| 薛 靖,连 勇,雷 敏,李 新,张智勇.MHR、血清ESM-1、sST2与急性ST段抬高型心肌梗死患者直接PCI术中慢血流/无复流的关系及对近期预后的预测价值[J].,2023,(14):2660-2665 |
| MHR、血清ESM-1、sST2与急性ST段抬高型心肌梗死患者直接PCI术中慢血流/无复流的关系及对近期预后的预测价值 |
| The Relationship between MHR, Serum ESM-1, sST2 and Intraoperative Slow Flow/No-Reflow During Primary PCI in Patients with Acute ST-Segment Elevation Myocardial Infarction and its Predictive Value for Short-Term Prognosis |
| 投稿时间：2023-03-03 修订日期：2023-03-25 |
| DOI：10.13241/j.cnki.pmb.2023.14.011 |
| 中文关键词: 急性ST段抬高型心肌梗死 直接经皮冠状动脉介入治疗 慢血流/无复流 MHR ESM-1 sST2 预后 |
| 英文关键词: Acute ST-segment elevation myocardial infarction Primary percutaneous coronary intervention Slow reflow/no-reflow MHR ESM-1 sST2 Prognosis |
| 基金项目:北京市科技计划项目（Z171100000417055） |
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| 中文摘要: |
| 摘要 目的：探讨单核细胞与高密度脂蛋白胆固醇比值（MHR）、血清内皮细胞特异性分子-1（ESM-1）、可溶性致癌抑制因子2（sST2）与急性ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PPCI）术中慢血流/无复流（SRF/NRF）的关系及对其近期预后的预测价值。方法：选取2019年1月～2022年4月首都医科大学附属北京朝阳医院心内科收治的187例接受PPCI术的急性STEMI患者为急性STEMI组，根据PPCI术中心肌梗死溶栓治疗（TIMI）血流分级分为SRF/NRF组47例和无SRF/NRF组140例，随访6个月，根据是否发生主要不良心血管事件分为预后不良组和预后良好组，另选取同期56名体检健康志愿者为对照组。收集急性STEMI患者临床资料，计算MHR并检测血清ESM-1、sST2水平。采用Spearman相关性分析SRF/NRF患者MHR和血清ESM-1、sST2水平与TIMI血流分级的相关性，多因素Logistic回归分析急性STEMI患者PPCI后近期预后不良的影响因素，受试者工作特征（ROC）曲线分析MHR和血清ESM-1、sST2水平对急性STEMI患者PPCI后近期预后不良的预测价值。结果：急性STEMI组MHR和血清ESM-1、sST2水平高于对照组（P＜0.05）。SRF/NRF组MHR和血清ESM-1、sST2水平高于无SRF/NRF组（P＜0.05）。SRF/NRF患者MHR和血清ESM-1、sST2水平与TIMI血流分级呈负相关（P＜0.05）。左心室射血分数升高为急性STEMI患者PPCI后近期预后不良的独立保护因素，年龄增加、SRF/NRF和MHR、ESM-1、sST2升高则为独立危险因素（P＜0.05）。ROC曲线分析显示，MHR和血清ESM-1、sST2水平联合预测急性STEMI患者PPCI后近期预后不良的曲线下面积（AUC）大于MHR、ESM-1、sST2单独预测。结论：急性STEMI患者MHR和血清ESM-1、sST2水平升高与PPCI术中SRF/NRF和近期预后不良密切相关，三者联合预测急性STEMI患者近期预后不良的价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between monocyte to high-density lipoprotein cholesterol ratio (MHR), serum endothelial cell specific molecule-1 (ESM-1), soluble suppression of tumorigenicity 2 (sST2) and intraoperative slow reflow/no-reflow (SRF/NRF) in patients with acute ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PPCI) and its predictive value for short-term prognosis. Methods: 187 patients with acute STEMI undergoing PPCI admitted to Department of Internal Medicine-Cardiovascular, Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2019 to April 2022 were selected as the acute STEMI group, and were divided into 47 cases in the SRF/NRF group and 140 cases in the non-SRF/NRF group according to the thrombolysis in myocardial infarction (TIMI) flow classification during PPCI, with a 6-month follow-up, and were divided into the poor prognosis group and the good prognosis group according to whether there are major adverse cardiovascular events, and 56 healthy volunteers with physical examination were selected as the control group during the same period. Clinical data of patients with acute STEMI were collected, MHR was calculated, and serum ESM-1 and sST2 levels were detected. Spearman correlation was used to analyze the correlation between MHR, serum ESM-1, sST2 levels and TIMI blood grading in SRF/NRF patients. Multivariate Logistic regression was used to analyze the influencing factors of poor short-term prognosis in patients with acute STEMI after PPCI. The predictive value of MHR and serum ESM-1 and sST2 levels in patients with acute STEMI after PPCI was analyzed by receiver operating characteristic(ROC) curve. Results: The MHR, ESM-1 and sST2 levels in the acute STEMI group were higher than those in the control group(P＜0.05). The levels of MHR and serum ESM-1 and sST2 in SRF/NRF group were higher than those in non-SRF/NRF group (P<0.05). MHR and serum ESM-1 and sST2 levels in patients with SRF/NRF were negatively correlated with TIMI flow classification (P＜0.05). Elevated left ventricular ejection fraction was an independent protective factor for the short-term poor prognosis of patients with acute STEMI after PPCI, while increasing age, SRF/NRF and elevated MHR, ESM-1, and sST2 were independent risk factors (P＜0.05). ROC curve analysis showed that the area under the curve (AUC) of MHR combined with serum ESM-1 and sST2 levels in predicting the short-term poor prognosis of patients with acute STEMI after PPCI was greater than that of MHR, ESM-1 and sST2 alone. Conclusion: Elevated MHR and serum ESM-1 and sST2 levels in patients with acute STEMI are closely related to intraoperative SRF/NRF during PPCI and poor short-term prognosis, the combination of MHR, ESM-1 and sST2 has a high value in predicting the short-term poor prognosis of patients with acute STEMI. |
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