目的:探讨急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction ,STEMI)且行急诊经皮冠状动脉介入治疗( percutaneous coronary intervention ,PCI)患者的血浆凝溶胶蛋白表达水平及其对预后的影响。方法连续入选粤北人民医院2012年1月至2014年6月发生STEMI并行急诊PCI的患者206例( STEMI组),同期148例稳定型心绞痛并行择期PCI患者(稳定型心绞痛组)及80例健康志愿者(健康对照组)。分别于入院后第1、3、5、7、9天采集患者外周静脉血,采用ELISA法检测血浆凝溶胶蛋白水平;同法取健康对照组血液行相同检测。常规记录患者一般信息、相关生化检查及手术情况、心血管疾病危险指标等,随访术后1年内主要不良心血管事件( MACE)发生情况。比较各组患者血浆凝溶胶蛋白水平,分析其与STEMI的关系。对数据进行方差分析,单因素及多因素logistic回归分析。结果(1)STEMI组分别与稳定型心绞痛组及健康对照组比较,入院后不同时相点血浆凝溶胶蛋白水平均显著下降,差异均有统计学意义(均P<0.05);而稳定型心绞痛组与健康对照组比较,差异无统计学意义( P>0.05)。(2)根据STEMI患者随访1年内预后情况分为MACE组及非MACE组,发现MACE组入院后第1、3、5、7、9天血浆凝溶胶蛋白水平[(53.2±6.8) mg/L比(70.1±11.2) mg/L, P =0.048;(40.2±7.3) mg/L 比(64.3±7.8) mg/L, P =0.033;(30.9±10.0)mg/L比(57.7±13.4)mg/L,P =0.027;(22.5±8.8)mg/L 比(55.6±9.2)mg/L,P =0.012;(23.3±7.4)mg/L比(69.8±12.7)mg/L,P=0.004]均显著低于非MACE组,差异均有统计学意义。且第7天血浆凝溶胶蛋白水平降至最低值。根据1年内预后情况再将MACE组患者分为死亡组及存活组。死亡组入院后第1、3天血浆凝溶胶蛋白水平与存活组比较,差异均无统计学意义(均P>0.05),第5、7、9天[(22.8±6.0)mg/L比(40.6±9.4)mg/L,P=0.034;(14.1±6.8)mg/L比(33.5±10.1)mg/L,P=0.036;(9.3±6.8)mg/L比(35.9±11.4)mg/L,P=0.007]均显著低于存活组,差异均有统计学意义。且第7天后血浆凝溶胶蛋白水平未见回升趋势。(3)单因素logistic回归分析提示第7天血浆凝溶胶蛋白水平是STEMI患者1年内发生MACE的危险因素(P=0.014)。(4)以第7天血浆凝溶胶蛋白水平=21.7 mg/L为最佳界值,预测行PCI的STEMI患者1年内发生MACE的特异度为82.1%,敏感度为81.4%,受试者工作者特征( ROC)曲线下面积为0.854(95% CI 0.732~0.961,P<0.01)。结论推测血浆凝溶胶蛋白水平与STEMI患者预后呈负相关,可作为STEMI患者预后的预测指标,能反映病情的严重程度。
Objective To investigate the predictive value of plasma gelsolin in the prognosis of patients with ST-sgement elevation myocardial infarction ( STEMI ) and undergone primary percutaneous coronary intervention ( PCI ) .Methods The study included 206 patients with STEMI and undergone primary PCI, 148 patients with stable angina pectoris and received elective PCI and 80 healthy volunteer as the health population (NP) control.Blood samples were taken at admission on day 1, 3, 5, 7 and 9 to determine the plasma gelsolin level .Patients′baseline clinical characteristics , blood biochemistry tests results , details of operation and their cardiovascular risk factors were recorded .Major adverse cardiovascular events (MACE) within one year were recorded.Results (1) Compared to the stable angina group and the NP group, the level of plasma gelsolin of STEMI patients were obviously decreased at various time points ( all P<0.05 ) .There were no statistical differences between the stable angina group and the NP group .( 2 ) Patients with STEMI were catagorized into MACE group (n=78) and non-MACE group (n=128) according their follow up record in 1 year.The level of plasma gelsolin in patients with MACE were lower than the non-MACE group ( P <0.05 ) with the minimum value detected on day 7.Among patients complicated with MACE (n=78), they were further devided into the deceased group (n=18) and the survival group (n=60).Plasma gelsolin levels were lower in the deceased group with satistical differences found on day 5, 7 and 9.(3) Single factor Logistic regression analysis showed that the level of plasma gelsolin on day 7 was independent risk factor of MACE within one year ( P =0.014 ) .( 4 ) Setting the cutoff value of plasma gelsolin on day 7 as 21.7 mg/L,the sensitivity and speciticity for the MACE in STEMI patients treated with primary PCI within one year were 82.1%and 81.4%respectively , with the area under the receiver operator characteristic curve ( ROC ) was 0.854 ( 95% confidence interval 0.732 -0.961 , P <0.01 ) . Conclusions Plasma gelsolin levels are correlated with the severity of STEMI lesions and plasma gelsolin can be used as predicting factor of prognosis .