摘要
目的 探讨血清Caspase-3在急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)前后的水平变化,以及其与PCI后再灌注损伤的关系。方法 回顾性分析沧州市中心医院自2018年6月至2021年6月行急诊PCI的124例急性STEMI患者的临床资料。根据是否发生再灌注损伤将患者分为两组,再灌注损伤组39例,无再灌注损伤组85例。比较两组患者的一般资料和血清Caspase-3水平,采用多因素二分类Logistic回归分析再灌注损伤的影响因素,绘制受试者工作特征曲线评价术前Caspase-3水平对再灌注损伤的预测价值。结果 两组年龄、性别、吸烟史、高血压、糖尿病、术前脑钠肽、术前心肌肌钙蛋白Ⅰ、术前低密度脂蛋白、缺血时间差异无统计学意义(P>0.05)。再灌注损伤组术前白细胞计数高于无再灌注损伤组,术前血钾低于无再灌注损伤组,差异有统计学意义(P<0.05)。再灌注损伤组和无再灌注损伤组术前即刻血清Caspase-3水平差异无统计学意义(P>0.05);再灌注损伤组术后即刻、术后6 h血清Caspase-3水平均高于无再灌注损伤组,差异有统计学意义(P<0.05);两组术后即刻、术后6 h血清Caspase-3水平均高于术前即刻,差异有统计学意义(P<0.05)。术前Caspase-3、术前血钾、术前白细胞计数、梗死相关动脉为右冠状动脉是急性STEMI患者急诊PCI后发生再灌注损伤的独立预测因素(P<0.05)。术前Caspase-3预测急性STEMI患者急诊PCI后发生再灌注损伤的受试者工作特征曲线下面积为0.612(95%可信区间0.502~0.722,P<0.05),以术前Caspase-3=4.42为临界点时,敏感度为64.1%,特异度为63.5%。结论 术前血清Caspase-3可以作为急性STEMI患者急诊PCI后是否发生再灌注损伤的预测因子,对术前高Caspase-3水平患者需加强术中和术后的心肌保护和意外事件预防。
Objective To investigate the changes of serum Caspase-3 levels in patients with acute ST-elevation myocardial infarction(STEMI)before and after emergency percutaneous transluminal coronary intervention(PCI),and the relationship between Caspase-3 levels and post-PCI reperfusion injury.MethodsThe clinical data of 124 patients with acute STEMI who underwent emergency PCI in Cangzhou Central Hospital from June 2018 to June 2021 were retrospectively analyzed.The patients were divided into two groups according to whether reperfusion injury occurred,39 cases in the reperfusion injury group and 85 cases in the no reperfusion i njury group.The general data and serum Caspase-3 levels of the two groups were compared,and the influencing factors of reperfusion injury were analyzed by multi-factor binary Logistic regression,and the work characteristic curve of subjects was drawn to evaluate the predictive value of preoperative Caspase-3 levels on reperfusion injury.ResultsThere were no significant diferences in age,sex,smoking history,hypertension,diabetes,preoperative brain natriuretic peptide,preoperative cardiac troponin I,preoperative low density lipoprotein and ischemic time between the two groups(P>0.05).The preoperative white blood cell count in the reperfusion injury group was higher than that in the no reperfusion injury group,and the preoperative blood potassium was lower than that in the no reperfusion injury group,the dfference was statistically significant(P<0.05).There was no significant difference in serum Caspase-3 level between reperfusion injury group and no reperfusion injury group(P>0.05).The serum Caspase-3 level in the reperfusion injury group immediately after surgery and 6 h afer surgery was higher than that in the no reperfusion injury group,and the difference was statistically significant(P<0.05).The level of serum Caspase-3 immediately after surgery and 6 h after surgery was higher than that immediately before surgery,and the difference was statistically significant(P<0.05).Preoperative Caspase-3,pre
作者
赵元平
于恺
薛莹
王磊
宋兆伟
刘静
张军
ZHAO Yuan-ping;YU Kai;XUE Ying;WANG Lei;SONG Zhao-wei;LIU Jing;ZHANG Jun(Department of Radiology Intervention,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Cardiology,Cangzhou Central Hospital,Cangzhou 061000,China;Department of Ultrasonography,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《临床军医杂志》
CAS
2023年第11期1117-1120,1124,共5页
Clinical Journal of Medical Officers
基金
河北省医学适用技术(GZ2023055)。
