老年急性ST段抬高型心肌梗死患者血清RF，Cys-C水平与直接PCI术后无复流的关系

目的　分析血清类风湿因子（rheumatoid factor, RF），胱抑素-C（cystatin C, Cys-C）水平与老年急性ST 段抬高型心肌梗死（ST-segment elevation myocardial infarction, STEMI）患者直接经皮冠状动脉介入（percutaneous coronary intervention, PCI）术后无复流的关系。方法　选取邯郸市中心医院于2018 年12 月～ 2019 年12 月收治的232 例行直接PCI 术的老年STEMI 患者，术后根据心肌梗死溶栓治疗（TIMI）血流分级将患者分为无复流组（47 例）和正常血流组（185 例），比较两组患者术前血清RF 和Cys-C 水平及一般临床资料的差异，分析老年STEMI 患者直接PCI 术后无复流的危险因素，分析RF 和Cys-C 对患者无复流的预测价值。结果　无复流组患者的血清RF（18.34±7.65 IU/ml vs8.47±4.16 IU/ml），Cys C（1.58±0.54mg/L vs 0.87±0.32mg/L）及支架置入数目（3.15±1.43 个 vs 2.02±1.12 个），多支血管病变比例30（63.83%） vs 66（35.68%）]，糖尿病比例33（70.21%） vs 77（41.62%）] 明显高于正常血流组，差异均有统计学意义（χ2/t=11.954~111.607，均P <0.05）。Logistic 多因素回归分析显示年龄、糖尿病、RF 和Cys-C 是老年STEMI 患者直接PCI 术后无复流的危险因素（OR=1.893~3.025，均P< 0.05）。RF 和Cys-C 预测行直接PCI 术的老年STEMI 患者术后无复流的受试者工作特征（ROC）曲线下面积（AUC）分别为0.864 和0.821，二者联合检测的AUC 为0.918，高于RF 和Cys-C 任一单项指标。结论　老年STEMI 直接PCI 术后无复流患者血清RF 和Cys-C 水平升高，且二者均是无复流发生的危险因素，有助于早期识别无复流。

Correlation between Serum RF,Cys-C Levels and No-reflow after Primary PCI in Elderly Patients with Acute ST-segment Elevation Myocardial Infarction

Objective　To analyze the relationship between serum rheumatoid factor (RF), cystatin -C (Cys-C) levels and no reflow after direct percutaneous coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI). Methods　A total of 232 elderly STEMI patients undergoing direct PCI were selected from Handan Central Hospital from December 2018 to December 2019. According to postoperative myocardial infarction (TIMI) flow thrombolysis treatment classification，the patients were divided into the no-reflow group (47 cases) and normal blood flow group (185 cases). Differences in serum RF and Cys-C levels and general clinical data were compared between the two groups. Analyzed the risk factors of no reflow after direct PCI in elderly patients with STEMI ,and analyzed the predictive value of RF and Cys-C for no reflow in patients. Results　The serum RF(18.34±7.65 IU/ml vs 8.47±4.16 IU/ml), Cys-C(1.58±0.54mg/L vs 0.87±0.32mg/ L) and number of stent implantation(3.15±1.43 vs 2.02±1.12), number of diseased vessels
30(63.83%) vs 66(35.68%)] and diabetes
33(70.21%) vs 77(41.62%)] rate of patients in the no-reflow group were significantly higher than those in the normal blood flow group， the difference was statistically significant(χ2/t=11.954~111.607，all P<0.05). Logistic multivariate regression analysis showed that age, diabetes, RF and Cys-C were risk predictors of no-reflow after direct PCI in elderly patients with STEMI (OR=1.893~3.025, all P<0.05). The receiver operating characteristic (ROC) area under curve (AUC) of RF and Cys-C predicted no-reflow after direct PCI in elderly patients with STEM were 0.864 and 0.821 respectively, and the AUC of the combined detection was 0.918, which was higher than either single index of RF and Cys-C. Conclusion　Serum RF and Cys-C levels of no-reflow after direct PCI in elderly patients with STEM were increased, and the two are risk factors for the occurrence of no-reflow, which is helpful for the early recognition of no-flow.