可溶性ST2水平对急诊冠状动脉介入治疗术后室壁运动障碍的预测价值

目的探讨术前可溶性ST2(sST2)水平对急诊冠状动脉介入治疗(PCI)术后室壁运动障碍的预测价值。方法前瞻性纳入分析泰州市人民医院2019年1-9月行急诊PCI的114例急性心肌梗死患者的临床、实验室资料。术后1周完善超声心动图,计算室壁运动积分(WMS)以评价室壁运动。根据术前sST2水平分为Q1组(10.71-39ng/mL,38例)、Q2组(39.11-68ng/mL,38例)、Q3组(69~254.21ng/mL,38例),分析组间临床、实验室资料及左室射血分数(LVEF)、WMS差异。采用多因素线性回归分析急诊PCI术后WMS的影响因素。结果组间WMS差异有统计学意义,Q3组显著高于Q1组[21(20.75-23)vs 17(17-18)](P<0.001)。多因素分析结果显示,术前高sST2水平是急诊PCI术后WMS的独立危险因素(β=0.321,P<0.001)。其他包括高肌钙蛋白I、前降支病变、高血栓负荷、高血压病史亦是术后WMS的独立危险因素。结论术前高sST2水平是急诊PCI术后室壁运动障碍的独立危险因素,对缺血梗死范围有早期预测价值。

Value of soluble ST2 level in predicting ventricular wall motion abnormality after emergency percutaneous coronary intervention

Objective To investigate the value of preoperative soluble ST2(sST2) level in predicting ventricular wall motion abnormality after emergency percutaneous coronary intervention(PCI). Methods A prospective analysis was performed for the clinical and laboratory data of 114 patients with acute myocardial infarction who underwent emergency PCI in Taizhou People’s Hospital from January to September, 2019. Echocardiography was performed at 1 week after surgery, and wall motion score(WMS) was calculated to evaluate wall motion. According to preoperative s ST2 level, the patients were divided into Q1 group(10.71-39 ng/mL, 38 patients), Q2 group(39.11-68 ng/mL, 38 patients), and Q3 group(69-254.21 ng/mL, 38 patients), and the three groups were compared in terms of clinical data, laboratory data, left ventricular ejection fraction, and WMS. A multivariate linear regression analysis was used to investigate the influencing factors for WMS after emergency PCI. Results There was a significant difference in WMS between groups, and the Q3 group had a significantly higher WMS than the Q1 group [21(20.75-23) vs 17(17-18), P<0.001]. The multivariate analysis showed that high preoperative sST2 level was an independent risk factor for WMS after emergency PCI(β =0.321, P<0.001). Other independent risk factors included high troponin I level, lesions in the anterior descending branch,high thrombus load, and a medical history of hypertension. Conclusion High preoperative sST2 level is an independent risk factor for ventricular wall motion abnormality after emergency PCI and has a certain value in the early prediction of the extent of ischemic infarction.