摘要
目的探讨可溶性血管细胞黏附分子-1(sVCAM-1)、高迁移率族蛋白B1(HMGB1)与不稳定型心绞痛(UA)经皮冠状动脉介入治疗(PCI)后心力衰竭发生的关系。方法回顾性收集2019年1月至2023年12月于西安大兴医院行PCI治疗的196例UA患者资料,患者于PCI后随访6个月,随访资料完整,根据随访期间心力衰竭发生情况分为发生组35例与未发生组161例,比较两组一般资料,PCI前血清sVCAM-1、HMGB1及其他实验室指标,重点分析血清sVCAM-1、HMGB1与UA患者PCI后心力衰竭发生的关系。结果与未发生组比较,发生组糖尿病、病变血管支数多支占比高[28.57%(10/35)比13.66%(22/161)、62.86%(22/35)比32.30%(52/161)],左心室内径大[(4.73±0.54)cm比(4.52±0.51)cm],血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶-MB(CK-MB)、sVCAM-1、HMGB1水平高[0.07(0.05,0.08)μg/L比0.05(0.04,0.06)μg/L、(8.16±1.58)μg/L比(7.08±1.21)μg/L、(458.26±41.23)μg/L比(422.19±37.41)μg/L、(6.39±1.86)μg/L比(5.24±1.45)μg/L],差异有统计学意义(P<0.05)。Logistic回归分析显示,UA患者PCI后心力衰竭的发生可能与左心室内径大、血清cTnI、sVCAM-1、HMGB1水平异常有关(P<0.05)。限制性立方样条法分析发现,血清sVCAM-1、HMGB1与UA患者PCI后心力衰竭发生呈非线性剂量反应关系(P<0.05),当血清sVCAM-1≥422.37μg/L、HMGB1≥5.26μg/L时,患者PCI后心力衰竭发生风险随二者水平升高而增加。血清sVCAM-1、HMGB1对UA患者PCI后心力衰竭发生具有正向交互作用。绘制决策曲线及列线图测模型发现,血清sVCAM-1、HMGB1辅助血清cTnI构建的预测模型对UA患者PCI后心力衰竭的发生有一定预测效能。结论UA患者PCI后心力衰竭的发生可能与sVCAM-1、HMGB1异常高水平有关,随着二者水平升高,患者心力衰竭风险增加,将二者用于辅助预测患者心力衰竭风险有一定价值。
Objective To investigate the relationship between soluble vascular cell adhesion molecule-1(sVCAM-1),high mobility group protein B1(HMGB1),and heart failure after percutaneous coronary intervention(PCI)in patients with unstable angina(UA).Methods This study was a retrospective study.The data of 196 UA patients who underwent PCI treatment in Xi′an Daxing Hospital from January 2019 to December 2023 were collected through the hospital′s electronic medical record system.The patients were followed up for 6 months after PCI,and the follow-up data were completed.According to the occurrence of heart failure during the follow-up period,they were divided into the occurrence group(35 cases)and the non occurrence group(161 cases).The general data,serum sVCAM-1,HMGB1 and other laboratory indicators before PCI were compared between the two groups,and the relationship between serum sVCAM-1,HMGB1 and the occurrence of heart failure in UA patients after PCI was analyzed.Results Compared with the non occurrence group,the occurrence group had higher proportion of diabetes mellitus and multi-vessel disease:28.57%(10/35)vs.13.66%(22/161),62.86%(22/35)vs.32.30%(52/161);larger left ventricular diameter:(4.73±0.54)cm vs(4.52±0.51)cm;higher levels of serum cardiac troponin I(cTnI),creatine kinase MB isoenzyme(CK-MB),sVCAM-1 and HMGB1:0.07(0.05,0.08)μg/L vs.0.05(0.04,0.06)μg/L,(8.16±1.58)μg/L vs.(7.08±1.21)μg/L,(458.26±41.23)μg/L vs.(422.19±37.41)μg/L,(6.39±1.44)μg/L vs.(5.24±1.45)μg/L,there were statistical differences(P<0.05).Logistic regression analysis showed that the occurrence of heart failure in UA patients after PCI may be related to a larger left ventricular diameter,abnormal levels of serum cTnI,sVCAM-1,and HMGB1(P<0.05).Restrictive cubic spline(RCS)analysis revealed a non-linear dose-response relationship between serum sVCAM-1,HMGB1,and the occurrence of heart failure in UA patients after PCI(P<0.05).When serum sVCAM-1≥422.37μg/L and HMGB1≥5.26μg/L,the risk of heart failure in patients after PCI increased with the level of both.Serum sVCAM-1 and HMGB1 had a positive interactive effect on the occurrence of heart failure in UA patients after PCI.Decision curves and column charts were drawn to measure the model,it was found that the predictive model constructed with serum sVCAM-1 and HMGB1 assisted serum cTnI had certain predictive efficacy for the occurrence of heart failure in UA patients after PCI.Conclusions The occurrence of heart failure in UA patients after PCI may be related to abnormally high levels of sVCAM-1 and HMGB1.As the levels of both increase,the risk of heart failure in patients increases.Using both to assist in predicting the risk of heart failure in patients has certain value.
作者
闫育平
屈文静
马彩娜
Yan Yuping;Qu Wenjing;Ma Caina(Department of Cardiovascular Medicine,Daxing Hospital,Xi′an 710016,China;Department of Emergency,Yan′an People′s Hospital,Yan′an 716000,China)
出处
《中国医师进修杂志》
2025年第6期548-554,共7页
Chinese Journal of Postgraduates of Medicine
