| 摘要: |
| ［摘要］ 目的 分析ST段抬高型心肌梗死（STEMI）患者血清多克隆联合游离轻链（cFLC）与经皮冠状动脉介入（PCI）术后心功能早期改善及预后的关联性。方法 选择2019年1月至2021年12月于内蒙古自治区人民医院行PCI术治疗的STEMI患者332例（STEMI组），另选择同期非冠心病者162例作为对照组。采用N-Latex FLC系统和散射比浊法测定入院时，发病72 h、7 d和30 d时的血清cFLC水平。PCI术后进行随访，在入院后24 h和3个月后进行超声心动图检查，并记录主要心脏不良事件（MACEs）的发生情况。结果 STEMI组血清cFLC水平于发病7 d时达到峰值，高于对照组入院时水平（P<0.05）。以STEMI组发病后7 d时的血清cFLC中位值为界值将患者分为低cFLC组（<0.66 mg/dl，166例）和高cFLC组（≥0.66 mg/dl，166例）。高cFLC组入院时峰值心肌肌钙蛋白I（cTnI）、峰值N末端B型脑钠肽（NT-proBNP）、峰值超敏C反应蛋白（hs-CRP）、SYNTAX评分、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室舒张末期容积（LVEDV）和左心室收缩末期容积（LVESV）均高于低cFLC组，差异有统计学意义（P<0.05）。PCI术后，低cFLC组左心室射血分数（LVEF）较术前改善显著（Z=3.578，P<0.001），但高cFLC组LVEF改善不显著（Z=0.612，P=0.544）。多因素Cox回归分析结果显示，发病7 d时较高的血清cFLC水平是促进STEMI患者PCI术后发生MACEs的独立危险因素（P<0.05），具有预测MACEs发生的应用价值［AUC（95%CI）=0.924(0.889～0.960)］。结论 急性STEMI患者早期血清cFLC水平升高与PCI术后左心功能改善不良以及MACEs的发生有关，有作为左心室功能障碍新型生物标志物的应用前景。 |
| 关键词: 血清游离轻链 ST段抬高型心肌梗死 经皮冠状动脉介入术 心功能 主要心脏不良事件 |
| DOI：10.3969/j.issn.1674-3806.2023.03.09 |
| 分类号:R 542.2 |
| 基金项目:内蒙古自治区自然科学基金项目（编号：2021MS08105） |
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| Analysis on the association of serum polyclonal combined free light chain with early improvement of cardiac function and prognosis after PCI in patients with ST-segment elevation myocardial infarction |
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MENG Jun-jun, WU Zhen-li, SONG Ming-zhe, et al.
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Geriatric Medical Center, Inner Mongolia Autonomous Region People′s Hospital, Hohhot 010010, China
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| Abstract: |
| ［Abstract］ Objective To analyze the association of serum polyclonal combined free light chain(cFLC) with early improvement of cardiac function and prognosis after percutaneous coronary intervention(PCI) in patients with ST-segment elevation myocardial infarction(STEMI). Methods Three hundred and thirty-two STEMI patients(the STEMI group) who underwent PCI in Inner Mongolia Autonomous Region People′s Hospital from January 2019 to December 2021 were selected, and 162 patients without coronary heart disease during the same period were selected as the control group. N-Latex FLC system and scattering turbidimetric method were used to determine the serum cFLC levels at admission, 72 hours, 7 days and 30 days after onset. A follow-up was performed on the patients after PCI. Echocardiography was conducted 24 hours and 3 months after admission, and major adverse cardiovascular events(MACEs) were recorded. Results The serum cFLC level in the STEMI group peaked 7 days after onset, which was higher than that in the control group at admission(P<0.05). The patients in the STEMI group were divided into the low cFLC group(<0.66 mg/dl, n=166) and the high cFLC group(≥0.66 mg/dl, n=166), using the median value of serum cFLC as the threshold 7 days after onset. The peak cardiac troponin I(cTnI), peak N-terminal pro-brain natriuretic peptide(NT-proBNP), peak high-sensitive C-reactive protein(hs-CRP), SYNTAX score, left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD), left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) in the high cFLC group were higher than those in the low cFLC group at admission, and the differences were statistically significant(P<0.05). After PCI, the left ventricular ejection fraction(LVEF) in the low cFLC group was significantly improved compared with that before PCI(Z=3.578, P<0.001), but the LVEF in the high cFLC group was not significantly improved compared with that before PCI(Z=0.612, P=0.544). The results of multivariate Cox regression analysis showed that higher serum cFLC level 7 days after onset was an independent risk factor for MACEs after PCI in the STEMI patients(P<0.05), and the higher serum cFLC level 7 days after onset had application value in predicting the occurrence of MACEs ［AUC(95%CI)=0.924(0.889～0.960)］. Conclusion Early elevation of serum cFLC in acute STEMI patients is associated with poor improvement of left ventricular function after PCI and the occurrence of MACEs, which has a promising application as a novel biomarker for left ventricular dysfunction. |
| Key words: Serum free light chain ST-segment elevation myocardial infarction(STEMI) Percutaneous coronary intervention(PCI) Cardiac function Major adverse cardiovascular events(MACEs) |
