| 冯金月,李来传,陈红芬,等.冠状动脉内血管性血友病因子裂解蛋白酶活性和全球急性冠状动脉事件注册评分对急诊经皮冠脉介入术治疗 ST段抬高型心肌梗死病人住院期间主要心血管不良事件的预测价值[J].安徽医药,2022,26(12):2460-2465. |
| 冠状动脉内血管性血友病因子裂解蛋白酶活性和全球急性冠状动脉事件注册评分对急诊经皮冠脉介入术治疗 ST段抬高型心肌梗死病人住院期间主要心血管不良事件的预测价值 |
| Predictive value of intracoronary ADAMTS13 activity and GRACE score for MACE during hospitalization in STEMI patients undergoing emergency PCI |
| |
| DOI：10.3969/j.issn.1009-6469.2022.12.028 |
| 中文关键词: ST段抬高型心肌梗死 经皮冠状动脉介入治疗 血管性血友病因子裂解蛋白酶( vWF-cp) 全球急性冠状动脉事件注册评分 主要心血管不良事件 猪金属肽酶含血小板反应蛋白 13(ADAMTS13) 肌钙蛋白 I 预后 |
| 英文关键词: ST elevation myocardial infarction Percutaneous coronary intervention Von willebrand factor-cleaving protease (vWF-cp) GRACE score MACE A disintegrin and metalloprotease with a thrombospondin type 1 motif member 13 (AD. AMTS13) Troponi I Prognosis |
| 基金项目: |
|
| 摘要点击次数: 834 |
| 全文下载次数: 249 |
| 中文摘要: |
| 目的探讨冠状动脉内血管性血友病因子裂解蛋白酶( ADAMTS13)活性和全球急性冠状动脉事件注册( GRACE)评分对 ST段抬高型心肌梗死( STEMI)行急诊经皮冠脉介入术( PCI)的病人住院期间主要心血管不良事件( MACE)的预测价值。方法选取 2019年 10月至 2021年 6月在潍坊医学院附属医院住院的 162例 STEMI接受急诊 PCI治疗的病人，根据住院期间是否发生 MACE，分为 MACE组( 38例)和无 MACE组( 124例)。记录两组病人的重要临床特征、 GRACE评分。采用荧光共振能量转换法( FRETS-VWF73)分别测定两组病人急诊 PCI术前外周血和冠脉内的 ADAMTS13活性。四格表 χ2检验及独立样本 t检验比较两组病人的重要临床特征、 GRACE评分。 Pearson相关性分析探讨 ADAMTS13活性与 GRACE评分的相关性。多因素 logistic回归分析 MACE的独立危险因素。应用受试者操作特征曲线( ROC曲线)分析冠脉内 ADAMTS13活性、 GRACE评分以及联合诊断对 MACE的预测效能。结果两组比较， MACE组病人糖尿病史、吸烟史更多，年龄较大、外周血血小板计数更低、凝血酶原时间( PT)更长、 N端脑钠肽前体( NT-proBNP)和肌钙蛋白 I(cTnI)更高( P<0.05)； MACE组病人 GRACE评分更高［(187.26±35.50)分比(153.87±32.95)分， P<0.001］术前外周血［(59.01±4.56)%比( 63.86±5.75)%］和冠脉内［(46.37±5.43)%比(54.26±5.70)%］的 ADAMTS13活性更低(均 P<0.001)，。术前冠脉内 ADAMTS13活性与 GRACE评分中等强度负相关( r=.0.40， P<0.001)而外周血 ADAMTS13活性与 GRACE评分无明显相关性( r=.0.08，P=0.457)。多因素 logistic回归分析，糖尿病史和 GRACE评分，为 MACE的独立危险因素［ OR=2.513，95%CI:(2.045，3.381)， P=0.007；OR=1.089，95%CI:(1.033，1.147)， P=0.001］术前冠脉内 ADAMTS13活性是 MACE的保护性因素［ OR=0.568，95%CI:(0.429，0.753)P=0.001］。术前冠脉内 AD. AMTS13性、 GRACE评分诊断 MACE的 AUC及其 95%CI分别为 0.833(0.735，0.932)和 0.7424，0.867)截断值分别为活，6(0.6，50.95%和158.50分，联合诊断的 AUC为 0.893(0.824，0.962)。结论 GRACE评分增高、术前冠脉内 ADAMTS13活性降低均是接受急诊 PCI治疗的 STEMI病人住院期间 MACE的独立危险因素，二者联合诊断的预测价值更高。 |
| 英文摘要: |
| Objective To investigate the predictive value of intracoronary a disintegrin and metalloprotease with thrombospondinmotifs 13 (ADAMTS13) activity and the Global Registry of Acute Coronary Events (GRACE) score for major adverse cardiovascularevents (MACE) during hospitalization in patients undergoing emergency percutaneous coronary intervention (PCI) for ST-segment eleva. tion myocardial infarction (STEMI).Methods A total of 162 patients with STEMI treated with emergency PCI who were hospitalized atthe Affiliated Hospital of Weifang Medical College from October 2019 to June 2021 were selected and divided into a MACE group (38patients) and a nonMACE group (124 patients) according to whether MACE occurred during hospitalization. The important clinical fea.tures and GRACE scores of patients in both groups were recorded. The activity of ADAMTS13 in peripheral blood and intracoronary ar. teries before emergency PCI was measured by the fluorescence resonance energy transfer assay using a truncated, synthetic 73-amino-acid VWF peptide as a substrate for the determination of ADAMTS-13 activity (FRETS-VWF73). The chi-square test and independent samples t test were used to compare the important clinical characteristics and GRACE scores of the two groups of patients. Pearson cor.relation analysis was performed to explore the correlation between ADAMTS13 activity and GRACE score. Multivariate logistic regres.sion analysis of the independent risk factors for MACE. The receiver operating characteristic (ROC) curve was applied to analyze thepredictive efficiency of intracoronary ADAMTS13 activity, GRACE score, and combined diagnosis on MACE.Results Compared withnonMACE patients, patients with MACE had a greater history of diabetes, smoking history, older age, lower peripheral platelet count,longer prothrombin time (PT), and higher N-terminal B-type brain natriuretic peptide precursor (NT-proBNP) and troponin I (cTnI) lev. els. Patients in the MACE group had a higher GRACE score (187.26±35.50 vs. 153.87±32.95, P<0.001), and the activity of AD. AMTS13 in preoperative peripheral blood [(59.01±4.56)% vs. (63.86±5.75)%] and intracoronary blood [(46.37±5.43)% vs. (54.26± 5.70)%] was significantly lower (P<0.001). Preoperative intracoronary ADAMTS13 activity was moderate (r=.0.40, P<0.001), whereas peripheral blood ADAMTS13 activity was not significantly correlated with GRACE score (r=.0.08, P=0.457). According to multivariatelogistic regression analysis, a history of diabetes and GRACE score were independent risk factors for MACE [OR=2.513, 95%CI: (2.045, 3.381), P=0.007; OR=1.089, 95%CI:(1.033, 1.147), P=0.001], and preoperative intracoronary ADAMTS13 activity was a protec. tive factor for MACE [OR=0.568, 95%CI:(0.429, 0.753), P=0.001]. The areas under the curve (AUCs) of GRACE score and AD. AMTS13 activity for diagnosing of MACE were 0.833 [95%CI:(0.735, 0.932)] and 0.746 [95%CI:(0.624, 0.867)], with cutoff values were 50.95% and 158.50 points, respectively, and the AUC for combined diagnosis was 0.893 [95%CI:(0.824, 0.962)].Conclusion HigherGRACE scores and lower intracoronary ADAMTS13 activity before PCI were both the independent risk factors for MACE during hospi.talization in STEMI patients undergoing emergency PCI, and the combined diagnosis of the two had higher predictive value. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
