分泌型磷脂酶A2对预测急性心肌梗死行经皮冠状动脉介入治疗预后的价值

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)患者长期预后的预测价值.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),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预测预后的价值.结果: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(≥2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＞5.48 μg/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＜ 0.50(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:血浆sPLA2水平的升高与行急诊PCI AMI患者的不良预后相关.%Objective: To evaluate the prognostic value of plasma type II secretory phospholipase A2 (sPLA2) levels in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 223 patients with AMI who underwent primary PCI were divided into major adverse cardiac events (MACE) group (n=95) and no-MACE group (n=128) after 2-year follow-up. The baseline characteristics,plasma level of sPLA2 and angiographic characteristics were compared between two groups. Cox's proportional hazard regression analysis was used to assess 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: The proportion of male,type 2 diabetes mellitus,number of white blood cells,urea nitrogen (BUN),glucose,creatine kinase (CK),CK-MB,sPLA2,multiple (≥double-vessel CAD) coronary with stenosis,symptom-to-balloon time and no-reflow after PCI were significantly higher in MACE group than those of no-MACE group. The left ventricular ejection fraction (LVEF) was lower in MACE group than that of no-MACE group. Multivariate forward stepwise Cox proportional hazard regression analysis showed that sPLA2>5.48 μg/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 stenosis (RR: 2.37,95%CI: 1.66-6.79,P < 0.001) and LVEF< 0.50 (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 was associated with the poor prognosis in patients with AMI undergoing primary PCI.