Correlation between serum parathyroid hormone and perioperative myocardial injury and prognosis in patients with PCI
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摘要: 目的:探讨血清甲状旁腺素(PTH)水平对择期经皮冠状动脉介入治疗(PCI)围手术期心肌损伤(PMI)的预测价值及与PCI预后的相关性。方法:纳入199例因心绞痛行择期PCI的患者,根据术后肌钙蛋白I(cTnI)水平分成无损伤组(NC组,cTnI≤0.04 ng/mL,33例)、PCI围手术期心肌损伤组(PMI组,0.04 ng/mL<cTnI≤0.2 ng/mL,85例)、PCI围手术期心肌梗死组(PPMI组,cTnI>0.2 ng/mL,81例),检测PCI手术前后血清PTH水平、术后24 h及48 h内cTnI水平,记录造影结果及手术操作情况,术后规律随访。结果:术前PTH水平在NC组、PMI组、PPMI组中逐渐升高,组间两两比较,差异有统计学意义(P<0.01)。Pearson相关分析显示术前PTH水平与术后cTnI水平显著相关(r=0.449,P<0.001)。受试者工作特征(ROC)曲线分析显示,PTH预测PMI的最佳临界值为43.70 pg/mL,敏感度为69.3%,特异度为75.8%,AUC为0.771。多因素Logistic回归分析显示,术前血清PTH是PCI PMI的独立危险因素(OR=7.42,95%CI:2.56~21.48,P<0.001)。多因素Cox回归分析表明,术前PTH水平(HR=2.07,95%CI:1.11~3.88,P=0.023)和术后发生PMI(HR=2.46,95%CI:1.06~5.73,P=0.037)是PCI患者预后的独立危险因素。结论:术前PTH可预测PMI,并与PCI预后不良独立相关。
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关键词:
- 甲状旁腺素 /
- 心肌损伤 /
- 经皮冠状动脉介入治疗 /
- 冠心病
Abstract: Objective: To investigate the predictive value of serum parathyroid hormone(PTH) level in perioperative myocardial injury(PMI) and its correlation with prognosis of elective percutaneous coronary intervention(PCI).Methods: One hundred and ninety-nine patients undergoing elective PCI due to angina pectoris were divided into three groups according to the level of cardiac troponin I(cTnI) after operation: normal control group(NC group, cTnI ≤ 0.04 ng/mL, n=33), PCI perioperative myocardial injury group(PMI group, 0.04 ng/mL<cTnI ≤ 0.2 ng/mL, n=85), PCI perioperative myocardial infarction group(PPMI group, cTnI>0.2 ng/mL, n=81). The level of serum PTH before and after PCI and the level of cTnI within 24 hours and 48 hours after operation were measured. The results of radiography and operation were recorded, and the postoperative follow-up was regular.Results: Preoperative PTH level increased gradually in the NC group, PMI group and PPMI group, and there was significant difference between the two groups(P<0.01). Pearson correlation analysis showed that the level of PTH before operation was significantly correlated with the increase of cTnI after operation(r=0.449, P<0.001). The receiver operating characteristic curve(ROC curve) showed that the cut-off value of PTH for predicting PMI was 43.70 pg/mL, the sensitivity was 69.3%, the specificity was 75.8%, and the AUC was 0.771. Multivariate Logistic regression analysis showed that preoperative serum PTH was an independent risk factor for perioperative myocardial injury in PCI(OR=7.42, 95%CI: 2.56-21.48, P<0.001). Multivariate COX regression showed that preoperative PTH level(HR=2.07, 95%CI: 1.11-3.88, P=0.023) and postoperative PMI(HR=2.46, 95%CI: 1.06-5.73, P=0.037) were independent risk factors for the prognosis of PCI patients.Conclusion: Preoperative PTH can predict perioperative myocardial injury in PCI and is independently associated with poor prognosis of PCI. -
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