预测的AUC(95%CI)为0.901(0.849~0.953)。无复流组糖尿病史占比、Killip心功能分级Ⅲ~Ⅳ级占比、多支病变血管占比、低密度脂蛋白胆固醇水平、D-二聚体水平高于正常血流组,LVEF小于正常血流组,差异均有统计学意义(χ^(2)/t=5.144、4.952、5.592、22.527、3.923、7.390,P均<0.05)。多因素logistic逐步回归分析显示,有糖尿病史(OR=2.259,95%CI:1.533~3.330)、Killip心功能分级Ⅲ~Ⅳ级(OR=2.063,95%CI:1.427~2.982)、高水平D-二聚体(OR=2.428,95%CI:1.637~3.600)、CCL7≥123.15 pg/mL(OR=2.492,95%CI:1.671~3.717)、CTHRC1≥46.39μg/L(OR=2.889,95%CI:1.859~4.491)是AMI患者直接PCI术后无复流现象的独立危险因素(P均<0.001)。结论血清CCL7、CTHRC1水平升高与AMI患者直接PCI术后无复流现象密切相关,两项指标可作为预测患者直接PCI术后无复流现象的潜在生物标记物。

Objective To investigate the correlation of serum levels of chemokine ligand 7(CCL7)and collagen triple helix repeat containing 1(CTHRC1)with no-reflow phenomenon after primary percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods One hundred and twenty-seven AMI patients admitted to the Cardiology Department of Cangzhou People's Hospital between January 2022 and October 2023 were enrolled,and classified into no-reflow group(n=21)and normal flow group(n=106)according to the presence or absence of no-reflow phenomenon after primary PCI.Serum levels of CCL7 and CTHRC1 were detected by enzyme-linked immunosorbent assay.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of serum CCL7 and CTHRC1 for no-reflow phenomenon in AMI patients after primary PCI,and multivariate logistic stepwise regression analysis was performed to identify the influencing factors of no-reflow phenomenon in AMI patients after primary PCI.Results Serum CCL7 and CTHRC1 levels were abnormally elevated in no-reflow group compared to normal flow group(t=6.838,11.244;all P<0.05).The area under the curve(AUC)of separate test of serum CCL7 and CTHRC1 in predicting no-reflow phenomenon in AMI patients after primary PCI were 0.773(95%CI:0.751-0.825)and 0.859(95%CI:0.807-0.911),whereas the combined test of the two reached an AUC of 0.901(95%CI:0.849-0.953).No-reflow group reported a larger proportion of patients with diabetes mellitus history,Killip classⅢ-Ⅳ,and multivessel disease and higher low-density lipoprotein cholesterol(LDL-C)and D-dimer(D-D)compared to normal flow group(χ^(2)/t=5.144,4.952,5.592,22.527,3.923,7.390;all P<0.05).Multivariate logistic stepwise regression analysis indicated that diabetes mellitus history(OR=2.259,95%CI:1.533-3.330),Killip classⅢ-Ⅳ(OR=2.063,95%CI:1.427-2.982),high D-D(OR=2.428,95%CI:1.637-3.600),CCL7≥123.15 pg/mL(OR=2.492,95%CI:1.671-3.717)and CTHRC1≥46.39μg/L(OR=2.889,95%CI:1.859-4.491)were independent risk factors for no-reflow phenomenon after primary PCI in AMI patients(P<0.05).Conclusion Elevated serum CCL7 and CTHRC1 levels were closely related to development of no-reflow phenomenon after primary PCI in AMI patients,so these two indicators could serve as potential biomarkers for predicting the no-reflow phenomenon in patients after primary PCI.