可溶性生长刺激表达基因2蛋白对急性心肌梗死后主要不良心血管事件的预测价值

Predictive value of soluble growth STimulation expressed gene 2 on major adverse cardiovascular events after acute myocardial infarction

目的明确可溶性生长刺激表达基因2蛋白(soluble growth STimulation expressed gene2,sST2)对急性心肌梗死(acute myocardial infarction,AMI)后行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法入选2015年1月至2016年5月入住兰州大学第一医院心脏中心的初发AMI患者148例,收集患者术前血清sST2水平及其他临床资料,并于PCI术后随访6~12个月,记录随访结果。结果(1)根据是否发生MACE,MACE组(23例)血清sST2水平明显高于非MACE组(125例)[(44.50±5.32)ng/ml比(23.59±1.15)ng/ml,P=0.001],差异有统计学意义。(2)血清sST2水平与体重指数(r=0.190,P=0.008)、高血压病(r=0.148,P=0.034)、三酰甘油(r=0.212,P=0.003)、中性粒细胞百分比(r=0.324,P<0.001)、谷丙转氨酶(r=0.152,P=0.031)、左心室收缩末期容积(r=0.195,P=0.018)及左心室射血分数(r=-0.275,P=0.001)等因素相关。(3)经双变量相关分析可知:血清sST2与MACE、Ⅲ型前胶原氨基端肽呈正相关,与氨基末端B型脑钠肽前体(N terminalprobrain natriuretic peptide,NT-proBNP)无相关性。(4)预测PCI术后MACE发生的ROC曲线。sST2+NT-proBNP联合曲线下面积明显大于sST2(0.820比0.787,P=0.045),sST2曲线下面积明显大于NF-proBNP(0.787比0.690,P=0.030)。(5)血清sST2水平≤29 ng/ml患者PCI术后6个月的生存率高于其sST2水平>29 ng/ml患者(100%比95.5%,P=0.029)。结论 sST2受多种因素影响,与NT-proBNP联合可提高对PCI术后MACE的预测价值,且患者sST2水平越高PCI术后6个月的死亡率越高。

Objective To explore the predictive value of soluble growth STimulation expressed gene 2 （ sST2 ） on major adverse cardiovascular events （ MACE ） of acute myocardial infarction （ AMI ） after percutaneous coronary intervention （PCI） . Methods The study included 148 patients with first episode of AMI admitted from January 2015 to May 2016 in the heart center of the First Hospital of Lanzhou University. Serum sST2 level before PCI was tested and all patients were followed up clinically for 6 months after PCI. Results 1. MACEs were found in 23 patients during follow up. The sST2 leveles were significantly higher in patients with MACEs than the non-MACE group [ （44. 50 ±5.32 ） ng/ml vs. （23.59 ±1.15 ） ng/ml, P = 0. 001 ]. Pearson correlation analysis showed that serum sST2 were positively correlated with MACE and type Ⅲ procollagen amine terminal peptide （ P Ⅲ NP） but was not correlated with NT- proBNP. 2. Serum sST2 found to be correlated with the body mass index, blood pressure, triglycerides, aspartate aminotransferase, left ventrieular end-systolic volume （LVESV） and left ventricular ejection fraction （LVEF）. 3. The area under the ROC curve of sST2 to predict the occurrence of MACE after PCI was 0. 787 which was higher than that of NT-proBNP. The area under curve of sST2 combined with NT-proBNP was 0. 820. 4. The survival rate of patients with serum sST2 level ≤29 ng/ml was higher than patients with sST2 〉 29 ng/ml in 6 months after PCI. Conclusions sST2 is affected by a variety of factors, sST2 combined with NT-proBNP can improve the predictive value of MACE after PCI, and higher the level of sST2, higher the mortality rate in 6 months after PCI.