血清sTWEAK、KLK1水平预测老年急性非ST段抬高型心肌梗死病人急诊PCI预后的研究

doi:10.3969/j.issn.1003-9198.2022.04.010

摘要/Abstract

摘要： 目的分析血清可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、组织激肽释放酶1(KLK1)水平预测老年急性非ST段抬高型心肌梗死(NSTEMI)病人急诊行经皮冠状动脉介入治疗(PCI)预后的价值。方法回顾性分析本院接受急诊PCI治疗的117例老年NSTEMI病人资料,观察并比较病人入院时和PCI术后1 d血清sTWEAK、KLK1、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)水平;根据随访1年的结果分为预后良好组和预后不良组,比较2组血清sTWEAK、KLK1水平,并分析血清sTWEAK、KLK1水平预测病人预后的价值。结果 117例老年NSTEMI病人术后1 d sTWEAK、cTnT、CK-MB水平均较入院时降低,KLK1水平较入院时升高,差异有统计学意义(P＜0.01)。随访1年时,117例病人中32例(27.35%)预后不良,预后不良组NSTEMI病人入院时sTWEAK水平高于预后良好组, KLK1水平低于预后良好组(P＜0.05)。Logistic回归分析显示, 高sTWEAK水平(OR=1.167,95%CI: 1.095~1.243)、低KLK1水平(OR=0.526, 95%CI: 0.402~0.688)是老年NSTEMI病人急诊PCI预后不良的风险因子(P＜0.05)。ROC曲线显示入院时血清sTWEAK、KLK1单一及联合预测老年NSTEMI病人急诊PCI预后不良的AUC分别为0.814、0.895、0.907。结论老年NSTEMI病人急诊PCI预后不良可能与sTWEAK过表达、KLK1低表达有关,尽早检测病人入院时sTWEAK、KLK1水平,对病人预后风险有一定预测价值。

关键词: 急性非ST段抬高型心肌梗死, 可溶性肿瘤坏死因子样凋亡弱诱导因子, 组织激肽释放酶1, 经皮冠状动脉介入术, 预后, 预测价值

Abstract: Objective To analyze the prediction value of serum levels of soluble tumor necrosis factor like weak inducer of apoptosis(sTWEAK) and tissue kallikrein 1(KLK1) for the prognosis of the elderly patients with acute non-ST segment elevation myocardial infarction(NSTEMI) after emergency percutaneous coronary intervention(PCI). Methods The data of 117 elderly patients with NSTEMI receiving emergency PCI in our hospital from April 2018 to December 2019 were retrospectively analyzed. The serum levels of sTWEAK, KLK1, cardiac troponin T(cTnT)and creatine kinase MB(CK-MB) at admission and 1 d after PCI were observed and compared. Aceording to the prognosis 1 year after PCI, the patients were divided into the good prognosis group and the poor prognosis group, and the serum levels of sTWEAK and KLK1 were compared between the two groups.The prediction value of serum sTWEAK and KLK1 was analyzed. Results The levels of sTWEAK, cTnT and CK-MB were significantly lower and the level of KLK1 was higher in 117 elderly patients with NSTEMI 1 day after PCI than those at admission(P<0.05). After 1 year of follow-up, there was 32 cases (27.35%)showing poor prognosis, and the level of sTWEAK in the poor prognosis group was higher and the level of KLK1 was lower than that in the good prognosis group(P<0.05).Logistic regression analysis showed that the over expression of sTWEAK (OR=1.167,95%CI: 1.095-1.243)and low expression of KLK1(OR=0.526, 95%CI: 0.402-0.688) might be risk factors for poor prognosis of emergency PCI in the elderly NSTEMI patients(P<0.05). Receiver operating characteristic curve(ROC) curve was drawn and showed that the AUC of serum sTWEAK and KLK1 or combination in predicting the prognosis of emergency PCI in the elderly NSTEMI patients was 0.814, 0.895 and 0.907 respectively. Conclusions The poor prognosis may be related to the over expression of sTWEAK and the low expression of KLK1. Early detection of sTWEAK and KLK1 levels at admission has certain predictive value for the prognosis in the elderly NSTEMI patients after the emergency PCI.

Key words: acute non ST segment elevation myocardial infarction, soluble tumor necrosis factor like weak inducer of apoptosis, tissue kallikrein-1, percutaneous coronary intervention, prognosis, prediction value

中图分类号:

R 542.22

殷雪娇, 李慧, 梁荣珍, 柳雯, 王灵纳, 林莉. 血清sTWEAK、KLK1水平预测老年急性非ST段抬高型心肌梗死病人急诊PCI预后的研究[J]. 实用老年医学, 2022, 36(4): 364-368.

YIN Xue-jiao, LI Hui, LIANG Rong-zhen, LIU Wen, WANG Ling-na, LIN Li. Prediction value of sTWEAK and KLK1 for the prognosis of elderly patients with acute non-ST segment elevation myocardial infarction receiving emergency percutaneous coronary intervention[J]. Practical Geriatrics, 2022, 36(4): 364-368.

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