2023 年第 6 期 第 18 卷

血清胱抑素C和高敏C反应蛋白水平与急诊经皮冠状动脉介入手术中同时干预非罪犯血管病变患者预后的关系

Relationship between the levels of serum cystatin C and high-sensitivity C-reactive protein and the prognosis of patients with non-culprit vessel lesions undergoing emergency percutaneous coronary intervention

作者：黄辉孙静任锋寇进李然

英文作者：Huang Hui Sun Jing Ren Feng Kou Jin Li Ran

单位：中国人民武装警察部队陕西省总队医院心血管内科，西安710054

英文单位：Department of Cardiovascular Medicine Shaanxi Provincial General Hospital of Chinese People′s Armed Police Force Xi′an 710054 China

关键词：急性ST段抬高型心肌梗死；非罪犯血管病变；胱抑素C；高敏C反应蛋白

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Non-culpritvessellesions;CystatinC; High-sensitivityC-reactiveprotein

• 摘要：

• 目的  探究血清胱抑素C和高敏C反应蛋白（hs-CRP）水平与急诊经皮冠状动脉介入（PCI）手术中同时干预非罪犯血管病变患者预后的关系。方法  选取2013年1月至2018年12月于中国人民武装警察部队陕西省总队医院行急诊PCI手术的ST段抬高型心肌梗死患者256例进行前瞻性研究。根据是否在急诊PCI中干预非罪犯血管病变分为对照组（131例）和干预组（125例）。所有患者在急诊手术前通过肘静脉采集静脉血5 ml，检测血清胱抑素C和hs-CRP水平。比较2组患者中不同胱抑素C及hs-CRP水平者主要不良心血管事件（MACE）发生情况。采用多因素Logistic回归方法分析完全性血运重建患者1年内心血管复合终点事件和1个月内死亡的危险因素。结果  在胱抑素C水平≥0.87 mg/L的患者中，干预组1年内发生主要终点事件、1个月内死亡、发生手术并发症的比例均高于对照组，差异均有统计学意义（均P＜0.05）；在胱抑素C水平＜0.87 mg/L的患者中，干预组1年内发生MACE的比例低于对照组［17.2%（11/64）比43.8%（28/64）］，差异有统计学意义（P＜0.05）。在hs-CRP≥12.76 mg/L的患者中，干预组1年内发生MACE和1年内发生心血管死亡的比例均低于对照组［23.1%（12/52）比46.1%（35/76）、11.5%（6/52）比26.3%（20/76）］，差异均有统计学意义（均P＜0.05）；在hs-CRP＜12.76 mg/L的患者中，干预组发生手术并发症的比例高于对照组，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，年龄＞65岁、合并糖尿病、左心室射血分数＜45%是完全性血运重建患者1年内心血管复合终点事件的独立危险因素；年龄＞65岁、胱抑素C水平≥0.87 mg/L、左心室射血分数＜45%是完全性血运重建患者1个月内死亡的独立危险因素。结论  hs-CRP水平较高而胱抑素C水平较低的患者可能更能从急诊PCI治疗干预非罪犯血管病变中实现临床获益。胱抑素C水平和肾功能可能与非罪犯血管病变手术的1个月内死亡和手术并发症相关。

• Objective    To investigate the relationship between the levels of serum cystatin C (CyC) and high-sensitivity C-reactive protein (hs-CRP) and the prognosis of patients with non-culprit vessel lesions undergoing emergency percutaneous coronary intervention (PCI). Methods  From January 2013 to December 2018, 256 patients with ST-segment elevation myocardial infarction who underwent emergency PCI in Shaanxi Provincial General Hospital of Chinese People′s Armed Police Force were collected as prospective research. They were divided into control group （131 cases） and intervention group （125 cases） according to whether to intervene in non-culprit vessel lesions during emergency PCI. 5 ml of venous blood through the elbow vein were collected from all patients before emergency surgery， and the levels of serum CyC and hs-CRP were detected. The major adverse cardiovascular events (MACE) in patients with different levels of CyC and hs-CRP were compared in the two groups. Multivariate Logistic regression method was used to analyze risk factors for cardiovascular composite endpoint events within 1 year and death within 1 month in patients with complete revascularization. Results  In patients with level of CyC≥0.87 mg/L, the proportions of major endpoint events within 1 year, death within 1 month and surgical complications in the intervention group were higher than those in the control group（all P＜0.05）. In patients with level of CyC＜0.87 mg/L, the proportion of MACE within 1 year in the intervention group was lower than that in the control group ［17.2%（11/64） vs 43.8%（28/64）］（P＜0.05）. In patients with level of hs-CRP≥12.76 mg/L, the proportions of MACE and cardiovascular death within 1 year in the intervention group were lower than those in the control group［23.1%（12/52） vs 46.1%（35/76）, 11.5%（6/52） vs 26.3%（20/76）］（both P＜0.05）. In patients with level of hs-CRP＜12.76 mg/L, the proportion of surgical complications in the intervention group was higher than that in the control group （P＜0.05）. Multivariate Logistic regression analysis showed that age＞65 years, combined diabetes mellitus, and left ventricular ejection fraction＜45% were independent risk factors for cardiovascular composite endpoint events within 1 year in patients with complete revascularization, and age＞65 years, the level of CyC≥0.87 mg/L, and left ventricular ejection fraction＜45% were independent risk factors for death within 1 month in patients with complete revascularization. Conclusion  Patients with higher level of hs-CRP and lower level of CyC may be more able to achieve clinical benefits in the treatment of non-culprit vessel lesions undergoing emergency PCI. The level of CyC and renal function may be associated with death within 1 month and surgical complications in non-culprit vessel lesions surgery.