PECAM-1、心室重构与急性心肌梗死冠脉介入术后合并重度心力衰竭的相关性及预后预测

摘要/Abstract

摘要： 目的探讨血小板内皮细胞黏附分子-1（PECAM-1）、心室重构与急性心肌梗死冠脉介入术后合并重度心力衰竭的相关性及预后预测价值。方法选取2020年5月—2023年5月内蒙古包钢医院收治的80例急性心肌梗死冠脉介入术后合并心力衰竭患者作为研究对象,应用Killip分级来评价患者心力衰竭严重程度并进行分组,将其分为Ⅰ级组16例,Ⅱ级组23例,Ⅲ级组20例,Ⅳ级组21例,另选取同期来内蒙古包钢医院体检的30名健康志愿者作为对照组。对比五组患者PECAM-1与心室重构指标水平,应用Spearman相关分析PECAM-1、心室重构与急性心肌梗死冠脉介入术后合并重度心力衰竭的相关性。随后将80例急性心肌梗死冠脉介入术后合并心力衰竭患者中院内死亡者分为死亡组（n=20）,将其余患者分为存活组（n=60）,对比两组患者临床一般情况,并分析PECAM-1、心室重构对急性心肌梗死冠脉介入术后合并心力衰竭预后的预测价值。结果 Ⅳ级患者PECAM-1、左心室质量指数（LVMI）明显高于Ⅲ级、Ⅱ级、Ⅰ级和对照组,左心室重构指数（LVRI）低于Ⅲ级、Ⅱ级、Ⅰ级和对照组（P<0.05）;Spearman相关分析结果显示：PECAM-1、LVMI与急性心肌梗死冠脉介入术后合并重度心力衰竭呈正相关,LVRI与急性心肌梗死冠脉介入术后合并重度心力衰竭呈负相关（P<0.05）;存活组与死亡组患者Killip分级、合并陈旧性心肌梗死、PECAM-1、LVRI、LVMI水平对比,差异有统计学意义（P<0.05）;logistic回归分析结果表明：PECAM-1（OR=2.458,95% CI：1.359~3.257）、LVRI（OR=2.546,95% CI：1.364~3.475）、LVMI（OR=2.774,95% CI：1.876~4.010）为急性心肌梗死介入术后合并心力衰竭的独立预测指标（P<0.05）。结论 PECAM-1、心室重构与急性心肌梗死冠脉介入术后合并重度心力衰竭具有明显相关性,且能够通过PECAM-1与心室重构情况来预测急性心肌梗死冠脉介入术后合并重度心力衰竭的预后情况。

关键词: 血小板内皮细胞黏附分子-1, 心室重构, 急性心肌梗死, 冠脉介入, 心力衰竭

Abstract: Objective To investigate the correlation between platelet endothelial cell adhesion molecule-1 (PECAM-1), ventricular remodeling and severe heart failure after coronary intervention in patients with acute myocardial infarction, and the prognostic value. Methods A total of 80 patients with heart failure after coronary intervention in acute myocardial infarction admitted to our hospital from May 2020 to May 2023 were selected as the research subjects. The severity of heart failure in patients was evaluated using Killip grading and grouped into a Grade Ⅰ group of 16 cases, a Grade Ⅱ group of 23 cases, a Grade Ⅲ group of 20 cases, and a Grade Ⅳ group of 21 cases. In addition, 30 healthy volunteers who came to our hospital for physical examination during the same period were selected as the control group. Compare the levels of PECAM-1 and ventricular remodeling indicators in five groups of patients, and use Spearman correlation analysis to analyze the correlation between PECAM-1, ventricular remodeling, and severe heart failure after coronary intervention in acute myocardial infarction. Subsequently, 80 patients with heart failure after coronary intervention in acute myocardial infarction were divided into a death group (n=20) and the remaining patients into a survival group (n=60). The clinical general situation of the two groups of patients was compared, and the predictive value of PECAM-1 and ventricular remodeling on the prognosis of heart failure after coronary intervention in acute myocardial infarction was analyzed. Results The PECAM-1 and LVMI levels in grade IV patients were significantly higher than those in grade III, II, I, and control groups, while LVRI levels were lower than those in grade III, II, I, and control groups (P<0.05); Spearman correlation analysis showed that PECAM-1 and LVMI were positively correlated with severe heart failure after coronary intervention in acute myocardial infarction, while LVRI was negatively correlated with severe heart failure after coronary intervention in acute myocardial infarction (P<0.05); There were significant differences in Killip grade, comorbidities with old myocardial infarction, PECAM-1, LVRI, and LVMI levels between the survival group and the death group (P<0.05); The results of logistic regression analysis showed that PECAM-1 (OR=2.458, 95%CI:1.359~3.257), LVRI (OR=2.546, 95%CI:1.364~3.475), LVMI (OR=2.774, 95%CI:1.876~4.010) were independent predictive indicators of heart failure after acute myocardial infarction intervention (P<0.05). Conclusion PECAM-1, ventricular remodeling, and severe heart failure after coronary intervention in acute myocardial infarction are significantly correlated, and can predict the prognosis of severe heart failure after coronary intervention in acute myocardial infarction through PECAM-1 and ventricular remodeling.

Key words: platelet endothelial cell adhesion molecule-1, ventricular remodeling, cute myocardial infarction, coronary intervention, heart failure

中图分类号:

R542.22

陈荣红. PECAM-1、心室重构与急性心肌梗死冠脉介入术后合并重度心力衰竭的相关性及预后预测[J]. 中华养生保健, 2024, 42(9): 17-20.

CHEN Rong-hong. Correlation and Prognostic Prediction of PECAM-1, Ventricular Remodeling, and Severe Heart Failure after Coronary Intervention in Acute Myocardial Infarction[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(9): 17-20.

参考文献

[1] 吴家刚,郑睦锐.2013—2017年广州市急性心肌梗死流行特征及趋势分析[J].华南预防医学,2020,46(1):38-42.
[2] 廖慧,何睿颖,邹艳.急性心肌梗死伴心衰患者血清H-FABP,cTnⅠ,NT-proBNP的表达对预后的预测价值[J].贵阳医学院学报,2022,47(4):477-481.
[3] 杨飞,肖纯.血清凝集蛋白-1和可溶性细胞间黏附分子-1与急性心肌梗死患者经皮冠状动脉介入术后心肌无复流的关系[J].中华实用诊断与治疗杂志,2021,35(2):163-166.
[4] 陈凯,董静,赵学飞.槲皮素通过上调沉默信息调控因子1减轻心肌梗死后心室重构[J].国际心血管病杂志,2022,49(3):157-163.
[5] 蒋世亮,季晓平,张运.美国心脏病学会和美国心脏病协会发布关于ST段抬高型急性心肌梗死治疗指南(2004年修订版)[J].中华医学杂志,2005,85(1):62-64.
[6] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.急性心力衰竭基层诊疗指南(2019年)[J].中华全科医师杂志,2019,18(10):925-930.
[7] 王晶晶,蔡丽丽,丁海杰,等.渥太华研究应用模式构建循证干预对中青年急性心肌梗死伴心律失常患者心境状态和Killip分级及预后复发率的影响[J].中国心血管病研究,2021,19(11):1022-1027.
[8] 孙恒,胡宇才,张岚,等.心脏磁共振在评估急性心肌梗死后心室重构中作用的研究进展[J].中华实用诊断与治疗杂志,2021,35(9):964-966.
[9] 史苏娜,梁日晶,贾相科,等.血清可溶性细胞间黏附分子1,E-选择素,P-选择素预测急性心肌梗死介入术后患者主要不良心血管事件发生的应用价值[J].心脑血管病防治,2022,22(1):43-46.
[10] 刘国星,杜见霞,刘秀红,等.沉默miR-208a对急性心肌梗死大鼠心室重构的影响及机制研究[J].河北医药,2022,44(1):36-40.
[11] 李泽桦,曾宇宏,冯丽芸,等.氧化三甲胺促进M1型巨噬细胞极化加剧心肌梗死后心室重构[J].实用医学杂志,2022,38(20):2531-2537.
[12] 余明艳,李芳.尿激酶静脉溶栓治疗对急性轻型脑卒中患者血清脂蛋白相关磷脂酶A2,可溶性血管细胞黏附分子-1,基质金属蛋白酶-9水平及神经功能的影响[J].陕西医学杂志,2021,50(1):79-81,85.
[13] 王克,轩静静.罪犯血管为右侧冠状动脉急性心肌梗死患者左心衰竭的危险因素分析[J].临床荟萃,2020,35(10):890-894.
[14] 黄利强,程道宾,叶子明,等血小板内皮细胞黏附分子1联合血清脂蛋白相关磷脂酶A2对颈动脉粥样硬化斑块稳定性的诊断价值[J].中国全科医学,2021,24(2):170-175.
[15] 张梁,郭雨桐,刘越,等.炎症细胞在心肌梗死后心室重构中作用的研究进展[J].中国心血管杂志,2022,27(2):192-195.