摘要
目的分析急性ST段抬高型心肌梗死(STEMI)并行急诊经皮冠状动脉介入治疗术(pPCI)患者心肌缺血再灌注早期血清缺血修饰白蛋白(IMA)的变化,探讨其能否成为评价此类患者急性心肌缺血再灌注治疗效果及短期预后的指标。方法 56例急性STEMI并行pPCI的患者,检测其术前血清IMA浓度(IMA1)及pPCI术后40 min血清IMA浓度(IMA2),从而计算出IMA的变化(ΔIMA),根据pPCI术后90 min心电图上ST段回落情况分为ST段完全回落组(ST段回落≥70%)和ST段不完全回落组(ST段回落<70%)。结果与ST段完全回落组31例比较,ST段不完全回落组25例血清ΔIMA的水平显著升高[(0.372±0.054)A.U vs(0.145±0.044)A.U,P<0.001];当ΔIMA=0.233 A.U,对预测STEMI患者行pPCI再灌注治疗后1个月内发生不良心血管事件的敏感度为90%,特异度为63%,受试者工作特征曲线下面积为0.898(95%CI 0.798～0.998,P<0.001)。结论对于STEMI并行pPCI的患者,其再灌注早期血清IMA的变化可能是评价此类患者心肌缺血再灌注治疗效果的指标,并对此类患者行pPCI再灌注治疗后1个月内发生不良心血管事件具有一定的预测价值。
Objective To investigate the early changes of ischemia modified albumin （IMA） during the mechanical reperfusion in patients with acute ST -segment elevation myocardial infarction （STEMI） ; thus to investigate prognostic significance of IMA. Methods Fifty - six patients with acute STEMI were included. Serum IMA at admission （ IMA1 ） and 40 minutes after primary percutaneous coronary intervention （pPCI, IMA2） were measured for calculation of the IMA change （AIMA）. The worst electrocardiogram lead was analyzed before and 90 min after pPCI, thus patients were divided into two groups according to the degree of ST - segment resolution （STR） ： complete （ ≥70% ） and incomplete （ 〈 70% ） groups. Results Among the 56 patients, complete and incomplete STR were observed in 31 （55%） and 25 （45%） ca- ses, respectively. Serum AIMA was significantly higher in patients with incomplete STR [ （0. 372 ± 0. 054 ） A. U vs （0. 145 ＋0. 044） A. U, P 〈0. 001 ]. Setting AIMA of 0. 233A. U, the sensitivity and specificity for the adverse cardiovascular events in STEMI patients treated with pPCI within one month were 90% and 63% , respectively; with the area under the receiver operator characteristic curve was 0. 898 （95% CI 0. 798 - 0. 998, P 〈 0, 001 ）. Conclusion The early changes of IMA during the mechanical reperfusion provides prognostic indicator for STEMI patients treated with pPCI ; and can be further applied for predicting adverse cardiovascular events.
出处
《广东医学》
CAS
CSCD
北大核心
2013年第9期1356-1358,共3页
Guangdong Medical Journal
关键词
缺血修饰白蛋白
心肌再灌注
急性ST段抬高型心肌梗死
ischemia modified albumin
myocardial reperfusion
acute ST - segment elevation myocardial infarction
