急性ST段抬高心肌梗死患者血浆儿茶酚抑素水平的动态演变及临床意义

Dynamic Changes and Clinical Significance of Plasma Catestatin in Patients With ST Segment Elevation Myocardial Infarction

目的：观察血浆儿茶酚抑素（catestatin，CST）水平在急性ST段抬高心肌梗死（STEMI）患者病程中的动态演变及临床意义。方法：入选58例STEMI患者（STEMI组）及52例健康体检者（对照组），酶联免疫法测定患者发病第1、3、7天的血浆CST水平，免疫化学发光法测定患者发病第1、7天的血浆脑钠肽水平；入院1周时行超声心动图检查；对所有入选的患者进行随访。结果：STEMI患者血浆CST水平在发病第1天[1．00（0．66～1．50）ng/ml]、第3天[1．12（0．76～1．70）mg/ml]、第7天[1．32（0．81～1．73）ng／m1]逐渐升高，且均高于对照组[0．84（0．56～1．17）ng／ml]，差异有统计学意义（P〈0．05）发病第1天及第7天的血浆CST水平在左心室收缩功能障碍（左心室射血分数≤50％）者较左心室收缩功能正常者升高，差异有统计学意义（P〈0．05o发病第1天及第7天的血浆CST水平诊断急性期左心室收缩功能障碍的ROC曲线下面积分别为0．69（95％C10．55～0．83，P〈0．05）和0．71（95％c10．57。0．84，P〈0．01）；发病第1天及第7天的血浆脑钠肽水平的ROC曲线下面积分别为0．58（95％C10．42～0．74，P〉0．05）及0．85（95％C10．75～0．94，P〈0．01o随访发现，发病7天血浆CST水平〉1．32ng／mL者其终点事件发生率较血浆CST水平〈1．32ng／mL者升高，差异有统计学意义（P〈0．01）结论：STEMI患者发病后血浆CST水平进行性升高，并且可能与左心室收缩功能障碍及预后相关。

Objective： To observe the dynamic changes and clinical significance of plasma catestatin （CST） levels in patients with ST segment elevation myocardial infarction （STEMI）. Methods： There were 2 groups in our study, STEMI group, n=58 patients and Control group, n=52 healthy subjects. Plasma levels of CST were examined by ELISA on day 1, day 3, day 7 and BNP levels were measured by chemiluminescence immunoassay on day 1, day 7 after MI onset respectively. The cardiac function was evaluated by echocardiography at 1 week after MI. The clinical conditions were followed-up. Results： Plasma CST levels in STEMI group were elevated gradually on day 1, 1.00 （0.66-1.50）ng/ml, day 3, 1.12 （0.76- 1.70） ng/ml, day 7, 1.32 （0.81-1.73）ng/ml, and they were all higher than that in Control group, 0.84 （0.56-1.17） ng/ml, P〈0.05. Plasma CST levels were higher on day 1 and day 7 in MI patients with left ventricular systolic dysfunction （LVSD） defined as LVEF ≤ 50% and P〈0.05. The areas under the ROC curve （AUC） for plasma CST levels on day 1 and day 7 in eualuating LVSD were 0.69 （95%CI 0.55-0.83, P〈0.05） and 0.71 （95%CI 0.57-0.84, P〈0.01）. The AUC for plasma BNP levels on day 1 and day 7 were 0.58 （95%CI 0.42-0.74, P〉0.05） and 0.85 （95%CI 0.75-0.94, P〈0.01）. The follow-up study indicated that the patients with CST〉1.32 ng/ml on day 7 had more risk for suffering from MACE than those with CST〈1.32 ng/ml, P〈0.01. Conclusion： Plasma CST levels were elevated progressively at the acute stage of STEMI, and were related to LVSD and prognosis in those patients.