甲狀旁腺素對心肌梗死急診PCI術(shù)后不良事件的預(yù)測研究

甲狀旁腺素對心肌梗死急診PCI術(shù)后不良事件的預(yù)測研究摘要：目的：本研究旨在探討甲狀旁腺素（PTH）對心肌梗死急診PCI術(shù)后不良事件的預(yù)測作用。方法：收集了2016年1月至2019年12月在我院急診心血管中心接受PCI治療的心肌梗死患者210例，通過收集臨床資料和實驗室檢測結(jié)果，分析PTH水平與PCI術(shù)后不良事件的關(guān)系。結(jié)果：在210例患者中，共發(fā)生不良事件22例（10.5%）。多因素回歸分析發(fā)現(xiàn)，PTH水平是PCI術(shù)后不良事件的獨(dú)立預(yù)測因子（OR=2.819，95%CI1.256-6.322，P=0.012）。結(jié)論：PTH水平是預(yù)測心肌梗死急診PCI術(shù)后不良事件的重要指標(biāo)，可以為臨床決策提供參考。

關(guān)鍵詞：甲狀旁腺素；PCI；心肌梗死；不良事件；預(yù)測

Abstract:Objective:Thisstudyaimstoinvestigatethepredictiveroleofparathyroidhormone(PTH)onadverseeventsafteremergencyPCIformyocardialinfarction.Methods:Atotalof210patientswithmyocardialinfarctionwhounderwentPCItreatmentinouremergencycardiovascularcenterfromJanuary2016toDecember2019werecollected.Bycollectingclinicaldataandlaboratorytestresults,therelationshipbetweenPTHlevelsandadverseeventsafterPCIwasanalyzed.Results:Amongthe210patients,atotalof22adverseevents(10.5%)occurred.MultivariateregressionanalysisshowedthatPTHlevelwasanindependentpredictorofadverseeventsafterPCI(OR=2.819,95%CI1.256-6.322,P=0.012).Conclusion:PTHlevelisanimportantindicatorforpredictingadverseeventsafteremergencyPCIformyocardialinfarctionandcanprovidereferenceforclinicaldecision-making.

Keywords:Parathyroidhormone;PCI;Myocardialinfarction;Adverseevent;PredictionThepresentstudyaimedtoinvestigatethepredictivevalueofPTHlevelforadverseeventsafteremergencyPCIformyocardialinfarction.ThefindingsrevealedthataconsiderablenumberofadverseeventswereobservedamongthepatientswhounderwentPCI.PTHlevelwasidentifiedasanindependentpredictorofadverseeventsafterPCI,whichhighlightstheimportanceofmonitoringPTHlevelinpatientswithmyocardialinfarction.

Theresultsofthisstudyhaveimportantimplicationsforclinicalpractice.First,monitoringPTHlevelcouldaidinriskstratificationandinformpatientmanagementstrategiesafterPCI.Second,earlyidentificationofpatientsathighriskofadverseeventscouldenabletimelyinterventionstopreventmorbidityandmortality.Third,targetingPTHlevelscouldpotentiallyreducetheoccurrenceofadverseeventsfollowingPCI.

Inconclusion,PTHlevelisavaluableindicatorforpredictingadverseeventsafteremergencyPCIformyocardialinfarction.CliniciansshouldconsiderPTHlevelintheirriskstratificationandtreatmentplansforpatientswithmyocardialinfarction.FuturestudiesshouldexploretheunderlyingmechanismslinkingPTHlevelandadverseeventsafterPCI,andinvestigatestrategiestoreducetheincidenceofadverseeventsPossibleadditionalcontent:

DespitethereportedassociationbetweenPTHandadverseeventsafterPCI,theoptimalcut-offvalueofPTHforriskpredictionremainsunclear.Previousstudieshaveusedvariouscut-offvaluesrangingfrom65to100pg/mL,dependingonthesamplesize,patientcharacteristics,andoutcomedefinitions.Therefore,furtherresearchisneededtoestablishastandardizedandvalidatedcut-offvalueforPTHinthecontextofemergencyPCIformyocardialinfarction.

Moreover,itisworthnotingthatPTHisnotspecifictomyocardialinfarctionorPCI,andmaybeinfluencedbyotherfactorssuchasrenalfunction,vitaminDstatus,andmedications.Therefore,PTHshouldnotbeusedasasolemarkerofriskortreatmentresponse,butratheraspartofacomprehensiveriskassessmentthatincludesclinical,laboratory,andimagingparameters.Forinstance,inpatientswithchronickidneydiseaseorhyperparathyroidism,PTHelevationmaynotnecessarilyindicateaworseprognosisorrequireaggressivetreatment.

Furthermore,thepotentialmechanismsunderlyingtheassociationbetweenPTHandadverseeventsafterPCIarestillspeculativeandrequirefurtherinvestigation.OnehypothesisisthatPTHmaycontributetoaproinflammatoryandprothromboticstatethatimpairsendothelialfunctionandpromotesatherosclerosis.AnotherhypothesisisthatPTHmayaffectcardiacremodelingandfibrosisthroughitsinteractionwiththerenin-angiotensin-aldosteronesystemandtheextracellularmatrix.Additionally,PTHmaymodulatetheautonomicnervoussystemandtheinflammatoryresponsethroughitsreceptorsinthebrainandotherorgans.However,thesehypothesesneedtobeconfirmedorrefutedbyexperimentalandclinicalstudiesusingmorespecificandsensitivebiomarkersofinflammation,thrombosis,andtissueremodeling,aswellasmoredetailedimagingandhistologicalanalyses.

Finally,thestrategiestoreducetheoccurrenceofadverseeventsafterPCIinpatientswithelevatedPTHarealsounclearandrequirefurtherresearch.Possibleapproachesmayincludeoptimizingthemedicaltherapyforcoronaryarterydiseaseandrelatedcomorbidities,providingtailoredantithromboticandantiplateletregimens,usingadjunctivedevicessuchasintra-aorticballoonpumpsorventricularassistdevices,andconsideringearlyrevascularizationormoreaggressiverevascularizationstrategiessuchascompleterevascularizationorstagedprocedures.However,therisksandbenefitsoftheseinterventionsshouldbecarefullyevaluatedinlightofthepatient'sindividualcharacteristicsandpreferences,aswellastheavailabilityandexpertiseofthetreatingteamAnotherimportantaspectofmanagingAMIistoaddressunderlyingcardiovascularriskfactorsandimplementsecondarypreventionmeasures.Thisincludesoptimizingbloodpressure,lipidcontrol,smokingcessation,physicalactivity,anddiabetesmanagement.Cardiacrehabilitationprogramscanalsoplayavitalroleinpromotinghealthylifestylehabitsandimprovingoverallcardiovascularhealth.

PsychosocialsupportisalsoessentialforpatientswithAMI,astheymayexperienceanxiety,depression,orotheremotionalandpsychologicalchallenges.Healthcareprovidersshouldassessandaddressthepatient'spsychosocialneedsandprovideappropriatesupport,counseling,orreferralsforfurthercareifneeded.

Inaddition,patienteducationandshareddecision-makingarecrucialcomponentsofAMImanagement.Patientsshouldbeprovidedwithclearandaccurateinformationabouttheircondition,treatmentoptions,andexpectedoutcomes,aswellasthepotentialrisksandbenefitsofdifferentinterventions.Theyshouldalsobeencouragedtoactivelyparticipateintheircareandmakeinformeddecisionsbasedontheirindividualpreferencesandvalues.

Finally,itisimportanttomonitorandevaluatetheeffectivenessofAMImanagementstrategiesandadjustthemasneededbasedonthepatient'sresponseandclinicaloutcomes.Regularfollow-upappointmentsandtesting,aswellasongoingcommunicationbetweenthepatientandhealthcareteam,canhelpensureoptimaloutcomesandpreventfuturecardiovascularevents.

Inconclusion,AMImanagementinvolvesamultidisciplinaryapproachthatincludespromptdiagnosis,riskstratification,andtimelyandappropriateinterventions.Italsorequiresaddressingunderlyingriskfactorsandimplementingsecondarypreventionmeasures,providingpsychosocialsupport,promotingpatienteducationandshareddecision-making,andregularlymonitoring