Lp(a)与前壁STEMI患者经皮冠状动脉介入(PCI)术后左心室重构的关系

The Relationship between Lp(a) and Left Ventricular Remodeling after PCI in Patients with Anterior STEMI

摘要: 背景：脂蛋白a(Lp(a))是急性心肌梗死(AMI)患者发生不良心血管事件的独立危险因素，与AMI后心脏重构密切相关。目的：本研究旨在探讨Lp(a)与急性前壁ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心室重构的关系以及对心肌梗死后心室重构的预测价值。方法：纳入本院行冠状动脉介入治疗的前壁STEMI患者218例，在心肌梗死后1周和6个月通过心脏超声评估左心室功能和体积。不良心室重构(VR)的定义是基于心肌梗死后6个月左室舒张末期容积增加≥20%。根据患者左心室重构情况分为心室重构组和非心室重构组。比较两组患者的Lp(a)及临床资料，采用多因素Logistic回归法分析影响前壁STEMI患者PCI术后左心室重构的相关因素；将独立危险因素创建受试者工作特征曲线(ROC)，分析Lp(a)对心肌梗死后心室重构的预测价值。结果：6个月后，218例前壁STEMI患者中，58例患者出现心室重构。根据患者左心室重构情况分为心室重构组(160例)和非心室重构组(58例)。与非心室重构组比较，心室重构组年龄、糖尿病史、糖化血红蛋白、肌钙蛋白I、肌酸激酶同工酶、C反应蛋白、NT-proBNP、低密度脂蛋白胆固醇、Lp(a)、Gensini评分、室壁运动记分指数(WMSI)均显著升高，左心室射血分数(LVEF)显著下降，差异具有统计学意义；心室重构组LVEF显著降低，差异具有统计学意义；二元Logistic回归分析显示肌钙蛋白I、C反应蛋白、Lp(a)、LVEF是前壁STEMI患者PCI手术心室重构的独立危险因素。高Lp(a)是VR的独立预测因子(OR = 1.006, P < 0.001)。Lp(a)预测VR的最佳截断值为342，敏感性为82.6%，特异性为81.6% (AUC= 0.842, P < 0.001)。结论：Lp(a)与前壁STEMI患者经皮冠状动脉介入(PCI)术后左心室重构相关，入院监测时Lp(a)是一种有用的工具，可用于预测心梗后心室重构风险，建议临床早期干预Lp(a)。

Abstract: Background: Lipoprotein a (Lp(a)) is an independent risk factor for adverse cardiovascular events in patients with acute myocardial infarction (AMI) and is closely related to cardiac remodeling after AMI. Objective: The purpose of this study was to investigate the relationship between Lp(a) and ventricular remodeling after percutaneous coronary intervention (PCI) in patients with acute anterior ST-elevation myocardial infarction (STEMI) and its predictive value after myocardial infarction. Methods: A total of 218 patients with anterior STEMI undergoing coronary intervention in our hospital were enrolled in our hospital, and left ventricular function and volume were evaluated by cardiac ultrasound at 1 week and 6 months after myocardial infarction. Poor ventricular remodeling (VR) is defined as a ≥ 20% increase in left ventricular end-diastolic volume 6 months after myocardial infarction. According to the left ventricular remodeling, the patients were divided into ventricular remodeling group and non-ventricular remodeling group. The Lp(a) and clinical data of the two groups were compared, and the multivariate logistic regression method was used to analyze the relevant factors affecting left ventricular remodeling after PCI in patients with anterior STEMI. The receiver operating characteristic curve (ROC) was created for independent risk factors, and the predictive value of Lp(a) in ventricular remodeling after myocardial infarction was analyzed. Results: After 6 months, ventricular remodeling occurred in 58 of the 218 patients with anterior STEMI. According to the left ventricular remodeling, the patients were divided into ventricular remodeling group (160 cases) and non-ventricular remodeling group (58 cases). Compared with the non-ventricular remodeling group, the age, diabetes history, glycosylated hemoglobin, troponin I, creatine kinase isoenzyme, C-reactive protein, NT-proBNP, low-density lipoprotein cholesterol, Lp(a), Gensini score, and wall motion scoring index (WMSI) in the ventricular remodeling group were significantly increased, and the left ventricular ejection fraction (LVEF) was significantly decreased, and the difference was statistically significant. LVEF was significantly reduced in the ventricular remodeling group, and the difference was statistically significant. Binary logistic regression analysis showed that troponin I, C-reactive protein, Lp(a) and LVEF were independent risk factors for ventricular remodeling after PCI in patients with anterior STEMI. High Lp(a) was an independent predictor of VR (OR = 1.006, P < 0.001). The optimal cut-off value of Lp(a) for predicting VR was 342, with a sensitivity of 82.6% and a specificity of 81.6% (AUC = 0.842, P < 0.001). Conclusion: Lp(a) is associated with left ventricular remodeling after percutaneous coronary intervention (PCI) in patients with anterior STEMI, and Lp(a) is a useful tool for predicting the risk of ventricular remodeling after myocardial infarction, and early clinical intervention is recommended.