Department of Cardiology, Sanshui District People's Hospital, Foshan, Guangdong 528100, China)
目的]探究血管内超声(IVUS)参数与非ST段抬高型急性心肌梗死(NSTEAMI)患者冠状动脉病变及左心室功能的相关性。 [方法]选取2016年6月—2021年12月佛山市三水区人民医院收治的90例NSTEAMI患者为研究对象,根据冠状动脉病变支数分为单支病变组(42例)和多支病变组(48例)。分析NSTEAMI患者冠状动脉病变加重的独立预测因素,构建列线图预测模型并进行评价。采用Pearson检验分析斑块负荷、偏心指数、重构指数、纤维帽厚度与左心室射血分数(LVEF)间的相关性。采用受试者工作特征(ROC)曲线分析IVUS参数变化对NSTEAMI患者冠状动脉病变加重的预测价值。[结果]血清胱抑素C(CysC) ＞1.54 mg/L(OR＝2.115,95%CI:1.377～3.047)、高敏C反应蛋白(hs-CRP) ＞34.25 mg/L(OR＝1.342,95%CI:1.128～2.412)、斑块负荷＞60%(OR＝1.399,95%CI:1.232～2.405)、偏心指数＞6.99(OR＝1.357,95%CI:1.035～2.164)、重构指数＞0.99(OR＝1.840,95%CI:1.374～3.023)、纤维帽厚度＜0.72 mm(OR＝0.933,95%CI:0.785～0.994)及LVEF＜58%(OR＝0.726,95%CI:0.544～0.862)是NSTEAMI患者冠状动脉病变加重的独立危险预测因素(P＜0.05)。Pearson检验结果显示,斑块负荷、偏心指数、重构指数与LVEF呈明显负相关,纤维帽厚度与LVEF呈明显正相关(P＜0.05)。ROC曲线结果显示,斑块负荷升高、偏心指数升高、重构指数升高及纤维帽厚度降低联合预测冠状动脉病变加重的ROC曲线下面积(AUC)为0.887(95%CI:0.841～0.953),远大于各指标单独预测的AUC值。基于7项独立预测因素建立的列线图模型验证结果显示,AUC为0.839,C-index指数为0.825,Hosmer-Lemeshow拟合优度检验显示出较好的拟合度(χ2＝1.475,P＝0.386),且具有较高的净获益值。 [结论]NSTEAMI患者的斑块负荷、偏心指数、重构指数与LVEF呈负相关,纤维帽厚度与LVEF呈正相关。斑块负荷升高、偏心指数升高、重构指数升高及纤维帽厚度降低联合预测冠状动脉病变加重的诊断价值远大于各指标单独预测价值。
Aim To investigate the correlation of intravenous ultrasound (IVUS) with coronary artery disease and left ventricular function in patients with non-ST segment elevation acute myocardial infarction (NSTEAMI). Methods A total of 90 patients with NSTEAMI admitted to Sanshui District People's Hospital of Foshan from June 2016 to December 2021 were selected as the study subjects. They were divided into single-vessel disease group (42 cases) and multi-vessel disease group (48 cases). The independent factors influencing the exacerbation of coronary artery disease in NSTEAMI patients were analyzed, and the linear graph prediction model was constructed and evaluated. The correlation between plaque load, eccentricity index, remodeling index, fibrous cap thickness and left ventricular ejection fraction (LVEF) was analyzed. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of IVUS parameters for coronary exacerbation in patients with NSTEAMI. Results Serum cystatin C (CysC) ＞1.54 mg/L (OR＝2.5,5%CI:1.377～3.047), high sensitivity C-reactive protein (hs-CRP) ＞34.25 mg/L (OR＝1.2,5%CI:1.128～2.412), plaque load ＞60% (OR＝1.9,5%CI:1.232～2.405), eccentricity index ＞6.99 (OR＝1.7,5%CI:1.035～2.164), remodeling index ＞0.99 (OR＝1.0,5%CI:1.374～3.023), fibrous cap thickness ＜0.72 mm (OR＝0.3,5%CI:0.785～0.994) and LVEF ＜58% (OR＝0.6,5%CI:0.544～0.862) were independent risk predictors of coronary exacerbation in patients with NSTEAMI (P＜0.05). Pearson's test showed that plaque load, eccentricity index and remodeling index were significantly negatively correlated with LVEF (P＜0.05), and fiber cap thickness was significantly positively correlated with LVEF (P＜0.05). The results of ROC curve showed that the area under curve (AUC) of increased plaque burden, eccentricity index, remodeling index and decreased fiber cap thickness combined to predict the aggravation of coronary artery disease was 0.887 (95%CI:0.841～0.953), which was far higher than the AUC predicted by each index alone. The results of the lipopograph model based on seven independent predictors show that the AUC was 0.839, the C-index was 0.825, Hosmer-Lemeshow goodness of fit test showed a good fit (χ2＝1.475, P＝0.386), and it had a high net benefit value. Conclusions The plaque load, eccentricity index and remodeling index of NSTEAMI patients were negatively correlated with LVEF, and the fibrous cap thickness was positively correlated with LVEF. The diagnostic value of increased plaque burden, increased eccentricity index, increased remodeling index and decreased fiber cap thickness in predicting the exacerbation of coronary artery disease is much greater than that of each index alone.