经皮冠状动脉介入治疗急性心肌梗死患者的sST2对冠状动脉侧支循环形成的预测价值

摘要/Abstract

摘要： 目的经皮冠状动脉介入治疗急性心肌梗死患者的可溶性致癌抑制因子2（Soluble suppression of tumorigenesis 2,sST2）对冠状动脉侧支循环形成的预测价值。方法我们纳入2020年6月至2023年7月我院收治的 85 例行急诊PCI（Percutaneous coronary intervention）的ST段抬高型心肌梗死（ST elevation myocardial infarction,STEMI）患者作为研究对象,入院后患者均根据最新急性ST段抬高型心肌梗死治疗指南行急诊PCI术,通过标准血管造影在基线时收集冠状动脉侧支循环（Collateral circulation,CC）数据。根据Rentrop分级法对侧支循环进行分级：没有填充任何血管等级为0,小侧支充填为1级,部分心外膜动脉充盈为2级,完全心外膜动脉灌注为3级。其中0级和1级被视为侧支循环形成不良,2级和3级被视为侧支循环形成良好。患者被分为两组：CC良好组（n=33）和CC不良组（n=52）。急性心肌梗死患者入院第一天介入术前用ELISA法测定血清sST2,所有患者均行急诊PCI术。对比CC形成良好组与CC形成不良组的一般资料,用 Logistic 回归分析危险因素,以受试者工作特征（ROC）曲线下面积（AUC）分析入院时血清sST2 水平,以及对STEMI患者侧支循环的预测价值。结果通过回顾性分析发现,85例患者中冠状动脉侧支循环形成良好33例,冠状动脉侧支循环形成不良52例,冠脉侧支循环形成率38%。冠状动脉侧支循环形成不良组血清sST2浓度高于侧支循环形成良好组,差异有统计学意义（P<0.05）;入院sST2预测STEMI患者急诊PCI术后侧支循环的ROC曲线下面积为0.706（95%CI: 0.579~0.833, P<0.05）。结论 sST2水平对STEMI患者冠状动脉侧支循环形成具有良好的预测价值。

关键词: 可溶性致癌抑制因子2, ST 段抬高型心肌梗死, 侧支循环, 预测价值

Abstract: Objective To investigate the value of soluble suppression of tumorigenesis 2 (sST2) in predicting the formation of coronary collateral circulation in patients with acute myocardial infarction after percutaneous coronary intervention. Methods A total of 85 patients with ST-elevation myocardial infarction (STEMI) who were admitted to The First People's Hospital of Jining from June 2020 to July 2023 and underwent emergency percutaneous coronary intervention (PCI) were enrolled as subjects. After admission, all patients underwent emergency PCI according to the latest guidelines for the treatment of acute STEMI, and standard angiography was performed to collect coronary collateral circulation data. Collateral circulation was graded according to the Rentrop's grading system: collateral circulation without filling any blood vessels as grade 0; small collateral filling as grade 1; partial epicardial artery filling as grade 2; complete epicardial artery perfusion as grade 3. Grades 0 and 1 were considered as poor collateral circulation formation, and grades 2 and 3 were considered as good collateral circulation formation. The patients were divided into good collateral circulation group with 33 patients and poor collateral circulation group with 52 patients. ELISA was used to measure the serum level of sST2 before intervention on day 1 of admission, and all patients underwent emergency PCI. General data were compared between the good collateral circulation group and the poor collateral circulation group. A logistic regression analysis was used to investigate risk factors, and the area under the ROC curve (AUC) was used to analyze the serum level of sST2 on admission and its value in predicting collateral circulation in patients with STEMI. Results The retrospective analysis showed that among the 85 patients, 33 had good coronary collateral circulation and 52 had poor coronary collateral circulation, resulting in a rate of coronary collateral circulation of 38%. The poor collateral circulation group had a significantly higher serum level of sST2 than the good collateral circulation group (P<0.05). The serum level of sST2 on admission had an AUC of 0.706 (95% confidence interval: 0.579-0.833, P<0.05) in predicting collateral circulation after PCI in patients with STEMI. Conclusion The level of sST2 has a good value in predicting the formation of coronary collateral circulation in STEMI patients.

Key words: Soluble suppression of tumorigenesis 2, ST-elevation myocardial infarction, Collateral circulation, Predictive value

岳福伟, 查艳萍, 朱涛, 宁婧. 经皮冠状动脉介入治疗急性心肌梗死患者的sST2对冠状动脉侧支循环形成的预测价值[J]. 心血管病防治知识, 2024, 14(1): 3-8.

Yue Fu-wei, Zha Yan-ping, Zhu Tao, Ning Jing. Value of Soluble Suppression of Tumorigenesis 2 in Predicting the Formation of Coronary Collateral Circulation in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention[J]. Prevention and Treatment of Cardiovascular Disease, 2024, 14(1): 3-8.

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