儿茶酚抑素与急性ST段抬高型心肌梗死患者心功能的相关性研究

Relationship between catestatin and heart function of STEMI patients

目的 探讨血浆儿茶酚抑素(catestatin,CST)与急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者心功能的相关性.方法 入选2014年6月至2017年6月期间就诊于昆明医科大学第二附属医院心内科的STEMI患者130例,同期入选健康人群40名作为对照组.采用ELISA法检测血浆CST浓度.根据Killip心功能分级法将STEMI患者分为Killip心功能Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级组,超声心动图检测左心室射血分数(left ventricular ejection fraction,LVEF)、荧光免疫定量分析法检测氨基末端脑钠肽前体(N-terminal fragment of pro-brain natriuretic peptide,NT-proBNP)水平.通过Spearman秩相关分析CST与NT-proBNP的关系,利用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评价CST对STEMI患者发生心力衰竭的预测价值.结果 ①STEMI组血浆CST浓度水平高于正常人群[(2.2±0.8)ng/ml比(0.2±0.1) ng/ml,P<0.001].②不同Killip心功能分级患者的LVEF、NT-proBNP、CST组间差异有统计学意义:KillipⅣ级的患者LVEF(0.35±0.06)显著低于其他三组(P<0.05),KillipⅢ级(0.40±0.08)高于KillipⅠ级、Ⅱ级(P<0.05).KillipⅣ级患者NT-proBNP (13044.53±2928.37) pg/ml显著高于其他三组(P<0.05),KillipⅢ级(4557.88±1016.12)pg/ml高于Killip Ⅰ级、Ⅱ级(P<0.05).KillipⅣ级CST水平(8.2±2.4)ng/ml显著高于其他三组(P<0.05),而Ⅱ级、Ⅲ级组高于Ⅰ级组(P<0.05).③Spearman相关分析显示,CST与NT-proBNP呈正相关(r=0.608,P=0.036).④ROC曲线分析提示,NT-proBNP与CST对STEMI患者发生心力衰竭的预测价值,曲线下面积分别为0.798 (P=0.015)、0.898 (P<0.001).结论 STEMI患者血浆CST浓度水平明显高于正常人群,血浆CST浓度对STEMI患者并发心力衰竭有一定预测价值.

Objective:To investigate the relationship between Serum catestatin (CST) and and heart function on ST segment elevation myocardial infarction (STEMI ) patients. 【Methods】:A total of 130 STEMI patients and 40 health people were selected. CST plasma concentration was tested by ELISA.Killip classification was use to evaluate the heart function.Left ventricular ejection fraction (LVEF) was detected by Echocardiography. NT-proBNP was measured by Fluorescence immunoassay. Spearman rank correlation analysis was used to analyze the relation between CST and NT-proBNP. ROC curves was used to evaluate the predictive value of CST on heart failure among STEMI patients. 【Results】:1.STEMI patients were divided into four groups according to Killip cardiac function grading: Killip class I, Killip class II, Killip class III, Killip cclass IV. There was no significant difference in age, sex, BMI, smoking, hypertension, diabetes mellitus, TC, TG, LDL among different groups (P > 0.05). 2.The CST concentration of STEMI patients is higher than normal people(P<0.001). 3.The LVEF,NT-proBNP and CST level were significantly different in different groups. 4.CST is positively correlated with NT-proBNP(r=0.302,P=0.048) according to Spearman rank correlation analysis. 5.CST and NT-proBNP level were used to predict heart failure for STEMI patients according to ROC curves, the area is 0.742(P=0.01),0.992(P<0.001) respectively. 【Conclusion】:The CST concentration of STEMI patients is higher than normal people. CST plasma concentrationcan be used to predict heart failure for STEMI patients.