2026 年第 8 期 第 21 卷

程序性细胞死亡蛋白1动态变化对急诊经皮冠状动脉介入治疗术后的急性ST段抬高型心肌梗死患者预后的预测价值

Predictive value of dynamic changes in programmed cell death protein 1 for prognosis in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作者：李晟羽邱惠

英文作者：Li Shengyu Qiu Hui

单位：首都医科大学附属北京友谊医院心血管内科，北京100050

英文单位：Department of Cardiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：急性ST段抬高型心肌梗死；急诊经皮冠状动脉介入；程序性细胞死亡蛋白1；预后

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Primarypercutaneouscoronaryintervention; Programmedcelldeathprotein1;Prognosis

• 摘要：

• 目的 探讨行急诊经皮冠状动脉介入（pPCI）治疗的ST段抬高型心肌梗死（STEMI）患者程序性细胞死亡蛋白1（PD-1）浓度的动态变化，并分析术后PD-1变化值（ΔPD-1）对2年主要不良心血管事件（MACE）的预测价值。方法 回顾性纳入2017年2月至2020年12月于首都医科大学附属北京友谊医院接受pPCI治疗的STEMI患者500例，于入院即刻、术后24 h及术后5 d检测血浆PD-1浓度。计算Δ1PD-1（术后24 h PD-1减去入院即刻PD-1）。通过局部加权回归散点平滑法（LOWESS）和受试者工作特征（ROC）曲线确定Δ1PD-1的最佳界值，并以此将患者分为低Δ1PD-1组（≤7.68 ng/L）和高Δ1PD-1组（＞7.68 ng/L）。采用Logistic回归和Cox比例风险回归模型分析Δ1PD-1与2年MACE及亚组事件的关系。结果 2年随访期间共115例（23.0%）发生MACE。MACE组Δ1PD-1显著低于非MACE组［-0.80（-18.74，3.83）ng/L比0.03（-9.42，12.14）ng/L，P=0.036］。Δ1PD-1预测2年MACE的曲线下面积（AUC）为0.564（95%置信区间：0.505～0.624），最佳界值7.68 ng/L的敏感度为81.7%，特异度为30.4%。多因素Logistic回归显示，低Δ1PD-1是2年MACE的独立危险因素（比值比=1.916，95%置信区间：1.067～3.443，P=0.030），其他独立预测因子包括既往经皮冠状动脉介入/冠状动脉旁路移植术史、糖尿病、N末端B型脑钠肽前体峰值及完全血运重建。Cox生存分析提示，低Δ1PD-1组2年MACE累积发生率显著高于高Δ1PD-1组（26.0%比15.2%，风险比=1.784，95%置信区间：1.111～2.863，P=0.017），且心源性再住院风险亦显著升高（风险比=1.938，95%置信区间：1.182～3.179，P=0.009）。结论 STEMI患者pPCI术后24 h PD-1浓度较入院时的下降程度与远期不良预后相关，Δ1PD-1≤7.68 ng/L是2年MACE及心源性再住院的独立预测因子，可为早期危险分层提供参考，但其单独预测效能有限，需结合其他临床指标综合评估。

• Objective To investigate the dynamic changes of plasma programmed cell death protein 1 (PD-1) concentration in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), and analyze the predictive value of postoperative PD-1 change value (ΔPD-1) for 2-year major adverse cardiovascular events (MACE). Methods A total of 500 STEMI patients receiving pPCI at Beijing Friendship Hospital, Capital Medical University from February 2017 to December 2020 were retrospectively enrolled. Plasma PD-1 concentrations were detected at admission, 24 h after operation and 5 d after operation. Δ1PD-1 was calculated as PD-1 level at 24 h postoperatively minus PD-1 level on admission. Locally weighted scatterplot smoothing (LOWESS) and receiver operating characteristic (ROC) curve were adopted to determine the optimal cut-off value of Δ1PD-1. Patients were divided into low Δ1PD-1 group (≤7.68 ng/L) and high Δ1PD-1 group (>7.68 ng/L) based on the cut-off value. Logistic regression and Cox proportional hazards regression models were used to analyze the association between Δ1PD-1 and 2-year MACE as well as subgroup events. Results During the 2-year follow-up, MACE occurred in 115 patients (23.0%). Δ1PD-1 was significantly lower in the MACE group than that in the non-MACE group ［-0.80(-18.74, 3.83)ng/L vs 0.03(-9.42, 12.14)ng/L, P=0.036］. The area under the curve (AUC) of Δ1PD-1 for predicting 2-year MACE was 0.564 (95% confidence interval: 0.505-0.624). The optimal cut-off value of 7.68 ng/L yielded a sensitivity of 81.7% and specificity of 30.4%. Multivariate Logistic regression showed that low Δ1PD-1 was an independent risk factor for 2-year MACE (odds ratio=1.916, 95% confidence interval: 1.067-3.443, P=0.030). Other independent predictors included previous history of percutaneous coronary intervention/coronary artery bypass grafting, diabetes mellitus, peak N-terminal pro-B-type natriuretic peptide and complete revascularization. Cox survival analysis indicated that the cumulative incidence of 2-year MACE was markedly higher in the low Δ1PD-1 group than in the high Δ1PD-1 group (26.0% vs 15.2%, hazard ratio=1.784, 95% confidence interval: 1.111-2.863, P=0.017), and the risk of cardiac rehospitalization was also significantly elevated (hazard ratio=1.938, 95% confidence interval: 1.182-3.179, P=0.009). Conclusions The degree of decline in PD-1 concentration at 24 h after pPCI compared with admission is correlated with long-term adverse prognosis in STEMI patients. Δ1PD-1 ≤7.68 ng/L serves as an independent predictor for 2-year MACE and cardiac rehospitalization, which can provide reference for early risk stratification. However, its single predictive performance is limited, and comprehensive evaluation combined with other clinical indicators is required.