摘要目的 探讨外周血髓样树突状细胞(MDC)在预测急性 ST 段抬高性心肌梗死(STEMI)患者不良心脏事件中的预测价值.方法 选取2016年2月至2017年8月在四川省德阳市人民医院心内科收治的39例STEMI患者为研究对象,依据7 d发生不良心脏事件分为非合并不良事件组(uncomMI组,23例)和合并不良事件组(comMI组,16例),另外选取同期24例健康体检者作为健康对照组.比较各组一般情况、临床特征以及uncomMI组和comMI组发病第1天和第3天的MDC、浆细胞样树突状细胞(PDC),分析影响STEMI患者发生不良心脏事件的影响因素.结果 STEMI患者早期(发病第1天)外周血MDC及PDC水平显著低于正常对照组(P<0.05),发病第3天时uncomMI组的MDC和PDC水平与健康对照组比较差异无统计学意义(P>0.05),而comMI组的MDC和PDC水平仍低于健康对照组和uncomMI组.Logistic分析结果显示,高龄、总胆固醇、MDC(发病第3天)均为STEMI患者7 d发生不良心脏事件的危险因素(P<0.05).受试者工作特征(ROC)曲线结果显示,MDC截断点取7时曲线下面积取最大值为0.828 6,灵敏度为80.0%,特异度为85.7%.结论 外周血的MDC与STEMI患者7 d发生不良心脏事件存在一定的相关性,外周血的MDC百分比(发病第3天)对于STEMI患者7 d发生不良心脏事件诊断具有一定的临床价值,此外高龄的STEMI患者7 d不良心脏事件的发生率增加.

abstractsObjective To investigate the effect of peripheral blood MDC on predicting adverse cardiac events of patients with acute STEMI. Methods Thirty-nine patients with acute ST segment elevation myocardial infarction admitted in the People′s Hospital of Deyang from February 2016 to August 2017 were selected by random sampling. According to 7-day adverse cardiac events, the patients were divided into non-combination adverse cardiac events group (uncomMI group, 23 patients) and combination adverse cardiac events group (comMI group, 16 patients), and 24 healthy persons were selected as normal control group. The general situation, clinical characteristics and MDC, PDC, analysis of uncomMI group and comMI group in the 1st and 3rd day after the onset of acute ST segment elevation myocardial infarction was compared. Factors influencing adverse cardiac events in patients with acute ST segment elevation myocardial infarction were analyzed. Results The peripheral blood MDC and plasmacytoid dendritic cell (PDC) counts in patients with STEMI were significantly lower than those in normal controls in early time(at the time of day 1)(P<0.05), but the peripheral blood MDC and PDC counts in uncomMI group was not significantly different from that in normal control group at the time of day 3 (P>0.05). The peripheral blood MDC and PDC counts in comMI group were lower than those in uncomMI group and control group. The Logistic analysis showed that the elderly patients, total cholesterol (TC), MDC (at the time of day 3) were all risk factors of 7-day adverse cardiac events (P < 0.05). The receiver operating characteristic (ROC) results showed that the maximum area under curve(AUC) was 0.8286 when the MDC truncation point was 7 mg/L, and the sensitivity was 80.0% and the specificity was 85.7% . Conclusions For STEMI patients, MDC of peripheral blood is associated with 7-day adverse cardiac events. The percentage of MDC in peripheral blood of patients with acute STEMI has a certain clinical value in the diagnosis of 7-day adverse cardiac events. In addition, elderly patients with STEMI have an increased risk of 7-day adverse cardiac events.