当前位置:

网站首页>文章详情

STEMI梗死血管自然再通的患者血清爱帕琳肽表达水平的临床研究

【PDF在线阅读】 【下载PDF】
  • Author:

  • Author Unit:

  • Keywords:

摘要:

目的 探讨血清爱帕琳肽(apelin)水平与急性ST段抬高型心肌梗死(STEMI)患者梗死相关血
管自然再通及预后的关系。方法 前瞻性选择2014年10月至2016年12月于莱芜市人民医院和山东省千佛山医院
心内科收治的103例拟行急诊经皮冠状动脉介入治疗(PCI)的STEMI患者,根据冠状动脉(冠脉)造影TIMI
血流分级将患者分为自然再通组(21例,TIMI血流分级2~3级)和非自然再通组(82例,TIMI血流分级0~1
级)。所有患者入院即刻、PCI后检测血清apelin水平,术后随访6个月统计主要不良心血管事件(MACE)
发生情况。结果 自然再通组患者血清apelin水平高于非自然再通组(P<0.05),PCI后非自然再通组患者血
清apelin水平与术前对比显著升高(P<0.05)。Apelin与梗死血管自然再通独立相关(OR=3.743,95%CI:
1.235~9.351,P<0.001),预测梗死血管自然再通的曲线下面积(AUC)为0.869(95%CI:0.765~0.973,P
<0.001),灵敏度和特异度分别为85.71%,91.46%。随访结果表明,apelin水平预测患者预后价值不大。结
论 血清apelin水平可预测STEMI梗死相关血管自然再通的发生,但对预后价值不大。

Abstract:

Objective To investigate the relationship among level of serum apelin, natural recanalization of
infarction related artery (NR-IRA) and prognosis in patients with acute ST-segment elevation myocardial infarction
(STEMI). Methods STEMI patients (n=103) scheduled emergent PCI were prospectively chosen from Department
of Cardiology in People’s Hospital of Laiwu City and Qianfoshan Hospital of Shandong Province from Oct. 2014
to Dec. 2016. The patients were divided, according to TIMI flow grading, into NR-IRA group (n=21, TIMI flow
grades=2-3) and non-NR-IRA group (n=82, TIMI flow grades=0-1). The level of serum apelin was detected
immediately after hospitalization and after PCI in all patients. The incidence of major adverse cardiovascular events
(MACE) were counted after followed up for 6 months. Results The level of serum apelin was higher in NR-IRA
group than that in non-NR-IRA group (P<0.05). The level of serum apelin increased significantly in non-NR-IRA
group after PCI (P<0.05). The level of serum apelin was independently correlated to NR-IRA (OR=3.743, 95%CI:
1.235~9.351, P<0.001). The area under curve (AUC) for predicting NR-IRA was 0.869 (95%CI: 0.765~0.973,
P<0.001), and the sensitivity was 85.71% and specificity was 91.46%. The results of follow-up showed that the
predictive value of apelin level to patients’ prognosis was lower. Conclusion The level of serum apelin can
predict the incidence of NR-IRA but has lower value to prognosis in STEMI patients.

基金项目:

2015年度山东省自然科学基金项目(2015ZRB14495)

参考文献:

[1] 张克良,刘晓堃. 重组人脑利钠肽对行补救PCI术的急性前壁心
肌梗死患者预后的影响[J]. 医学研究杂志,2016,45(7):163-6.
[2] Fefer P,Hod H,Hammerman H,et al. Relation of clinically defined
spontaneous reperfusion to outcome in ST-elevation myocardial
infarction[J]. Am J Cardiol,2009,103(2):149-53.
[3] Zeymer U,Huber K,Fu Y,et al. Impact of TIMI 3 patency
before primary percutaneous coronary intervention for STelevation
myocardial infarction on clinical outcome: results from
the ASSENT-4 PCI study[J]. Eur Heart J Acute Cardiovasc
Care,2012,1(2):136-42.
[4] 李新春,丁水印,王霞,等. Apelin-13对H9c2心肌细胞增殖及
E R K 1 / 2信号通路活化的影响[ J ] . 中国循证心血管医学杂
志,2016,8(7):868-71.
[5] 倪萍,赵志强. 血浆Apelin在不同类型冠心病中的表达及与左心
室重构的关系[J]. 中国循证心血管医学杂志,2016,8(7):868-71.
[6] 申健, 张旭, 李志明, 等. 急性S T 段抬高型心肌梗死患者
外周血a p e l i n 的水平变化及意义[ J ] . 南方医科大学学
报,2015,35(3):407-12.
[7] Babaev A,Frederick PD,Pasta DJ,et al. Trends in management and
outcomes of patients with acute myocardial in farction complicated by
cardiogenic shock[J]. JAMA,2005,294(3):448.
[8] Gibson CM,Cannon CP,Murphy SA,et al. Relationship of the
TIMI myocardial perfusion grades, flow grades,frame count,and
percutaneous coronary intervention to long-term outcomes after
thrombolytic administration in acute myocardial infarction[J]. Circula
tion,2002,105(16):1909-13.
[9] Cura FA,L'Allier PL,Kapadia SR,et al. Predictors and prognosis
of suboptimal coronary blood flow after primary coronary
angioplasty in patients with acute myocardial infarction[J]. Am J
Cardio,2001,88(2):124-8.
[10] Masri B,Knibiehler B,Audigier Y. Apelin signalling:a promising pathway
from cloning to pharmacology[J]. Cell Signal,2005,17(4):415-26.
[11] 张昌琳,乔树宾. Apelin-APJ系统在心肌肥厚发生发展过程中作
用的研究进展[J]. 中国循环杂志,2015,30(4):398-400.
[12] 孙倩,张文. Apelin-血管紧张素受体相关蛋白系统在心血管疾病
中的研究进展[J]. 中国循环杂志,2015,30(11):1134-6.
[13] Zhang BH,Guo CX,Wang HX,et al. Cardioprotective effects of
adipokine Apelin on myocardial infarction[J]. Heart Vessels,2014,29
(5):679-89.
[14] Liu HT,Chen M,Yu J,et al. Serum Apelin level predicts the major
adverse cardiac events in patients with ST elevation myocardial
infarction receiving percutaneous coronary intervention[J]. Medicine
(Baltimore),2015,94(4):e449.
[15] F?ldes G,Horkay F,Szokodi I,et al. Circulating and cardiac levels of
Apelin, the novel ligand of the orphan receptor APJ,in patients with
heart failure[J]. Biochem Biophys Res Commun,2003,308(3):480-5.
[16] Ashley EA,Powers J,Chen M,et al. The endogenous peptide Apelin
potently improves cardiac contractility and reduces cardiac loading in
vivo[J]. Cardiovasc Res,2005,65(1):73-82.
[17] 王妮,刘伟,毕四锐,等. 外周血Apelin水平对急性ST段抬高型
心肌梗死病情及预后评估价值[ J ] . 中华实用诊断与治疗杂
志,2016,30(7):669-71.
[18] Scimia MC,Hurtado C,Ray S,et al. APJ acts as a dual receptor in
cardiac hypertrophy[J]. Nature,2012,488(7411):394-398.
[19] Tempel D,De Boer M,Van Deel ED,et al. Apelin enhances cardiac
neovascularization after myocardial infarction by recruiting aplnr plus
circulating cells[J]. Circ Res,2012,111(5):585-98.
[20] Tunon J,Blanco-Colio L,Cristobal C,et al. Usefulness of a
combination of monocyte chemoattractant protein-1,galectin-3,and
N-Terminal probrain natriuretic peptide to predict cardiovascular
events in patients with coronary artery disease[J]. Am J Cardiol,2014,
113(3):434-40.
[21] Zencirci AE,Zencirci E,Degirmencioglu A,et al. The relationship
between Gensini score and ST- segment resolution in patients
with acute ST-segment elevation myocardial infarction undergoing
p r i m a r y p e r c u t a n e o u s c o r o n a r y i n t e r v e n t i o n [ J ] . K a r d i o l
Pol,2014,72(6):494-50.
  • 2008

  • 1

通讯地址:北京市东城区东四十条南门仓5号
电话: 237499284 邮编:100700
网址:www.ebcvm..org Email: ebcvm_cj@126.com

copyright © 《中国循证心血管医学杂志》编辑部
当您在使用本网站投稿遇到困难时,
请直接将稿件投送到编辑部邮箱ebcvm_cj@126.com