急性心肌梗死短期预后与血清sST2、hs-cTnI水平的相关性

Correlation between short-term prognosis of acute anterior wall myo cardial infarction and serum sST2 and hs-cTnI levels

目的探究急性前壁心肌梗死(AAMI)短期预后与血清可溶性生长刺激表达基因2蛋白(sST2)、超敏肌钙蛋白I(hs-cTnI)水平的相关性。方法选取2021年5月—2022年4月上海交通大学医学院附属苏州九龙医院收治的AAMI患者124例,出院后随访12个月,根据随访期内是否发生主要不良心血管事件(MACE)将患者分为预后不良组48例和预后良好组76例。比较两组入院时血清sST2、hs-cTnI和脑钠肽(BNP)、高密度脂蛋白胆固醇(HDL-C)等基线资料,绘制受试者工作特性曲线(ROC)评价血清sST2、hs-cTnI水平预测AAMI患者短期预后的效能,采用多因素Logistic回归分析AAMI患者短期预后的独立危险因素。结果预后不良组Killips分级≥Ⅲ级、冠状动脉三支病变占比及BNP、sST2、hs-cTnI明显高于预后良好组(P<0.05),HDL-C明显低于预后良好组(P<0.05)。ROC曲线分析结果显示,sST2、hs-cTnI对AAMI患者短期预后均有一定预测效能,曲线下面积分别为0.893、0.801。多因素Logistic回归分析结果显示,Killips分级≥Ⅲ级、冠状动脉三支病变、BNP≥806.680 pg/mL、sST2≥132.00 pg/mL、hs-cTnI≥1.750μg/L是AAMI患者短期预后的独立危险因素(P<0.05),HDL-C<0.920 mmol/L是AAMI患者短期预后的独立保护因素(P<0.05)。结论sST2、hs-cTnI是潜在的预测AAMI患者短期预后的生物标记物,其血清水平升高与AAMI患者短期预后密切相关。

Objective To investigate the correlation between short-term prognosis of acute anterior myocardial infarction(AAMI)and serum levels of soluble growth stimulating expression gene 2 protein(sST2)and high-sensitivity cardiac troponin I(hs-cTnI).Methods 124 AAMI patients were divided into 2 groups according to whether major adverse cardiovascular event(MACE)occurred during a 12-months follow-up period:good prognosis group(without MACE,n=48)and poor prognosis group(with MACE,n=76).Fasting peripheral venous blood samples were colleted the next day after hospitalization to undergo testing of sST2 and hs-cTnI by immunofluorescent chromatography.Color Doppler diagnostic apparatus was used to test the left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF).Related clinical data were collected too.Receiver operating characteristic curve(ROC)was drawn to evaluate the efficacy of serum sST2 and hs-cTnI levels in predicting short-term prognosis of AAMI patients,and multivariate Logistic regression was used to analyze the independent risk factors for short-term prognosis of AAMI patients,according to whether major adverse cardiovascular events(MACE)occurred during the follow-up period,the patients were divided into 48 cases in the poor prognosis group and 76 cases in the good prognosis group.The baseline data of serum sST2,hs-cTnI,brain natriuretic peptide(BNP)and high density lipoprotein cholesterol(HDL-C)were compared between the two groups at admission,receiver operating characteristic curve(ROC)was drawn to evaluate the efficacy of serum sST2 and hs-cTnI levels in predicting short-term prognosis of AAMI patients,and multivariate Logistic regression was used to analyze the independent risk factors for short-term prognosis of AAMI patients.Results The proportions of Killips grade≥gradeⅢand,coronary artery disease,and the serum levels of BNP,sST2,and hs-cTnI in the poor prognosis group were all significantly higher than those in the good prognosis group(all P<0.05),while the serum HDL-C level in the poor prognosis group was significantly lower than that in the good prognosis group(P<0.05).ROC curve analysis showed that sST2 and hs-cTnI had certain predictive efficacy for short-term prognosis of AAMI patients,and the area under the curve was 0.893 and 0.801,respectively.Multivariate Logistic regression analysis showed that Killips grade≥gradeⅢ,triple coronary artery disease,BNP≥806.680 pg/mL,sST2≥132.00 pg/mL,and hs-cTnI≥1.750μg/L were independent risk factors for short-term prognosis of AAMI patients(all P<0.05),and HDL-C<0.920 mmol/L was an independent protective factor for short-term prognosis in patients with AAMI(P<0.05).Conclusion s ST2 and hs-cTnI are potential biomarkers for predicting short-term prognosis of patients with AAMI,and their elevated serum level is closely related to short-term prognosis of patients with AAMI.