多维度心脏康复模式对急性心肌梗死PCI术后患者预后及Lp-PLA<sub>2</sub>的影响

胡业梅; 邵胜胜; 张雅文; 汤慧; 李君; 商卓

doi:10.16766/j.cnki.issn.1674-4152.003155

多维度心脏康复模式对急性心肌梗死PCI术后患者预后及Lp-PLA₂的影响

doi: 10.16766/j.cnki.issn.1674-4152.003155

蚌埠市第二人民医院心脏中心，安徽蚌埠 233000

基金项目:

安徽省卫生健康委科研项目 AHWJ2021b095

详细信息

通讯作者:
商卓，E-mail：zhuoshangdl@163.com

中图分类号: R542.22
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出版历程
- 收稿日期: 2023-03-11
- 网络出版日期: 2023-10-19

Effect of multidimensional cardiac rehabilitation model on prognosis and Lp-PLA₂ in patients with acute myocardial infarction after PCI

Heart Center, the Second People' s Hospital of Bengbu, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨多维度心脏康复模式对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗术(PCI)术后心功能、生活质量及血浆脂蛋白相关磷脂酶A₂(Lp-PLA₂)的影响。方法选取2021年1—10月于蚌埠市第二人民医院行PCI治疗的AMI患者234例，按照随机数字表法分为对照组和观察组各117例，对照组进行一般心脏康复模式干预，观察组行多维度心脏康复模式干预。比较2组患者干预前、干预6个月及12个月后的心功能，包括左室射血分数(LVEF)、6 min步行距离(6MWD)、不良心血管事件(MACE)、简明健康调查量表(SF-36)评分、健康问卷-9项(PHQ-9)评分及Lp-PLA₂水平。结果干预6个月及12个月后，2组患者的LVEF、6MWD等均高于干预前，且观察组各指标均显著优于对照组(均P＜0.05)。2组患者的SF-36评分均高于干预前，PHQ-9评分均低于干预前，且观察组相比对照组差异有统计学意义(均P＜0.05)。干预12个月后观察组Lp-PLA₂水平显著低于对照组(282.54±21.82 vs. 318.66±12.89, t=243.340，P＜0.001)。结论 AMI患者PCI术后多维度心脏康复模式能够降低血管粥样硬化斑块破裂的风险，有效改善其心功能，降低不良心血管事件发生率，提高生活质量。
- 急性心肌梗死 /
- 心脏康复 /
- 脂蛋白相关磷脂酶A₂
Abstract: Objective To investigate the effects of multidimensional cardiac rehabilitation model on cardiac function, quality of life and plasma lipoprotein-associated phospholipase A₂ (Lp-PLA₂) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods A total of 234 AMI patients who underwent PCI in the Second People' s Hospital of Bengbu from January to October 2021 were selected and divided into control group and observation group according to the random number table method, with 117 cases in each group. The control group received general cardiac rehabilitation model intervention, and the experimental group received multidimensional cardiac rehabilitation model intervention. Cardiac function, including left ventricular ejection fraction (LVEF), six-minute walking distance (6MWD), major adverse cardiovascular events (MACE), 36-item short-form (SF-36) score, patient health questionnaire-9 (PHQ-9) score and Lp-PLA₂ level were compared between the two groups before intervention, 6 months and 12 months after intervention. Results After 6 months and 12 months of intervention, the LVEF and 6MWD of the two groups were higher than those before intervention, and the indexes of the experimental group were significantly better than those of the control group (all P < 0.05). The SF-36 scores of the two groups were higher than those before intervention, the PHQ-9 scores were lower than those before intervention, and there was significant difference between the experimental group and the control group (all P < 0.05). After intervention, the level of Lp-PLA₂ in the experimental group was significantly lower than that in the control group (282.54±21.82 vs. 318.66±12.89, t=243.340, P < 0.001). Conclusion The multidimensional cardiac rehabilitation model after PCI in AMI patients can reduce the risk of atherosclerotic plaque rupture, effectively improve their cardiac function, reduce adverse cardiovascular events, and improve their quality of life.
- Acute myocardial infarction /
- Cardiac rehabilitation /
- Lipoprotein-associated phospholipase A₂

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表 1 2组急性心肌梗死患者临床基线资料比较

Table 1. Comparison of clinical baseline data of patients with AMI in two groups

组别	例数	年龄(x±s，岁)	性别(男性/女性，例)	AMI类型(例)		基础疾病(例)			BMI (x±s)	病变血管数(例)		吸烟史(例)
组别	例数	年龄(x±s，岁)	性别(男性/女性，例)	ST段太高	非ST段太高	高血压	糖尿病	高血脂	BMI (x±s)	单支	多支	吸烟史(例)
观察组	117	66.87±10.30	79/38	69	48	28	26	22	23.51±2.68	34	83	63
对照组	117	66.23±10.76	76/41	64	53	31	25	19	23.20±2.57	37	80	68
统计量		0.465^a	0.172^b	0.435^b		0.204^b	0.025^b	0.266^b	0.903^a	0.182^b		0.434^b
P值		0.643	0.678	0.509		0.652	0.874	0.606	0.367	0.670		0.510
注：^a为t值，^b为χ²值。

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表 2 2组急性心肌梗死患者LVEDD、LVEDV、LVEF比较(x±s)

Table 2. Comparison of LVEDD, LVEDV and LVEF of patients with AMI in two groups(x±s)

组别	例数	LVEDD(mm)			F值	P值
组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	30.98±3.69	31.51±3.43	30.25±4.56	0.634	0.318
对照组	117	30.52±3.28	31.13±3.62	30.76±3.44	0.513	0.572
F值		2.774	1.139	1.265
P值		0.097	0.287	0.262

组别	例数	LVEDV(mm)			F值	P值
组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	48.63±5.41	47.13±3.41^a	47.88±4.22^a	24.610	＜0.001
对照组	117	47.85±5.16	46.85±5.06	46.92±4.35	1.551	0.214
F值		0.483	0.385	1.713
P值		0.612	0.535	0.088

组别	例数	LVEF(%)			F值	P值
组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	52.83±8.92	55.83±7.21^a	58.32±4.85^ab	18.450	＜0.001
对照组	117	52.52±8.36	52.32±6.32	52.64±5.32	0.260	0.771
F值		0.004	14.660	78.014
P值		0.950	＜0.001	＜0.001
注：与同组干预前比较，^aP＜0.05；与同组干预6个月比较，^bP＜0.05。

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表 3 2组急性心肌梗死患者6MWD、运动后血压比较(x±s)

Table 3. Comparison of 6MWD and BP after exercise of patients with AMI in two groups(x±s)

组别	例数	6MWD(m)			F值	P值
组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	403.42±53.31	458.40±46.31^a	510.44±64.30^ab	119.780	＜0.001
对照组	117	408.52±48.63	428.53±40.32^a	480.52±36.61^ab	56.053	＜0.001
t值		0.666	28.902	23.212
P值		0.415	＜0.001	＜0.001

组别	例数	运动后收缩压(mmHg)			F值	P值
组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	138.51±13.25	136.50±14.27	134.55±10.40	2.970	0.053
对照组	117	135.26±16.83	134.23±12.81	135.21±13.82	0.890	0.750
t值		3.127	1.692	0.366
P值		0.078	0.195	0.546

组别	例数	运动后舒张压(mmHg)			F值	P值
组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	86.57±10.24	82.51±8.23^a	78.50±10.23^ab	18.395	＜0.001
对照组	117	84.32±9.21	81.32±10.66	80.34±9.29^a	4.906	0.008
t值		2.293	0.534	2.306
P值		0.131	0.466	0.130
注：与同组干预前比较，^aP＜0.05；与同组干预6个月比较，^bP＜0.05。1 mmHg=0.133 kPa。

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表 4 2组急性心肌梗死患者Lp-PLA₂(x±s)

Table 4. Measurement of Lp-PLA₂ in patients with AMI between two groups(x±s)

组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	1 611.11±126.29	346.75±10.37^a	282.54±21.82^ab	6 271.837	＜0.001
对照组	117	1 601.16±130.16	431.50±60.79^a	318.66±12.89^ab	6 032.893	＜0.001
t值		0.327	209.363	243.340
P值		0.568	＜0.001	＜0.001
注：与同组干预前比较，^aP＜0.05；与同组干预6个月比较，^bP＜0.05。

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表 5 2组急性心肌梗死患者SF-36评分比较(x±s, 分)

Table 5. Comparison of SF-36 score in patients with AMI between two groups(x±s, points)

组别	例数	干预前	干预6个月	干预12个月	F值	P值
观察组	117	45.62±6.09	71.06±9.37^a	85.06±8.12^ab	1 047.414	＜0.001
对照组	117	46.18±6.35	69.15±8.05^a	73.06±6.32^ab	557.403	＜0.001
t值		0.105	2.587	146.542
P值		0.747	0.109	＜0.001
注：与同组干预前比较，^aP＜0.05；与同组干预6个月比较，^bP＜0.05。

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表 6 2组急性心肌梗死患者PHQ-9评价比较(例)

Table 6. Comparison of PHQ-9 in patients with AMI between two groups (cases)

组别	时间	例数	PHQ-9			Z值	P值
组别	时间	例数	轻度	中度	重度	Z值	P值
观察组	干预前	117	70	35	12	1.196	0.232
对照组		117	80	25	12
观察组	干预后	117	102	12	3	3.168	0.020
对照组		117	82	28	7

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表 7 2组急性心肌梗死患者MACE事件比较(例)

Table 7. Comparison of MACE events in patients with AMI between two groups (cases)

组别	例数	再住院	心因死亡	非心因死亡	再发心肌梗死	合计
观察组	117	18	2	2	1	23
对照组	117	35	4	3	6	48
χ²值		7.050	0.684	0.204	3.680	12.630
P值		0.008	0.408	0.651	0.045	＜0.001

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