[1]刘丹丹 王海珠 任凤波.ST段抬高型心肌梗死PCI术后血浆微囊泡浓度对再次血运重建的风险预测分析[J].心血管病学进展,2019,(7):1056-1061.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.023]
　LIU Dandan,WANG Haizhu,REN Fengbo.Predictive analysis of plasma microvesicles concentration in patients with ST-segment elevation myocardial infarction after target lesion revascularization[J].Advances in Cardiovascular Diseases,2019,(7):1056-1061.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.023]
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ST段抬高型心肌梗死PCI术后血浆微囊泡浓度对再次血运重建的风险预测分析()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2019年7期
页码:
1056-1061
栏目:
综述
出版日期:
2019-10-25

文章信息/Info

Title:
Predictive analysis of plasma microvesicles concentration in patients with ST-segment elevation myocardial infarction after target lesion revascularization
作者:
刘丹丹 王海珠 任凤波
周口市中心医院心血管内科,河南 周口 466000
Author(s):
LIU Dandan; WANG Haizhu;  REN Fengbo
(Department of Cardiovascular Medicine, Zhoukou Central Hospital. Zhoukou. 466000HenanChina)
关键词:
ST段抬高型心肌梗死; 经皮冠脉介入术; 血浆微囊泡浓度; 再次血运重建; 风险预测
Keywords:
ST-segment elevation myocardial infarction;  Percutaneous coronary intervention;  Plasma microvesicles concentration;  Target lesion revascularization;  Risk prediction
DOI:
10.16806/j.cnki.issn.1004-3934.2019.07.023
摘要:
目的 探讨ST段抬高型心肌梗死（STEMI）经皮冠脉介入术（PCI）术后血浆微囊泡（MVs）浓度对再次靶病变血运重建（TLR）的风险预测价值。方法 回顾性分析2016年5月—2018年5月医院收治的行PCI治疗的223例STEMI患者的临床资料，术后随访6~32个月，根据是否再次发生TLR分为发生组和未发生组，统计可能引起PCI术后再次发生TLR的相关因素，对比两组可能的影响因素的差异，并采用多因素Logistic回归分析法明确相关危险因素。对比PCI术后不同时刻及发生组和未发生组不同时刻血浆MVs浓度变化；通过绘制受试者工作曲线，分析术后不同时刻血浆MVs浓度对TLR的预测价值。结果 223例患者中共33例再次发生TLR，发生率为14.80%；发生组男性、体重指数＞23.9 kg/m2、有吸烟史、合并高血压病、高脂血症、即刻血浆MVs浓度≥≥13.5 nmol/L、支架最小开放直径＜3.5 mm患者构成比高于未发生组，差异有统计学意义（P＜0.05），且经Logistic回归分析证实均是导致PCI术后再次TLR的危险因素（P＜0.05）；PCI患者术后3 d 、7 d 血浆MVs浓度低于术后即刻，术后7 d 低于术后3 d ，差异有统计学意义（P＜0.05）；发生组术后不同时刻血浆MVs水平均高于未发生组，差异有统计学意义（P＜0.05），且两组术后3 d 、7 d 血浆MVs水平均低于术后即刻，术后7 d 低于术后3 d ，差异有统计学意义（P＜0.05）；术后即刻、术后3 d 、7 d 血浆MVs浓度预测TLR发生的最佳截断点分别为20.58、17.10、14.21 nmol/L。术后7 d 血浆MVs浓度预测TLR发生的灵敏度、特异度和准确度均高于术后即刻、术后3 d 检测，且术后7 d 血浆MVs浓度预测TLR发生的曲线下面积为0.836，高于术后即刻和术后3 d 。结论 血浆MVs浓度≥13.5 nmol/L是PCI术后再次TLR的危险因素，且与术后即刻、术后3 d 相比，术后7 d 血浆MVs浓度对STEMI患者PCI术后再次TLR风险预测价值更高。
Abstract:
Objective: To investigate the predictive value of plasma microvesicles (MVs) concentration for target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods: The clinical data of 223 patients with STEMI who underwent PCI in May 2017-2018 were retrospectively analyzed. The patients were followed up for 6 to 20 months, and divided into the occurrence group and the non-occurrence group according to the recurrence of TLR. The related factors that may cause TLR recurrence after PCI were analyzed, and the differences between the 2 groups were compared, and the related factors were determined by multivariate logistic regression analysis. The changes of plasma MVs concentration at different time after PCI and changes at different time between the occurrence group and the non-occurrence group were compared. The predictive value of plasma MVs concentration at different time after PCI for TLR was analyzed by drawing ROC. The predictive value for the predicted TLR of the plasma MVs concentration immediately at different time after PCI were analyzed and compared by plotting the subject working curve (ROC). Results: TLR occurred again in 33 of 128 patients, the incidence was 25.78%. The proportion of male, BMI higher than 23.9 kg/m2, smoking history, hypertension, hyperlipidemia, immediate plasma MVs concentration greater than or equal to 13.5 nmol/L and minimum open stent diameter less than 3.5 mm in the occurrence group were higher than those in the non-occurrence group (P<0.05), and logistic regression analysis confirmed that those were risk factors for TLR recurrence after PCI (P<0.05). The plasma MVs concentration at 3 days and 7 days after intervention were lower than those immediately after surgery, 7 days after surgery lower than that at 3 days after surgery(P<0.05). The plasma MVs concentration at different time after intervention in the occurrence group were higher than those in the non-occurrence group (P<0.05), and the plasma MVs concentration in both groups were lower at 3 days and 7 days after intervention than at immediately after intervention, and lower at 7 days after operation than at 3 days after intervention (P<0.05). The best cutoff points for the occurrence of TLR of plasma MVs immediately after intervention, 3 days and 7 days after intervention were 20.58 nmol/L, 17.10 nmol/L, 14.21 nmol/L, respectively. The sensitivity, specificity and accuracy of plasma MVs concentration 7 days after intervention prediction for TLR were higher than those immediately after intervention and 3 days after intervention, and the AUC of plasma MVs concentration prediction for TLR at 7 days postoperatively was 0.836, which was higher than immediately after intervention and 3 days after intervention. Conclusion: The plasma MVs concentration greater than or equal to 13.5 nmol/L may be a risk factor for TLR after PCI, and compared with immediate postoperative and postoperative 3 days, plasma MVs concentration at 7 days postoperatively has a higher predictive value of TLR risk after PCI in patients with STEMI

参考文献/References:


[1]Brown OI, Allgar V, Wong KY. Coffee reduces the risk of death after acute myocardial infarction: a meta-analysis [J]. Coron Artery Dis, 2016, 27(7):566-572.

[2]Liu H, Tian Y, Xiang X, et al. Air Pollution and Hospitalization for Acute Myocardial Infarction in China [J]. Am J Cardiol, 2017, 120(5):753-758.

[3]曾均凤, 陈世群, 陈艺,等. 急性心肌梗死患者冠状动脉介入治疗术后造影剂肾病一例[J]. 心血管病学进展, 2018, 39(3):510-511.

[4]de Gonzalo-Calvo D, Cenarro A, Garlaschelli K,et al. Translating the microRNA signature of microvesicles derived from human coronary artery smooth muscle cells in patients with familial hypercholesterolemia and coronary artery disease [J]. J Mol Cell Cardiol, 2017, 106(1):55-67.

[5]杨玉亚, 冯六六, 刘天华. 急性冠状动脉综合征患者血浆微囊泡浓度及其与冠状动脉粥样硬化斑块稳定性的相关性分析[J]. 解放军医药杂志, 2018, 30(6):91-96.

[6]Mello BH, Oliveira GB, Ramos RF, et al. Validation of the Killip-Kim ball classification and late mortality after acute myocardial infarction [J]. Arq BrasCardiol, 2014, 103(2):107-117.

[7]范书英. 2015年《中国急性ST段抬高型心肌梗死(STEMI)诊断治疗指南》要点解读[J]. 中国全科医学, 2015, 14(27):3268-3269.

[8]Sim HW, Thong EH, Tan HC, et al. Clinical outcomes one year and beyond after combination sirolimus eluting endothelial progenitor cell capture stenting during primary percutaneous coronary intervention in ST-segment elevation myocardial infarction [J]. Cardiovasc Revasc Med, 2018, S1553-8389(18)30493-30497.

[9]曹斌, 蒋柏枫, 邓振兴, 等. 冠状动脉侧支循环对行急诊经皮冠状动脉介入治疗的急性心肌梗死患者预后影响的Meta分析[J]. 实用心脑肺血管病杂志, 2018, 26(9):14-18,22.

[10]Fricke A, Ullrich PV, Cimniak AFV, et al. Levels of activated platelet-derived microvesicles in patients with soft tissue sarcoma correlate with an increased risk of venous thromboembolism [J]. BMC Cancer, 2017, 17(1):527-533.

[11]郭绪昆, 井永乐, 李明珍. 微囊泡与冠状动脉粥样硬化不稳定斑块关系的研究[J]. 临床心血管病杂志, 2017, 33(1):22-26.

[12]Su Y, Deng X, Ma R, et al. The Exposure of Phosphatidylserine Influences Procoagulant Activity in Retinal Vein Occlusion by Microparticles, Blood Cells, and Endothelium [J]. Oxid Med Cell Longev, 2018, 11(3):297-302.

[13]Korybalska K, Kawka E, Breborowicz A, et al. The role of mTOR inhibitors and HMG-CoA reductase inhibitors on young and old endothelial cell functions, critical for re-endothelialisation after percutaneous coronary intervention: an in vitro study [J]. J Physiol Pharmacol, 2017, 68(3):397-405.

[14]Parrish DC, Francis Stuart SD, Olivas A, et al. Transient denervation of viable myocardium after myocardial infarction does not alter arrhythmia susceptibility [J]. Am J Physiol Heart Circ Physiol, 2018, 314(3):415-423.

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更新日期/Last Update: 2019-12-17