血浆凝溶胶蛋白在急性ST段抬高型心肌梗死患者中的水平及意义

The plasma level of Gelsolin and its clinical significance in patients with acute ST-elevation myocardial infarction

目的 分析急性ST段抬高型心肌梗死（STEMI）患者血浆凝溶胶蛋白（p GSN）的水平,以及急诊经皮冠状动脉介入术（PCI）对其影响,探讨其能否作为心肌梗死和心肌缺血再灌注损伤的血清标志物,及其对短期预后的影响。方法 连续收集126例首次发生STEMI并行急诊PCI的患者和60例稳定性心绞痛并行择期PCI的冠心病患者术前即刻及术后90 min血清标本,另抽取30名无心肌缺血证据的健康者血清标本作为对照,采用酶联免疫吸附试验（ELISA）检测p GSN浓度。p GSN在术前和术后的变化量记录为ΔG。STEMI组患者根据术后90 min心电图ST段回落程度分为ST段完全回落组（STR≥70%）和ST段不完全回落组（STR〈70%）。记录患者手术情况、实验室检查结果及3个月内所有心脏不良事件（MACE）。比较不同组间p GSN的水平差异,及其对预后的影响。结果 （1）p GSN基线水平在STEMI组明显低于稳定性心绞痛组和健康组[（104.51±35.91）ng/ml比（129.47±41.61）ng/ml和（138.17±43.43）ng/ml,F=9.641,P〈0.01],在稳定性心绞痛组和健康组之间差异无统计学意义（P〉0.05）;（2）p GSN在STEMI组术后90 min较术前明显下降[（95.42±36.50）ng/ml比（104.51±35.91）ng/ml,t=4.959,P〈0.01],而在稳定性心绞痛组PCI术前后水平无明显变化（P〉0.05）;（3）STEMI患者中ΔG在ST段完全回落组低于ST段不完全回落组[（1.92±4.46）ng/ml比（5.37±5.14）ng/ml,F=0.938,P=0.007];（4）基线p GSN诊断STEMI的ROC曲线下面积为0.742（95%CI：0.638-0.826,P〈0.01）,选p GSN=96.13 ng/ml为诊断界点时,对诊断STEMI的敏感度为54.8%,特异度为80.6%;（5）STEMI组有22例患者出现MACE,基线p GSN在MACE组明显低于非MACE组[（82.28±23.56）ng/ml比（108.35±30.13）ng/ml,F=0.281,P=0.021],ΔG在MACE组明显高于非MACE组[（6.87±6.22）ng/ml比（3.25±4.14）ng/ml,F=3.276,P=0.008]。多因素Logistic回归分析显示,基线p GSN是独立预测3个月内MACE的主要因素之一。结论 p GSN术后的水平变化能较好反映急诊PCI术后的心肌灌注水平,对短期预后具有一定的预测价值。

Objective To explore the level of plasma Gelsolin （ pGSN） in patients with acute ST-segment elevation myocardial infarction （STEMI） as a useful marker for myocardial infarction,reperfusion injury,effect of primary percutaneous coronary intervention （ pPCI） and its short-term prognostic value . Methods A total of 126 patients with first onset of STEMI undergoing pPCI and 60 patients with stable angina pectoris （ SAP） receiving elective PCI were enrolled in this study.pGSN was measured using ELISA before and 90 min after PCI,and then calculated the change of pGSN（ΔG）.pGSN was also measured in another 30 healthy controls.STEMI patients were divided into two groups：complete ST-segment depression （ ST≥70%） and incomplete ST-segment depression （ STR 〈70%） .The patients′surgery, laboratory findings,and all cardiac adverse events （ MACE） within 3 months after PCI were recorded.SPSS-20.0 was used for statistical analysis. Results （1） Baseline level of pGSN in STEMI group was significantly lower than healthy group or SAP group [（104.51 ±35.91） ng/ml vs.（129.47 ±41.61） ng/ml and （138.17 ± 43.43） ng/ml,F=9.641,P〈0.01] ,while there was no significant difference between healthy group and SAP group.（2） The level of pGSN was changed significantly after PCI in STEMI group [（95.42 ±36.50） ng/ml vs.（104.51 ±35.91） ng/ml,t=4.959,P〈0.01],while there was no statistical change in SAP group.（3） ΔG was significantly higher in incomplete STR group than in complete STR group [（5.37 ± 5.14） ng/ml vs.（1.92 ±4.46） ng/ml,F=0.938,P=0.007].（4） The area of pGSN under the receiver operator characteristic curve was 0.742 （95%CI：0.638-0.826,P〈0.01）.When taking pGSN=96.13 ng/ml as cutoff point, the sensitivity and specificity in diagnosing STEMI were 54.8% and 80.6%, respectively.（5） There was significant difference of pGSN [（82.28 ±23.56） ng/ml vs.（108.35 ±30.13） ng/ml,F=0.281,P=0.021] andΔG [（6.87 ±6.22） ng/ml vs.（3.25 ±4.14） ng/ml,F=3.276,P=0.008] between MACE group and non-MACE group.Multivariate Cox stepwise regression indicated that pGSN was one of the independent predictors of MACE within 3 months. Conclusions The level of pGSN could be a good serum marker for patients with STEMI.The early changes of pGSN after PCI may be an indicator to assess the degree of myocardial ischemia-reperfusion injury, and have a predictive value for adverse cardiovascular events in such patients within 3 months.