STEMI患者血清25-(OH)D3水平在急诊直接PCI后ST段回落预测中的价值
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摘要
目的:探讨急性ST段抬高型心肌梗死(STEMI)患者血清25羟维生素D3(25-(OH)D3)水平在急诊直接PCI(pPCI)后ST段回落(STR)预测中的价值。方法:以某院2016年5月～2018年5月178例STEMI患者为研究对象,PCI术后180min根据患者STR位点分为A组(STR≥50%)和B组(STR<50%),对比两组临床资料、心脏标志物,采用单因素分析、Logistic回归分析方法等确定STR<50%的影响因素。结果:PCI术后180min,147例患者STR≥50%,31例患者STR<50%;B组血清25-(OH)D3、血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT)水平均明显高于A组(P<0.05);B组左室射血分数(LVEF)明显低于A组,而其左室舒张末期内径(LVEDD)明显大于A组(P<0.05); Logistic分析显示血清25-(OH)D3含量是STR不良的独立危险因子;受试者工作曲线(ROC)分析显示,血清25-(OH)D3含量对STR不良的敏感度(82.9%)与特异性(72.3%)均较高。结论:血清25-(OH)D3含量是STEMI患者pPCI术后STR不良的独立危险因素,对STR不良具有较高的敏感性和特异性,可以作为STEMI患者STR不良的一个评估指标。
Objective: To investigate the value of serum 25-(OH)D3 level in STEMI patients in the prediction of ST segment fallback after emergency direct PCI. Methods: 178 patients with STEMI in a hospital from May 2016 to May 2018 were enrolled. Atr 180 minutes after PCI, they were divided into group A(STR≥50%) and group B(STR<50%) according to the STR site. Compared the two groups of clinical data and cardiac markers, single factor analysis and Logistic regression analysis were used to determine the influencing factors of STR<50%. Results: 180 min after PCI, there were 147 patients with STR≥50%, 31 patients with STR<50%; The serum 25-(OH)D3, serum creatine kinase(CK), creatine kinase isoenzyme(CK-MB) and the level of troponin(cTnT) of group B was significantly higher than that of group A(P<0.05). The left ventricular ejection fraction(LVEF) of group B was significantly lower than that of group A, and the left ventricular end-diastolic diameter(LVEDD) was significantly higher than group A(P<0.05); Logistic analysis showed that serum 25-(OH)D3 content was an independent risk factor for STR failure; The receiver operating curve(ROC) analysis showed that both the sensitive(82.9%) and specificity(72.3%) of serum 25-(OH)D3 content to STR deficiency were higher. Conclusion: Serum 25-(OH)D3 level is an independent risk factor for STR dysplasia after PCI in STEMI patients. It has high sensitivity and specificity for STR dysfunction and can be used as an evaluation index for STR dysplasia in STEMI patients.
Objective: To investigate the value of serum 25-(OH)D3 level in STEMI patients in the prediction of ST segment fallback after emergency direct PCI. Methods: 178 patients with STEMI in a hospital from May 2016 to May 2018 were enrolled. Atr 180 minutes after PCI, they were divided into group A(STR≥50%) and group B(STR<50%) according to the STR site. Compared the two groups of clinical data and cardiac markers, single factor analysis and Logistic regression analysis were used to determine the influencing factors of STR<50%. Results: 180 min after PCI, there were 147 patients with STR≥50%, 31 patients with STR<50%; The serum 25-(OH)D3, serum creatine kinase(CK), creatine kinase isoenzyme(CK-MB) and the level of troponin(cTnT) of group B was significantly higher than that of group A(P<0.05). The left ventricular ejection fraction(LVEF) of group B was significantly lower than that of group A, and the left ventricular end-diastolic diameter(LVEDD) was significantly higher than group A(P<0.05); Logistic analysis showed that serum 25-(OH)D3 content was an independent risk factor for STR failure; The receiver operating curve(ROC) analysis showed that both the sensitive(82.9%) and specificity(72.3%) of serum 25-(OH)D3 content to STR deficiency were higher. Conclusion: Serum 25-(OH)D3 level is an independent risk factor for STR dysplasia after PCI in STEMI patients. It has high sensitivity and specificity for STR dysfunction and can be used as an evaluation index for STR dysplasia in STEMI patients.
引文
1 苏荏,张琳,任宇超,等.STEMI患者NT-proBNP水平对急诊直接PCI后ST段回落的预测能力.广东医学,2017,38(20):3138～3142.
2 买热木古·阿布都热依木,阿帕尔·卡哈尔,范桂君,等.老年患者冠脉狭窄严重度与血清25-(OH)D3水平的关系分析.重庆医学,2017,46(12):1676～1678.
3 杨琴,张梅.急性ST段抬高型心肌梗死患者急诊PCI术前血清心型脂肪酸结合蛋白水平与预后的关系.天津医药,2017,45(11):1157～1161.
4 ?mer ?en,Topuz M ,Arma■an Acele.The Influence of Plasma 25-(OH) Vitamin D Levels in Acute ST Elevation Myocardial Infarction.Cardiology Journal,2017,24(6):677～684.
5 彭彬,倪爱华,方永祥.心电图3级心肌缺血对急性心肌梗死患者直接PCI后ST段回落的预测价值.医学临床研究,2016,33(8):1480～1483.
6 熊伟平,黄高忠.慢性心力衰竭患者血清25-羟维生素D3水平检测及其意义.中华老年多器官疾病杂志,2017,16(11):832～836.
7 Tran D T,Welsh R C,Ohinmaa A,et al.Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention-Capable Hospitals.Canadian Journal of Cardiology,2017,33(4):485～492.
8 蔡智伟,叶燕珍,黄淮滨,等.血清BNP浓度变化监测对预测STEMI患者PCI术后预后的预测价值.现代生物医学进展,2017,21(31):6170～6174.
9 Leibundgut G,Gick M,Morel O,et al.Discordant Cardiac Biomarker Levels Independently Predict Outcome in ST-segment Elevation Myocardial Infarction.Clinical Research in Cardiology,2016,105(5):432～440.
10 雷红涛,阮焕钧,徐洪涛,等.红细胞分布宽度对行急诊PCI治疗的ST段抬高型心肌梗死患者预后的影响.解放军医学院学报,2017,38(9):839～842.
11 杨锦龙,刘欢,周学锋,等.中性粒细胞/淋巴细胞比值对ST段抬高型心肌梗死患者PCI术后心血管不良事件的预测价值.中国循证心血管医学杂志,2016,8(10):1216～1219.
12 Sinnaeve P R ,Van d W F .Transporting STEMI Patients for Primary PCI:A Long and Winding Road Paved with Good Intentions?.European Heart Journal,2016,37(13):1041～1043.
13 龙虹宇,邓波,伍玲娜,等.白细胞联合D-二聚体评分预测行急诊PCI的ST段抬高型心肌梗死患者在院死亡风险的效力分析.临床急诊杂志,2018,16(5):288～293.
14 Giustino G ,Mehran R ,Dangas G D ,et al.Characterization of the Average Daily Ischemic and Bleeding Risk After Primary PCI for STEMI.Journal of the American College of Cardiology,2017,70(15):1846～1857.
15 黄欣,钟妮尔,王欢,等.急性肾损伤在ST段抬高型心肌梗死急诊冠状动脉介入治疗患者中的发生情况、预测因素及其对预后的影响.中国医药导报,2016,13(14):8～12.
2 买热木古·阿布都热依木,阿帕尔·卡哈尔,范桂君,等.老年患者冠脉狭窄严重度与血清25-(OH)D3水平的关系分析.重庆医学,2017,46(12):1676～1678.
3 杨琴,张梅.急性ST段抬高型心肌梗死患者急诊PCI术前血清心型脂肪酸结合蛋白水平与预后的关系.天津医药,2017,45(11):1157～1161.
4 ?mer ?en,Topuz M ,Arma■an Acele.The Influence of Plasma 25-(OH) Vitamin D Levels in Acute ST Elevation Myocardial Infarction.Cardiology Journal,2017,24(6):677～684.
5 彭彬,倪爱华,方永祥.心电图3级心肌缺血对急性心肌梗死患者直接PCI后ST段回落的预测价值.医学临床研究,2016,33(8):1480～1483.
6 熊伟平,黄高忠.慢性心力衰竭患者血清25-羟维生素D3水平检测及其意义.中华老年多器官疾病杂志,2017,16(11):832～836.
7 Tran D T,Welsh R C,Ohinmaa A,et al.Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention-Capable Hospitals.Canadian Journal of Cardiology,2017,33(4):485～492.
8 蔡智伟,叶燕珍,黄淮滨,等.血清BNP浓度变化监测对预测STEMI患者PCI术后预后的预测价值.现代生物医学进展,2017,21(31):6170～6174.
9 Leibundgut G,Gick M,Morel O,et al.Discordant Cardiac Biomarker Levels Independently Predict Outcome in ST-segment Elevation Myocardial Infarction.Clinical Research in Cardiology,2016,105(5):432～440.
10 雷红涛,阮焕钧,徐洪涛,等.红细胞分布宽度对行急诊PCI治疗的ST段抬高型心肌梗死患者预后的影响.解放军医学院学报,2017,38(9):839～842.
11 杨锦龙,刘欢,周学锋,等.中性粒细胞/淋巴细胞比值对ST段抬高型心肌梗死患者PCI术后心血管不良事件的预测价值.中国循证心血管医学杂志,2016,8(10):1216～1219.
12 Sinnaeve P R ,Van d W F .Transporting STEMI Patients for Primary PCI:A Long and Winding Road Paved with Good Intentions?.European Heart Journal,2016,37(13):1041～1043.
13 龙虹宇,邓波,伍玲娜,等.白细胞联合D-二聚体评分预测行急诊PCI的ST段抬高型心肌梗死患者在院死亡风险的效力分析.临床急诊杂志,2018,16(5):288～293.
14 Giustino G ,Mehran R ,Dangas G D ,et al.Characterization of the Average Daily Ischemic and Bleeding Risk After Primary PCI for STEMI.Journal of the American College of Cardiology,2017,70(15):1846～1857.
15 黄欣,钟妮尔,王欢,等.急性肾损伤在ST段抬高型心肌梗死急诊冠状动脉介入治疗患者中的发生情况、预测因素及其对预后的影响.中国医药导报,2016,13(14):8～12.