三项检测在急性心梗急诊PCI术后预后不良中的预测应用

目的 探讨同型半胱氨酸（homocysteine，Hcy）、分泌型卷曲相关蛋白 5（secreted frizzled related protein 5，SFRP5）及尿酸（uric acid，UA）三项检测在急性心梗急诊PCI术后预后不良的预测价值。 方法 选取2017年1月～2018年12月在资阳市第一人民医院治疗的96例急性心肌梗死患者，根据2年随访数据划分为预后良好组（n=63）和预后不良组（n=33）。分析不同预后的患者Hcy、SFRP5、UA水平；Logistic回归分析影响患者预后不良的相关因素；绘制ROC曲线，分析三者联合（Hcy、SFRP5及UA）检测对PCI术后预后不良的预测价值。 结果 ①两组性别、年龄、体质量、高血压史、糖尿病史比较差异无统计学意义；两组心脑血管家族遗传史、吸烟史、饮酒史、冠脉病支数比较差异有统计学意义（均P<0.01）；② 预后不良组患者Hcy、UA水平明显高于预后良好组，SFRP5水平明显低于预后良好组（均P<0.01）；③心脑血管家族遗传史、吸烟史、饮酒史、冠脉病支数、Hcy、SFRP5、UA是影响急性心肌梗死患者PCI术后预后不良的相关危险因素（均P<0.01）；④Hcy、SFRP5、UA及三者联合检测AUC分别为0.948、0.894、0.823、0.991，灵敏度分别为87.56、85.12、83.65、91.56，特异度分别为89.45、87.26、84.19、92.14，各指标AUC、灵敏度、特异度均为联合检测最佳。 结论 Hcy、SFRP5及UA与急性心肌梗死患者PCI术后预后密切相关，临床可通过对急性心肌梗死患者PCI术后早期联合检测三项指标，有助于评估预后。

Preductive application of three detection in poor prognosis after emergency PCI in patients with acute myocardial infarction

AIM To explore the predictive value of homocysteine (Hcy), secreted frizzled related protein 5 (SFRP5) and uric acid (UA) three detection in poor prognosis after emergency PCI in patients with acute myocardial infarction. METHODS Ninety-six patients with acute myocardial infarction treated in Ziyang First People's Hospital from January 2017 to December 2018 were selected, according to 2-year follow-up data, they were divided into the control group (n=63) and the observation group (n=33). The levels of Hcy, SFRP5 and UA in patients with different prognosis were analyzed; Logistic regression was used to analyze the related factors that affected the poor prognosis in the patients; ROC curve was drawn to analyze the predictive value of the three combined (Hcy, SFRP5 and UA) detection for the poor prognosis after PCI. RESULTS ① There was no significant difference in gender, age, body weight, history of hypertension, and history of diabetes between the two groups; there were significant differences in the family history of cardiovascular and cerebrovascular diseases, smoking history, drinking history and coronary artery disease number between the two groups (all P<0.01). ② The levels of Hcy and UA in the observation group were significantly higher than those in the control group and the level of SFRP5 was lower than that in the control group (all P<0.01). ③ Cardiovascular and cerebrovascular family genetic history, smoking history, drinking history, coronary artery disease branch number, Hcy, SFRP5, UA were related risk factors for poor prognosis after PCI in patients with acute myocardial infarction (all P<0.01). The AUC of Hcy, SFRP5 and UA and combined detection of the three was 0.948, 0.894, 0.823 and 0.991,respectively, the sensitivities were 87.56, 85.12, 83.65 and 91.56, respectively, and the specificities were 89.45, 87.26, 84.19 and 92.14, respectively, the AUC, sensitivity and specificity of combined detection were the best. CONCLUSION Hcy, SFRP5 and UA are closely related to the prognosis of patients with acute myocardial infarction after PCI,, and the early combined detection of the three indicators in patients with acute myocardial infarction after PCI is helpful to evaluate the prognosis.