血清凝集蛋白-1和可溶性细胞间黏附分子-1与急性心肌梗死患者经皮冠状动脉介入术后心肌无复流的关系

目的 观察行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性心肌梗死(acute myocardial infarction,AMI)患者术前血清凝集蛋白-1(intelectin-1,ITLN-1)和可溶性细胞间黏附分子-1(soluble intercell...

Relationships of serum intelectin-1 and soluble intercellular adhesion molecule-1 with myocardial no reflow after percutaneous coronary intervention in patients with acute myocardial infarction

Objective To observe the serum levels of intelectin-1(ITLN-1) and soluble intercellular adhesion molecule-1(sICAM-1) before percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI), and to investigate their values to the prediction of myocardial no reflow in AMI patients after PCI. Methods Totally 412 AMI patients undergoing primary PCI were divided into no reflow group(n=92) and normal blood flow group(n=320) according to postoperative myocardial blood flow. The clinical data were compared between two groups. The serum levels of ITLN-1 and sICAM-1 were detected by ELISA before PCI. The influencing factors of myocardial no reflow in AMI patients after PCI were analyzed by multivariate logistic regression. ROC was drawn to evaluate the predictive efficacies of preoperative serum ITLN-1 and sICAM-1 on myocardial no reflow in AMI patients after PCI. Results In 412 patients with AMI after PCI, myocardial no reflow occurred in 92 patients, with the incidence of 22.33%. No reflow group had higher level of preoperative serum sICAM-1((614.67±84.63) ng/L), older age of the patients((69.13±10.14) years), higher proportion of multi-vessel lesions(70.65%) and more stents(3.17±1.43) than normal blood flow group((402.59±81.66) g/L,(64.58±9.49) years, 34.69%, 2.04±1.12)(P<0.05). The preoperative serum ITLN-1 level was significantly lower in no reflow group((269.57±59.67) mg/L) than that in normal blood flow group((398.59±78.56) mg/L)(P<0.05). The preoperative serum sICAM-1 level >449.95 ng/L(OR=1.972, 95%CI:1.218-3.048,P=0.005),age>65 years(OR=1.609,95%CI:1.023-2.531,P=0.019),and double vessel lesions(OR=1.669,95%CI:1.034-2.692,P=0.013)were the risk factors,while the preoperative ITLN-1 >369.78 mg/L(OR=0.603,95%CI:0.426-0.853,P=0.022)was the protective factor of myocardial no reflow after PCI in patients with AMI. When the optimal cut-off values of the preoperative ITLN-1 and sICAM-1 were 297.43 μg/L and466.27 mg/L,the AUCs of ITLN-1,sICAM-1 and ITLN-1+sICAM-1 for predicting no reflow after primary PCI were0.835(95%CI:0.783-0.886,P<0.001),0.882(95%CI:0.848-0.916,P<0.001),and 0.927(95%CI:0.902-0.953,P<0.001),the sensitivities were 73.47%,77.21% and 81.60%,and the specificities were 92.25%,90.92% and 93.66%,respectively.The AUCof combined detection was higher than that of either ITLN-1 or sICAM-1(P<0.05).Conclusion The preoperative serum ITLN-1 >369.78 mg/L is a protective factor and sICAM-1 >449.95 ng/L is a risk factor of myocardial no reflow after primary PCI in patients with AMI.The combined detection of ITLN-1 and sICAM-1 is helpful for early identification of myocardial no reflow in AMI patients.