目的:探讨血浆活化蛋白C(activated protein C,APC)、可溶性血栓调节蛋白(soluble thrombomod-ulin,sTM)与急性心肌梗死合并心源性休克(acute myocardial infarction with cardiogenic shock,AMICS)患者院内结局的关系.方法:选取2022年3月-2024年3月保定市第一中心医院收治的AMICS患者177例(AMICS组)和同期单纯AMI患者90例(单纯AMI组),根据院内结局,将177例AMICS患者分为死亡组(63例)与存活组(114例).采用酶联免疫吸附法检测血浆APC、sTM水平.多因素logistic回归分析AMICS患者院内死亡的影响因素,受试者工作特征(ROC)曲线分析血浆APC、sTM水平对AMICS患者院内死亡的预测效能.结果:AMICS组血浆APC水平低于单纯AMI组,sTM水平高于单纯AMI组,差异有统计学意义(P＜0.05).177例AMICS患者院内死亡率为35.59％(63/177).死亡组血浆APC水平低于存活组,sTM水平高于存活组,差异有统计学意义(P＜0.05).AMICS患者院内死亡的独立危险因素为年龄高、梗死面积大、乳酸高、N末端B型利钠肽前体高、机械循环支持和sTM高,独立保护因素为APC高,差异有统计学意义(P＜0.05).血浆APC、sTM水平联合预测AMICS患者院内死亡的曲线下面积为0.888,大于血浆APC、sTM水平单独预测的0.790、0.791(P＜0.05).结论:AMICS患者血浆APC水平降低和sTM水平升高与院内死亡密切相关,血浆APC、sTM水平联合预测AMICS患者院内死亡的效能较高.
Relationship between plasma APC,sTM and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock
Objective:To investigate the relationship between plasma activated protein C(APC),soluble thrombomodulin(sTM),and in-hospital outcomes in patients with acute myocardial infarction(AMI)complicated by cardiogenic shock(CS).Methods:A total of 177 patients with AMICS from March 2022 to March 2024 were selected(AMICS group),along with 90 patients with AMI alone(AMI group).Based on in-hospital outcomes,AMICS patients were divided into the survival group and the death group.Plasma APC and sTM levels were measured by enzyme-linked immunosorbent assay.Multivariate logistic regression was used to analyze the factors influencing in-hospital mortality in AMICS patients,and the receiver operating characteristic(ROC)curve was used to assess the predictive efficacy of plasma APC and sTM levels for in-hospital mortality.Results:Plasma APC levels in the AMICS group were lower,while sTM levels were higher compared to those in the AMI group(P＜0.05).The in-hospital mortality of the 177 AMICS patients was 35.59％(63/177).In the death group,plasma APC levels were lower and sTM levels were higher,compared to those in the survival group(P＜0.05).Independent risk factors for in-hospital mortality in AMICS patients were older age,larger infarct size,elevated lactate,high NT-proBNP levels,use of mechanical circulatory support,and elevated sTM,while high APC levels were independent protective factors(P＜0.05).The area under the ROC curve(AUC)for combined plasma APC and sTM levels in predicting in-hospital mortality in AMICS patients was 0.888,which was higher than the AUC for APC(0.790)or sTM(0.791)separately(P＜0.05).Conclusion:Decreased plasma APC levels and elevated sTM levels are closely associated with in-hospital mortality in AMICS patients.The combination of plasma APC and sTM levels has a high predictive efficiency for in-hospital mortality in AMICS patients.
acute myocardial infarctioncardiogenic shockactivated protein Csoluble thrombomodulinin-hospital outcome
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NSTL
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