关键词:

急性ST段抬高型心肌梗死, 经皮冠状动脉介入术, 强化调脂治疗, Lp-PLA2, ET-1, NO, 主要心血管不良事件

Abstract:

Objective　To investigate the relationships between lipoprotein-associated phospholipase A2 (Lp-PLA2), nitric oxide (NO), and endothelin-1 (ET-1) and major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) after intensive lipid-lowering therapy after percutaneous coronary intervention (PCI). Methods　A total of 130 STEMI patients who underwent PCI treatment at the Second Hospital of Tianjin Medical University from January 2020 to December 2022 were selected as the research subjects. There were 69 male patients and 61 female patients, aged 18-75 (65.16±5.04) years. All patients received intensive lipid-lowering therapy after PCI. After one-year follow-up, the patients were divided into a MACE group (52 cases) and a non-MACE group (78 cases) based on the occurrence of MACE. Compare the general data of the two groups as well as the levels of serum Lp-PLA2, ET-1, and NO. The levels of serum Lp-PLA2, NO, and ET-1 were examined using the main effect test. The relationship between vascular endothelial function (serum NO and ET-1 levels) and serum Lp-PLA2 levels 4 months after treatment was analyzed using the generalized additive model (GAM). A multivariate logistic regression analysis was conducted to examine the independent correlations between the levels of serum Lp-PLA2, NO, and ET-1 at 4 months after treatment and the occurrence of MACE. The dose-response relationship between serum Lp-PLA2 levels 4 months after treatment and MACE was analyzed using a restricted cubic spline model. Construct an mediation effect model to analyze the influence of serum Lp-PLA2 levels and vascular endothelial function 4 months after treatment on MACE. The log-binomial model was used to analyze the association between the serum Lp-PLA2 level 4 months after treatment and the subtypes of MACE. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　Three and four months after the treatment, the serum Lp-PLA2 levels in the MACE group were higher than those in the non-MACE group (both P<0.05). One month, two months, three months and four months after the treatment, the serum NO levels in the MACE group were all lower than those in the non-MACE group, while the serum ET-1 levels in the MACE group were all higher than those in the non-MACE group (all P<0.05). There were statistically significant differences in the time effects, group effects, and interaction effects of the levels of Lp-PLA2, NO, and ET-1 in the two groups (all P<0.05). The results of the GAM analysis showed that the effect of serum Lp-PLA2 levels 4 months after treatment on the serum NO and ET-1 levels of vascular endothelial function indicators presented a linear relationship. Among them, the negative effect of serum Lp-PLA2 levels on serum NO levels was statistically significant (F=3.618, P=0.011), and the positive effect on serum ET-1 levels was also statistically significant (F=4.205, P=0.007). The results of the multivariate logistic regression analysis showed that the levels of serum Lp-PLA2 (OR=1.334, 95%CI: 1.138-1.629), NO (OR=0.802, 95%CI: 0.723-0.867), and ET-1 (OR=1.877, 95%CI: 1.536-2.187) at 4 months after treatment were independently correlated with MACE (all P<0.05); compared with low serum Lp-PLA2, ET-1 levels and high serum NO levels, high serum Lp-PLA2, ET-1 levels, and low serum NO levels were independently correlated with MACE (all P<0.05). The association strength between the continuous changes in serum Lp-PLA2 levels 4 months after treatment and MACE showed a non-linear dose-response relationship(P<0.05). Serum Lp-PLA2 levels were positively correlated with MACE (P<0.05). The results of the mediation effect model analysis showed that the levels of serum NO and ET-1 played a partial mediating role between serum Lp-PLA2 levels and MACE. The mediating effects were 0.200 (z=11.065, P<0.001) and 0.178 (z=10.746, P<0.001) respectively, and the ratios of the mediating effect to the total effect were 23.84% and 21.26% respectively. The log-binomial analysis results showed that there was a statistically significant difference in the occurrence of MACE among patients with different serum Lp-PLA2 levels 4 months after treatment (P=0.042). Conclusion　The levels of Lp-PLA2 and ET-1 are positively correlated with MACE, and the level of NO is negatively correlated with MACE after intensive lipid-lowering therapy in STEMI patients after PCI.

Key words:

Acute ST-segment elevation myocardial infarction,  Percutaneous coronary intervention,  Intensive lipid-lowering therapy,  Lp-PLA2,  ET-1,  NO,  Major adverse cardiovascular events