青年急性心肌梗死患者血清脂滴蛋白-5水平与冠脉病变严重程度密切相关

王晶.青年急性心肌梗死患者血清脂滴蛋白-5水平与冠脉病变严重程度密切相关[J].内科急危重症杂志,2022,28(4):281-284

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DOI：10.11768/nkjwzzzz20220405

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作者	单位	E-mail
王晶	首都医科大学附属北京同仁医院急诊科	trzhangy@163.com

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中文摘要:

目的：探讨血清脂滴蛋白-5水平与青年急性心肌梗死（AMI）患者冠脉病变严重程度的相关性及其对预后的预测价值。方法：选择接受经皮冠状动脉介入治疗术（PCI）治疗的青年AMI患者110例作为青年AMI组，选择同期行体检并明确身体健康者100例作为正常对照组，比较PCI前2组血清脂滴蛋白-5水平的差异。分析血清脂滴蛋白-5水平与青年AMI患者病变严重程度的关系。随访期1年，青年AMI组失访24例，根据PCI后1年患者主要心血管不良事件（MACE）的发生情况分为MACE组（18例）和无MACE组（68例），采用logistics回归模型分析MACE发生的危险因素。结果：青年AMI组患者术前血清脂滴蛋白-5水平显著低于正常对照组（P＜0.05）。高脂滴蛋白-5组患者的病变支数少于低脂滴蛋白-5组，Gensini评分低于低脂滴蛋白-5组（P均＜0.05）。MACE组患者血清脂滴蛋白-5水平低于无MACE组患者（P＜0.05）。受试者工作特征曲线显示，血清脂滴蛋白-5水平预测青年AMI患者PCI后1年内MACE发生的临界值为4.680μg/L，曲线下面积为0.809（95% CI： 0.701~0.918），灵敏度为68.66%、特异性为71.43%。MACE组与无MACE组Killip心功能分级、发病至PCI时间、左室射血分数（LVEF）、病变支数、脂滴蛋白-5水平比较，差异有统计学意义（P均＜0.05）。Logistics分析发现，Killip心功能分级Ⅲ~Ⅳ级、发病至PCI时间较长、LVEF≤40%、病变支数≥3支、脂滴蛋白-5水平＜4.680μg/L是青年AMI患者1年随访期MACE发生的独立危险因素（P均＜0.05）。结论：青年AMI患者血清脂滴蛋白-5水平与病情严重程度密切相关，异常低水平的脂滴蛋白-5是术后MACE发生的独立危险因素。

英文摘要:

Objective: To investigate the correlation between serum perilipin-5 and severity of acute myocardial infarction (AMI) in young patients and its predictive value for prognosis. Methods: 110 young AMI patients who received PCI were treated as young AMI group, and 100 volunteers who underwent physical examination in our hospital during the same period were treated as normal control group. The preoperative serum perilipin-5 level was compared. Relationship between serum perilipin-5 level and lesion severity in young AMI patients was analyzed. During follow-up period, 24 cases fell out, major cardiovascular adverse events (MACEs) of patients were followed up. At 1st year after PCI, MACEs group (n=18) and non-MACEs group (n=68) were set up. Risk factors of MACEs were analyzed using logistics regression model. Results: Preoperative serum perilipin-5 level in AMI group was significantly lower than that in normal control group (P<0.05). Patients in high perilipin-5 group had fewer lesions than those in low perilipin-5 group, and Gensini score in high perilipin-5 group was lower than that in low perilipin-5 group (P<0.05). Serum perilipin-5 level in MACEs group was lower than that in non-MACEs group (P<0.05). The receiver operating characteristic (ROC) curve showed that serum perilipin-5 level predicting the critical value of MACEs occurrence in young AMI patients within 1 year after PCI was 4.680μg/L, the area under the ROC curve (AUC) was 0.809 (95% CI 0.701-0.918). Corresponding sensitivity and specificity were 68.66% and 71.43% respectively. There were no statistically significant differences in gender, age, BMI, lifestyle, underlying diseases, LVEDV, HB, TC, TG, LDL-C, HDL-C, cTnI, NT-proBNP, and postoperative use of antiplatelet drugs between MACEs group and non-MACE groups (P>0.05). Differences in Killip cardiac function classification, onset time to PCI, LVEF, number of lesions, perilipin-5 level were statistically significant (P<0.05). Logistics analysis showed that Killip heart function class Ⅲ - Ⅳ, longer time of infection to PCI, the LVEF of 40% or less, lesion count ≥ 3 and perilipin-5 level <4.680μg/L were independent risk factors of MACEs during the follow-up period in young AMI patients (P<0.05). Conclusion: Serum perilipin-5 level in young AMI patients is closely related to the severity of the disease. The abnormally low perilipin-5 level is an independent risk factor for postoperative MACEs.