急性ST段抬高型心肌梗死患者血清S100钙结合蛋白A8和S100钙结合蛋白A9水平与血栓负荷的关系

Relationships of serum S100 calcium binding protein A8 and S100 calcium binding protein A9 levels with thrombus burden in patients with acute ST-segment elevation myocardial infarction

  • 摘要:
    目的 探讨急性ST段抬高型心肌梗死(STEMI)患者血清S100钙结合蛋白A8(S100A8)和S100钙结合蛋白A9(S100A9)水平与STEMI患者血栓负荷的关系。
    方法 选取85例STEMI患者为研究对象,均接受经皮冠状动脉介入(PCI)治疗,根据冠状动脉造影及介入治疗术中情况分为高血栓负荷组心肌梗死溶栓治疗(TIMI)血栓分级4~5级40例和低血栓负荷组(TIMI血栓分级4级以下)45例。检测血清S100A8、S100A9水平,分析影响STEMI患者高血栓负荷的相关因素,探讨S100A9、S100A8预测STEMI患者高血栓负荷的价值。PCI术后进行3个月随访,记录并发症发生情况。
    结果 高血栓负荷组年龄及男性、有吸烟史、2型糖尿病、右冠状动脉梗死比率、术前Gensini评分、总胆固醇、低密度脂蛋白胆固醇水平高于低血栓负荷组,差异有统计学意义(P < 0.05)。与低血栓负荷组相比,高血栓负荷组血清S100A9、S100A8水平升高,差异有统计学意义(P < 0.05)。术前Gensini评分、低密度脂蛋白胆固醇、S100A9、S100A8是STEMI患者高血栓负荷的危险因素(P < 0.05)。S100A9、S100A8、Gensini评分、低密度脂蛋白胆固醇联合预测STEMI患者高血栓负荷的曲线下面积高于上述指标单独预测(Z=4.462、4.817、3.959、4.438,P < 0.05)。PCI术后3个月内,共有12例出现并发症(并发症组),包括穿刺部位出血6例、血肿3例、支架内血栓形成2例、急性冠状动脉闭塞1例。将无并发症的72例患者纳入无并发症组。并发症组患者血清S100A9、S100A8水平和高血栓负荷比率高于无并发症组,差异有统计学意义(P < 0.05)。
    结论 STEMI高血栓负荷患者血清S100A9、S100A8水平均增高,并有助于STEMI患者PCI术前动脉血栓负荷状态的评估。

     

    Abstract:
    Objective To explore the relationships of serum S100 calcium binding protein A8 (S100A8) and S100 calcium binding protein A9 (S100A9) levels with thrombus burden in patients with acute ST-segment elevation myocardial infarction (STEMI).
    Methods A total of 85 STEMI patients were selected and treated with percutaneous coronary intervention (PCI). According to the coronary angiography and intraoperative situation of interventional therapy, the patients were divided into high thrombotic burden group thrombosis grading of thrombolysis in myocardial infarction (TIMI) was grade 4 to 5 with 40 cases and low thrombotic burden group (thrombosis grading of TIMI grade was below grade 4) with 45 cases. Serum S100A8 and S100A9 levels were detected, relevant factors affecting high thrombotic burden in STEMI patients were analyzed, and the values of S100A9 and S100A8 in predicting high thrombotic burden in STEMI patients were explored. The patients were followed up for 3 months after PCI, and the complications were recorded.
    Results In the high thrombotic burden group, the age and the ratios of male, smoking history, type 2 diabetes and right coronary artery infarction and the preoperative Gensini score, total cholesterol and low-density lipoprotein cholesterol levels were also significantly higher than those in the low thrombotic burden group (P < 0.05). Compared with the low thrombotic burden group, the serum S100A9 and S100A8 levels were significantly higher in the high thrombotic burden group (P < 0.05). Preoperative Gensini score, low-density lipoprotein cholesterol, S100A9 and S100A8 were the risk factors for high thrombotic burden in STEMI patients (P < 0.05). The combined prediction of S100A9, S100A8, Gensini score and low-density lipoprotein cholesterol for high thrombotic burden in STEMI patients showed a significant higher area under the curve when compared to the independent prediction of the above indicators predicted alone (Z=4.462, 4.817, 3.959, 4.438, P < 0.05). Within 3 months after PCI, 12 cases in the complication group had complications, including 6 cases of puncture site bleeding, 3 cases of hematoma, 2 cases of stent thrombosis, and 1 case of acute coronary artery occlusion. A total of 72 patients without complications were included in no complication group. The serum levels of S100A9 and S100A8 as well as the high thrombotic burden ratio in the complication group were significantly higher than those in the no complication group (P < 0.05).
    Conclusion Both serum S100A9 and S100A8 levels increase in STEMI patients with high thrombotic burden, and are helpful for evaluating the arterial thrombotic burden status before PCI in STEMI patients.

     

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