摘要
目的分析外周血清核苷酸寡聚化结构域样受体热蛋白结构域相关蛋白3(NLRP3)、高迁移率族蛋白B1(HMGB1)水平与急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后心肌缺血再灌注损伤(MIRI)的关系。方法选取2020年1月—2021年7月武汉亚洲心脏病医院ICU收治接受PCI的STEMI患者165例,根据PCI术后是否发生MIRI分为MIRI组103例和非MIRI组62例。比较2组临床资料及外周血清NLRP3、HMGB1水平,多因素逐步Logistic回归分析STEMI患者PCI术后MIRI影响因素,受试者工作特征曲线(ROC)分析外周血清NLRP3、HMGB1水平对STEMI患者PCI术后MIRI的预测价值。结果MIRI组患者年龄、罪犯血管为右冠状动脉比例、Killip分级、血尿素氮、血肌酐、B型脑钠肽、住院天数、心血管不良事件发生率均高于非MIRI组,收缩压、舒张压、eGFR、ACEI/ARB/ARNI使用比例低于非MIRI组(P<0.05)。外周血清NLRP3、HMGB1水平MIRI组术前高于非MIRI组;术后即刻2组均降低,但MIRI组高于非MIRI组;术后24 h 2组均再次升高,且MIRI组高于非MIRI组(P均<0.05)。多因素Logistic逐步回归分析显示,年龄大、罪犯血管为右冠状动脉、B型脑钠肽高、血清NLRP3高、血清HMGB1高为STEMI患者PCI术后发生MIRI的独立危险因素[OR(95%CI)=1.052(1.010~1.096)、1.037(1.007~1.068)、1.003(1.001~1.004)、1.440(1.232~1.684)、1.728(1.312~2.276)],而收缩压、舒张压高为独立保护因素[OR(95%CI)=0.684(0.579~0.808)、0.551(0.406~0.746)]。ROC曲线显示,血清NLRP3、HMGB1及二者联合预测STEMI患者PCI术后MIRI的曲线下面积(AUC)分别为0.769、0.740、0.835,二者联合预测的AUC大于单项预测(Z=2.297、3.149,P=0.022、0.002)。结论PCI术后发生MIRI的STEMI患者外周血清NLRP3、HMGB1水平升高,为MIRI发生的独立危险因素,可作为PCI术后MIRI预测指标。
Objective To analyze of peripheral serum levels of nucleotide oligomerization domain-like receptor pyrin domain-related protein 3(NLRP3),high mobility group box protein B1(HMGB1)and percutaneous transcutaneous in patients with acute ST-segment elevation myocardial infarction(STEMI).Relationship of myocardial ischemia-reperfusion injury(MIRI)after coronary intervention(PCI).Methods From January 2020 to July 2021,165 STEMI patients who received PCI in the Intensive Care Unit of Wuhan Asia Heart Hospital were selected.According to whether MIRI occurred after PCI,they were divided into MIRI group of 103 cases and non-MIRI group of 62 cases.The clinical data and peripheral serum levels of NLRP3 and HMGB1 were compared between the two groups,and the multivariate stepwise Logistic regression was used to analyze the influencing factors of MIRI in STEMI patients after PCI.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of peripheral serum NLRP3 and HMGB1 levels for MIRI after PCI in STEMI patients.Results In MIRI group,the age,right coronary artery as the culprit vessel,Killip grade,blood urea nitrogen,serum creatinine,eGFR,B-type natriuretic peptide,proportion of ACEI/ARB/ARNI usage,length of hospital stay,and incidence of adverse cardiovascular events were all higher than those in MIRI group.In the non-MIRI group,the systolic blood pressure,diastolic blood pressure,and eGFR were lower than those in the non-MIRI group(P<0.05).Peripheral serum NLRP3 and HMGB1 levels in MIRI group before operation were higher than those in non-MIRI group;immediately after operation,both groups decreased,but MIRI group was higher than non-MIRI group;24 hours after operation,both groups increased,and MIRI group was higher than non-MIRI group(all P<0.05).Multivariate Logistic stepwise regression analysis showed that older age,right coronary artery as the culprit,high B-type natriuretic peptide,high serum NLRP3,and high serum HMGB1 were independent risk factors for MIRI after PCI in STEMI patients[OR(95%CI)
作者
左文霞
刘彬
黄园琴
肖红艳
Zuo Wenxia;Liu Bin;Huang Yuanqin;Xiao Hongyan(Intensive Care Unit,Wuhan Asian Heart Hospital,Hubei Province,Wuhan 432000,China;不详)
出处
《疑难病杂志》
CAS
2022年第7期683-688,699,共7页
Chinese Journal of Difficult and Complicated Cases
基金
湖北省卫生健康委员会科研项目(WJ2019F024)。
