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分泌型磷脂酶A2对急性心肌梗死患者行急诊经皮冠状动脉介入治疗的预后价值

陈孟英1,王伟2   

  1. 1. 天津市胸科医院心内科
    2. 天津市胸科医院 心内六科
  • 收稿日期:2011-11-14 修回日期:2012-03-25 出版日期:2012-09-15 发布日期:2012-09-15
  • 通讯作者: 陈孟英

Prognostic Value of the Plasma Levels of type II secretory phospholipase A2 in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

,Wei WANG   

  • Received:2011-11-14 Revised:2012-03-25 Published:2012-09-15 Online:2012-09-15

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摘要： 摘要 目的： 探讨血浆分泌型磷脂酶A2（sPLA2）水平对行急诊经皮冠状动脉介入（PCI）治疗的急性心肌梗死（AMI）患者的长期预后价值。方法：将223例行急诊PCI的AMI患者按2年随访期结束是否发生主要不良心脏事件（MACE）分为MACE组（95例）和无MACE组（128例），分别比较2组患者一般临床资料、血浆sPLA2水平及冠状动脉造影资料的差异。将单因素分析有意义的变量纳入Cox比例风险回归模型对预后进行多因素分析，并以无MACE组血浆sPLA2水平的P75为截断点（5.48 μg/L）分为高sPLA2组和低sPLA2组，应用乘积极限法分析sPLA2的预后价值。结果： 223例患者中有95例在随访期内发生MACE（42.60%），其中MACE组的男性、2型糖尿病、白细胞计数（WBC）、尿素氮（BUN）、入院血糖(Glu)、肌酸激酶(CK)、肌酸激酶同工酶（CK-MB）、sPLA2、多支病变（≥两支冠状动脉病变）、从发病到球囊扩张的时间和无复流的患者比例明显多于无MACE组，左室射血分数（LVEF）明显低于无MACE组；Cox回归分析显示sPLA2 >5.48μg/L(RR: 3.23, 95% CI: 1.24～12.36, P<0.001)、2型糖尿病(RR: 2.78, 95% CI: 1.52～7.24, P<0.001)、多支病变(RR: 2.37, 95% CI: 1.66～6.79, P<0.001)和LVEF<50%(RR: 1.74, 95% CI: 1.07～2.94, P=0.037)是AMI患者急诊PCI术后长期预后不良的预测因子。结论： 本研究表明血浆sPLA2水平的升高与行急诊PCI的AMI患者的不良预后相关。

关键词: 急性心肌梗死, 冠状动脉介入治疗, 分泌型磷脂酶A2, 预后

Abstract: Abstract Objective: To evaluate the prognostic value of the plasma levels of type II secretory phospholipase A2 in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Methods: A total of 223 patients with AMI who underwent primary PCI were divided into MACE group（95） and no MACE group （128）on the basis of whether happening MACE after 2 years’ follow-up. Compared the baseline characteristics, plasma levels of sPLA2 and angiographic characteristics and procedure related data in patients with PCI of the two groups. Cox's proportional hazard regression analysis was used to assessed the predictive value for MACE during the follow-up period and the Kaplan–Meier method was applied in survival analysis according to the levels of sPLA2. Results: 95 patients happened MACE during the follow-up period. The proportion of male, type 2 diabetes mellitus, number of white blood cells, BUN, Glucose, CK, CK-MB, sPLA2, multiple (≥double-vessel CAD) coronary arteries with stenosis, symptom-to-balloon time and no-reflow after PCI were significantly higher in MACE group than no MACE group while the left ventricular ejection fraction was lower. Multivariate forward stepwise Cox proportional hazard regression analysis showed that sPLA2 >5.48μg/L(RR: 3.23, 95% CI: 1.24-12.36, P<0.001), diabetes mellitus (RR: 2.78, 95% CI: 1.52-7.24, P<0.001), multiple coronary arteries with stenosis (RR: 2.37, 95% CI: 1.66-6.79, P<0.001)and left ventricular ejection fraction <50%(RR: 1.74, 95% CI: 1.07-2.94, P=0.037) were predictors of subsequent MACE. Conclusion: The present study showed that elevation of circulating levels of sPLA2 in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention was associated with the poor prognosis.

Key words: acute myocardial infarction, percutaneous coronary intervention, sPLA2, prognosis