血清VEGF、cTnI及内脂素水平对评估急性心肌梗死患者PCI术后短期MACE的临床意义
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摘要
目的探讨血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、肌钙蛋白I(cardiac troponin I,cTnI)及内脂素水平对急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后短期内发生主要不良心脏事件(major adverse cardiovascular events,MACE)的影响,为筛查PCI术后高危人群和制订AMI治疗方案提供参考依据。方法选取2016年1月至2018年6月本院收治的100例成功行PCI的AMI患者为研究对象,术后随访3个月,根据PCI术后是否发生MACE,将入选患者分为MACE组(26例)和非MACE组(74组),比较两组患者PCI术后24 h血清VEGF、cTnI及内脂素水平,以及上述指标对于MACE的影响。结果 MACE组患者PCI术后24 h血清VEGF、cTnI及内脂素水平均显著高于非MACE组(P_均<0.05);VEGF(OR=1.368)、cTnI(OR=1.231)、内脂素(OR=1.812)均为AMI患者PCI术后发生MACE的独立危险因素(P_均<0.05),VEGF、cTnI及内脂素水平越高,PCI术后发生MACE的风险越高。结论血清VEGF、cTnI及内脂素水平升高对于评估AMI患者PCI术后短期内发生MACE具有一定的临床价值,上述指标水平显著升高应引起警惕,可能有并发MACE的风险。
Objective To investigate the effects of serum levels of vascular endothelial growth factor(VEGF), cardiac troponin I(cTnI) and visfatin on evaluating short-term major adverse cardiovascular events(MACE) after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI), so as to screen high-risk population after PCI and formulate AMI treatment. The case provides clinical evidence. Method 100 case of patients with AMI who underwent PCI successfully from January 2016 to June 2018 were divided into MACE group(26 cases) and non-MACE group(74 cases) according to the occurrence of MACE followed up for 3 months after PCI. The levels and the influence for MACE of VEGF, cTnI and visfatin 24 h after PCI were compared between the two groups. Result The levels of VEGF, cTnI and visfatin after 24 h of PCI in MACE group were significantly higher than those in non-MACE group(P_(all)< 0.05); VEGF(OR = 1.368), cTnI(OR = 1.231) and visfatin(OR = 1.812) were independent influencing factors for MACE after PCI in patients with AMI(P_(all)< 0.05). The higher the levels of VEGF, cTnI and visfatin, the higher the risk of MACE after PCI in patients with AMI. Conclusion The elevated levels of serum VEGF, cTnI and visfatin have clinical value in assessing short-term MACE in patients with AMI after PCI. The elevated levels of these indexes should be alert and may be associated with the risk of MACE.
Objective To investigate the effects of serum levels of vascular endothelial growth factor(VEGF), cardiac troponin I(cTnI) and visfatin on evaluating short-term major adverse cardiovascular events(MACE) after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI), so as to screen high-risk population after PCI and formulate AMI treatment. The case provides clinical evidence. Method 100 case of patients with AMI who underwent PCI successfully from January 2016 to June 2018 were divided into MACE group(26 cases) and non-MACE group(74 cases) according to the occurrence of MACE followed up for 3 months after PCI. The levels and the influence for MACE of VEGF, cTnI and visfatin 24 h after PCI were compared between the two groups. Result The levels of VEGF, cTnI and visfatin after 24 h of PCI in MACE group were significantly higher than those in non-MACE group(P_(all)< 0.05); VEGF(OR = 1.368), cTnI(OR = 1.231) and visfatin(OR = 1.812) were independent influencing factors for MACE after PCI in patients with AMI(P_(all)< 0.05). The higher the levels of VEGF, cTnI and visfatin, the higher the risk of MACE after PCI in patients with AMI. Conclusion The elevated levels of serum VEGF, cTnI and visfatin have clinical value in assessing short-term MACE in patients with AMI after PCI. The elevated levels of these indexes should be alert and may be associated with the risk of MACE.
引文
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[15]赵国玉,耿学斌,李莉,等.血脂康预防急性心肌梗死冠脉支架置入术后冠脉再狭窄疗效及安全性评价[J].河北联合大学学报(医学版),2015,17(4):22-24.
[16]王婷,李结华.hs-CRP、BNP和cTnI联合检测对急性心肌梗死患者PCI术后MACE的预测价值[J].重庆医学,2017,46(3):380-382.
[17]Sigurjonsdottir R,Barywani S,Albertsson P,et al.Long-term major adverse cardiovascular events and quality of life after coronary angiography in elderly patients with acute coronary syndrome[J].Int J Cardiol,2016,222:481-485.
[18]Bry M,Kivela R,Leppanen VM,et al.Vascular Endothelial Growth Factor-B in Physiology and Disease[J].Physiol Rev,2014,94(3):779-794.
[19]艾民,颜昌福,夏福纯,等.血清hs-CRP及VEGF水平对急性心肌梗死经皮冠状动脉介入治疗术后心血管事件的影响[J].山东医药,2018,58(1):16-18.
[20]Wang JA,Qin Y,Lv J,et al.Clinical application of high-sensitivity cardiac troponin T test in acute myocardial infarction diag nosis[J].Genet Mol Res,2015,14(4):17959-17965.
[21]陈伟.内脂素与脂联素在急性心肌梗死经皮冠状动脉介入术后发生心力衰竭中的意义[J].中国循证心血管医学杂志,2015,7(3):365-367.
[2]陆菊.1325例次住院急性心肌梗死患者的流行病学特征分析[D].南宁:广西医科大学,2016.
[3]李明琰,崔永生,何文凯,等.冠心病患者经皮冠状动脉介入治疗术后规范药物治疗对颈动脉粥样硬化的影响[J].中国医科大学学报,2016,45(1):66-69.
[4]Mrdovic I,Savic L,Krljanac G,et al.Predicting 30-day major adverse cardiovascular events after primary percutaneous coronary intervention.The RISK-PCI score[J].Int J Cardiol,2013,162(3):220-227.
[5]訾会超,万伟民.经皮冠状动脉介入治疗冠心病208例临床分析[J].山东医药,2014,54(1):72-74.
[6]王晓宇,顾宇,冉晨光,等.老年高血压患者外周血内脂素水平变化与氧化应激及促炎因子的关系[J].中国老年学杂志,2017,37(9):2161-2163.
[7]张能,张丹,张煜,等.高敏心肌肌钙蛋白I动态变化在急性冠状动脉综合征早期诊断中的应用价值[J].中国循环杂志,2016,31(1):25-30.
[8]Kaess BM,Preis SR,Beiser A,et al.Circulating vascular endothelial growth factor and the risk of cardiovascular events[J].Heart,2016,102(23):1898-1901.
[9]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[10]Tousoulis D,Oikonomou E,Economou EK,et al.Inflammatory cytokines in atherosclerosis:current therapeutic approaches[J].Eur Heart J,2016,37(22):1723.
[11]Gimbrone MA Jr,Garcíacarde?a G.Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis[J].Circ Res,2016,118(4):620-636.
[12]张宇红,邓丽玉,林彬,等.缺氧诱导因子对急性心肌梗死后心肌细胞及细胞外基质的影响[J].国际心血管病杂志,2016,43(1):43-45.
[13]曾令恒,赵艳华,姜朝新,等.心肌损伤标志物在诊断急性心肌梗死中的临床诊断界值分析[J].国际检验医学杂志,2017,38(6):826-828.
[14]顾霞,孙勇.新生动脉粥样硬化斑块形成是支架晚期失败的重要病理机制[J].国际心血管病杂志,2013,40(6):337-340.
[15]赵国玉,耿学斌,李莉,等.血脂康预防急性心肌梗死冠脉支架置入术后冠脉再狭窄疗效及安全性评价[J].河北联合大学学报(医学版),2015,17(4):22-24.
[16]王婷,李结华.hs-CRP、BNP和cTnI联合检测对急性心肌梗死患者PCI术后MACE的预测价值[J].重庆医学,2017,46(3):380-382.
[17]Sigurjonsdottir R,Barywani S,Albertsson P,et al.Long-term major adverse cardiovascular events and quality of life after coronary angiography in elderly patients with acute coronary syndrome[J].Int J Cardiol,2016,222:481-485.
[18]Bry M,Kivela R,Leppanen VM,et al.Vascular Endothelial Growth Factor-B in Physiology and Disease[J].Physiol Rev,2014,94(3):779-794.
[19]艾民,颜昌福,夏福纯,等.血清hs-CRP及VEGF水平对急性心肌梗死经皮冠状动脉介入治疗术后心血管事件的影响[J].山东医药,2018,58(1):16-18.
[20]Wang JA,Qin Y,Lv J,et al.Clinical application of high-sensitivity cardiac troponin T test in acute myocardial infarction diag nosis[J].Genet Mol Res,2015,14(4):17959-17965.
[21]陈伟.内脂素与脂联素在急性心肌梗死经皮冠状动脉介入术后发生心力衰竭中的意义[J].中国循证心血管医学杂志,2015,7(3):365-367.