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Lp(a)与前壁STEMI患者经皮冠状动脉介入(PCI)术后左心室重构的关系
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Abstract:
背景：脂蛋白a(Lp(a))是急性心肌梗死(AMI)患者发生不良心血管事件的独立危险因素，与AMI后心脏重构密切相关。目的：本研究旨在探讨Lp(a)与急性前壁ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心室重构的关系以及对心肌梗死后心室重构的预测价值。方法：纳入本院行冠状动脉介入治疗的前壁STEMI患者218例，在心肌梗死后1周和6个月通过心脏超声评估左心室功能和体积。不良心室重构(VR)的定义是基于心肌梗死后6个月左室舒张末期容积增加≥20%。根据患者左心室重构情况分为心室重构组和非心室重构组。比较两组患者的Lp(a)及临床资料，采用多因素Logistic回归法分析影响前壁STEMI患者PCI术后左心室重构的相关因素；将独立危险因素创建受试者工作特征曲线(ROC)，分析Lp(a)对心肌梗死后心室重构的预测价值。结果：6个月后，218例前壁STEMI患者中，58例患者出现心室重构。根据患者左心室重构情况分为心室重构组(160例)和非心室重构组(58例)。与非心室重构组比较，心室重构组年龄、糖尿病史、糖化血红蛋白、肌钙蛋白I、肌酸激酶同工酶、C反应蛋白、NT-proBNP、低密度脂蛋白胆固醇、Lp(a)、Gensini评分、室壁运动记分指数(WMSI)均显著升高，左心室射血分数(LVEF)显著下降，差异具有统计学意义；心室重构组LVEF显著降低，差异具有统计学意义；二元Logistic回归分析显示肌钙蛋白I、C反应蛋白、Lp(a)、LVEF是前壁STEMI患者PCI手术心室重构的独立危险因素。高Lp(a)是VR的独立预测因子(OR = 1.006, P < 0.001)。Lp(a)预测VR的最佳截断值为342，敏感性为82.6%，特异性为81.6% (AUC= 0.842, P < 0.001)。结论：Lp(a)与前壁STEMI患者经皮冠状动脉介入(PCI)术后左心室重构相关，入院监测时Lp(a)是一种有用的工具，可用于预测心梗后心室重构风险，建议临床早期干预Lp(a)。
Background: Lipoprotein a (Lp(a)) is an independent risk factor for adverse cardiovascular events in patients with acute myocardial infarction (AMI) and is closely related to cardiac remodeling after AMI. Objective: The purpose of this study was to investigate the relationship between Lp(a) and ventricular remodeling after percutaneous coronary intervention (PCI) in patients with acute anterior ST-elevation myocardial infarction (STEMI) and its predictive value after myocardial infarction. Methods: A total of 218 patients with anterior STEMI undergoing coronary intervention in our hospital were enrolled in our hospital, and left ventricular function and volume were evaluated by cardiac ultrasound at 1 week and 6 months after myocardial infarction. Poor ventricular remodeling (VR) is defined as a ≥ 20% increase in left ventricular end-diastolic volume 6 months after myocardial infarction. According to the left ventricular remodeling, the patients were divided into ventricular remodeling group and non-ventricular remodeling group. The Lp(a) and clinical data of the two groups were compared, and the multivariate logistic regression method was used to analyze the relevant factors affecting left ventricular remodeling after PCI in patients with anterior STEMI. The receiver operating characteristic curve (ROC) was created for independent risk factors, and the predictive value of Lp(a) in ventricular remodeling after myocardial infarction was analyzed. Results: After 6 months, ventricular remodeling occurred in 58 of the 218 patients
| [1] | 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2022概要[J]. 中国循环杂志, 2023, 38(6): 583-612. |
| [2] | Tsao, C.W., Aday, A.W., Almarzooq, Z.I., et al. (2022) Heart Disease and Stroke Statistics-2022 Update: A Report from the American Heart Association. Circulation, 145, e153-e639. |
| [3] | Yancy, C.W., Jessup, M., Bozkurt, B., et al. (2013) 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62, e147-239. |
| [4] | 邢布点, 张宁汝. 可溶性ST2与急性心肌梗死后左室重构的相关性进展[J]. 齐齐哈尔医学院学报, 2022, 43(16): 1565-1569. |
| [5] | Kim, G.H., Uriel, N. and Burkhoff, D. (2017) Reverse Remodelling and Myocardial Recovery in Heart Failure. Nature Reviews Cardiology, 15, 83-96. https://doi.org/10.1038/nrcardio.2017.139 |
| [6] | Lopaschuk, G.D., Karwi, Q.G., Tian, R., Wende, A.R. and Abel, E.D. (2021) Cardiac Energy Metabolism in Heart Failure. Circulation Research, 128, 1487-1513. https://doi.org/10.1161/circresaha.121.318241 |
| [7] | Prabhu, S.D. and Frangogiannis, N.G. (2016) The Biological Basis for Cardiac Repair after Myocardial Infarction. Circulation Research, 119, 91-112. https://doi.org/10.1161/circresaha.116.303577 |
| [8] | Galli, A. and Lombardi, F. (2016) Postinfarct Left Ventricular Remodelling: A Prevailing Cause of Heart Failure. Cardiology Research and Practice, 2016, 1-12. https://doi.org/10.1155/2016/2579832 |
| [9] | Tsimikas, S. (2017) A Test in Context: Lipoprotein(a). Journal of the American College of Cardiology, 69, 692-711. https://doi.org/10.1016/j.jacc.2016.11.042 |
| [10] | 姬赞赞, 李鹏, 宋靖宇, 等. 脂蛋白A与急性冠脉综合征预后的相关性分析[J]. 临床医学进展, 2020, 10(11): 2799-2804. |
| [11] | 张莉, 张梦圆, 夏彬凤, 等. 脂蛋白a与钙化性主动脉瓣狭窄发生发展的关系及高脂蛋白a血症相关治疗的研究进展[J]. 吉林大学学报(医学版), 2024, 50(6): 1763-1772. |
| [12] | de Boer, L.M., Oorthuys, A.O.J., Wiegman, A., Langendam, M.W., Kroon, J., Spijker, R., et al. (2021) Statin Therapy and Lipoprotein(a) Levels: A Systematic Review and Meta-analysis. European Journal of Preventive Cardiology, 29, 779-792. https://doi.org/10.1093/eurjpc/zwab171 |
| [13] | Tsimikas, S., Karwatowska-Prokopczuk, E., Gouni-Berthold, I., Tardif, J., Baum, S.J., Steinhagen-Thiessen, E., et al. (2020) Lipoprotein(a) Reduction in Persons with Cardiovascular Disease. New England Journal of Medicine, 382, 244-255. https://doi.org/10.1056/nejmoa1905239 |
| [14] | Nissen, S.E., Wolski, K., Balog, C., Swerdlow, D.I., Scrimgeour, A.C., Rambaran, C., et al. (2022) Single Ascending Dose Study of a Short Interfering RNA Targeting Lipoprotein(a) Production in Individuals with Elevated Plasma Lipoprotein(a) Levels. JAMA, 327, 1679-1687. https://doi.org/10.1001/jama.2022.5050 |
| [15] | Ibánez, B., James, S., Agewall, S., Antunes, M.J., Bucciarelli-Ducci, C., Bueno, H., et al. (2017) 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with St-Segment Elevation. Revista Española de Cardiología (English Edition), 70, 1082 p. https://doi.org/10.1016/j.rec.2017.11.010 |
| [16] | 高亚洁, 潘静薇. 心肌梗死后左心室重构的无创影像评价进展[J]. 中国医学计算机成像杂志, 2021, 27(6): 566-569. |
| [17] | 涂永波, 徐刚, 顾敏, 等. 心室重构的影像学评价研究进展[J]. 山东医药, 2015, 55(30): 101-103. |
| [18] | Gensini, G.G. (1983) A More Meaningful Scoring System for Determining the Severity of Coronary Heart Disease. The American Journal of Cardiology, 51, 606 p. https://doi.org/10.1016/s0002-9149(83)80105-2 |
| [19] | 中华医学会超声医学分会超声心动图学组, 中国医师协会心血管分会超声心动图专业委员会. 超声心动图评估心脏收缩和舒张功能临床应用指南[J]. 中华超声影像学杂志, 2020, 29(6): 461-477. |
| [20] | Lustosa, R.P., Fortuni, F., van der Bijl, P., Goedemans, L., El Mahdiui, M., Montero-Cabezas, J.M., et al. (2020) Left Ventricular Myocardial Work in the Culprit Vessel Territory and Impact on Left Ventricular Remodelling in Patients with St-Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention. European Heart Journal—Cardiovascular Imaging, 22, 339-347. https://doi.org/10.1093/ehjci/jeaa175 |
| [21] | 朱鸿文. 分析慢性冠脉综合征与急性心肌梗死患者脂蛋白a水平差异及临床意义[D]: [硕士学位论文]. 南昌: 南昌大学, 2023. |
| [22] | 谢伟, 胡立涛, 陈海涛, 吴积团, 陶成敏. 急性心肌梗死患者经皮冠状动脉介入术后冠状动脉慢血流/无复流预测模型的构建研究[J]. 中国心血管病研究, 2023(9): 858-864. |
| [23] | 李金武. 冠状动脉非阻塞性心肌梗死患者相关危险因素单中心回顾性研究[D]: [硕士学位论文]. 长春: 吉林大学, 2023. |
| [24] | 王夏婉, 侯园, 李灿. 急性心肌梗死患者经皮冠脉介入术后支架内再狭窄的影响因素[J]. 中国卫生工程学, 2022(4): 588-590. |
| [25] | 周辉, 王岚峰. 脂蛋白(a)与急性ST段抬高型心肌梗死患者冠脉病变严重程度相关性研究[J]. 现代中西医结合杂志, 2016, 25(25): 2761-2764. |
