血清sST2对急性ST段抬高型心肌梗死患者急诊PCI术后慢血流现象预测价值

Predictive value of serum sST2 protein in patients with acute ST-segment elevation myocardial infarction after emergency PCI for slow coronary flow

目的探讨血清可溶性生长刺激表达基因2蛋白(sST2)对急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI术后冠状动脉慢血流(CSF)现象的预测价值。方法选取2020年11月—2021年6月就诊于辽宁省人民医院心脏中心因STEMI行急诊PCI术的患者213例,根据PCI术后患者连续校正的TIMI帧数(CTFC)分为CSF组(CTFC≥27帧)43例和血流正常组(CTFC<27帧)170例,采用荧光免疫分析法检测血清sST2水平,比较2组患者的临床资料,多因素Logistic回归分析发生CSF现象的独立危险因素,探讨血清sST2对STEMI患者急诊PCI术后CSF的预测价值。结果发生CSF现象患者43例(20.2%),CSF组患者年龄、糖尿病病史比例、N末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、中性粒/淋巴细胞比率(NLR)、空腹血糖(FPG)、血清sST2、术中出现低血压比例均高于血流正常组(χ^(2)/t/Z/P=2.185/0.030、4.991/0.005、2.277/0.023、3.375/0.001、3.791/0.000、3.139/0.002、2.811/0.005、5.085/0.000、14.018/0.000)。多因素Logistic回归分析显示,高NLR值、术中发生低血压、血清sST2水平升高为STEMI患者急诊PCI术后发生CSF现象的独立危险因素[OR(95%CI)=1.081(1.009~1.158),2.451(1.013~4.582),1.014(1.007~1.022)]。ROC分析显示,血清sST2预测CSF的AUC为0.751,最佳截断值为70.12 ng/ml,敏感度为0.705,特异度为0.800,约登指数为0.505。结论血清sST2是STEMI患者急诊PCI术后CSF现象有效预测指标。

Objective To investigate the predictive value of serum soluble growth-stimulating expression gene 2(sST2)in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing emergency PCI for coronary slow flow(CSF).Methods A total of 213 patients who underwent emergency PCI for STEMI in the Heart Center of Liaoning Provincial People's Hospital from November 2020 to June 2021 were selected and divided into CSF group(CTFC≥27 frames)43 cases and 170 cases in the normal blood flow group(CTFC<27 frames),the serum sST2 level was detected by fluorescence immunoassay,the clinical data of the two groups were compared,and the independent risk factors of CSF phenomenon were analyzed by multivariate Logistic regression.To investigate the predictive value of serum sST2 for CSF after emergency PCI in STEMI patients.Results There were 43 patients(20.2%)with CSF phenomenon.The age of the patients in the CSF group,the proportion of history of diabetes,N-terminal pro-brain natriuretic peptide(NT proBNP),creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),neutrophil/lymphocyte ratio(NLR),fasting blood glucose(FPG),serum sST2,and intraoperative hypotension ratio were higher than those in normal blood flow group(χ^(2)/t/Z/P=2.185/0.030,4.991/0.005,2.277/0.023,3.375/0.001,3.791/0.000,3.139/0.002,2.811/0.005,5.085/0.000,14.018/0.000).Multivariate Logistic regression analysis showed that high NLR value,intraoperative hypotension,and elevated serum sST2 level were independent risk factors for CSF after emergency PCI in STEMI patients[OR(95%CI)=1.081(1.009-1.158)],2.451(1.013-4.582),1.014(1.007-1.022).ROC analysis showed that the AUC of serum sST2 for predicting CSF was 0.751,the best cut-off value was 70.12 ng/ml,the sensitivity was 0.705,the specificity was 0.800,and the Youden index was 0.505.Conclusion Serum sST2 is an effective predictor of CSF phenomenon after emergency PCI in STEMI patients.