血清sST2联合NT-proBNP在急诊经皮冠状动脉介入治疗ST段抬高型心肌梗死患者早期危险分层中的应用价值

Application of serum sST2 combined with NT-proBNP in early risk stratification of patients with ST-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention

目的探讨血清可溶性基质溶素-2(soluble suppression of tumorigenicity 2,sST2)联合N末端B型脑钠肽前体(N-terminal pro-B-type brain natriuretic peptide,NT-proBNP)在急诊经皮冠状动脉介入(percutaneouscoronary intervention,PCI)治疗ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者早期危险分层中的应用价值。方法回顾性分析2012年1月至2015年12月在铜川矿务局中心医院接受急诊PCI治疗的STEMI患者180例的临床资料。根据1年后有无主要不良心脑血管事件(major adverse cardiovascularand cerebrovascular events,MACCE)发生,将患者分为MACCE发生组(n=36)和MACCE未发生组(n=144)。比较两组患者在临床特征、实验室指标、PCI治疗及经胸超声心动图检查结果方面的差异。采用Cox比例风险回归分析进行单因素、多因素分析,确定影响PCI治疗1年后MACCE发生的危险因素。采用Kaplan-Meier法计算PCI治疗1年后MACCE的累积发生率,再运用Log-rank法进行比较。结果 MACCE发生组年龄及血糖、糖化血红蛋白、C-反应蛋白、sST2、NT-proBNP、肌酸激酶同工酶、肌钙蛋白I浓度,最终心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级为3级的患者比例显著高于MACCE未发生组,差异有统计学意义(P<0.05);MACCE发生组体质量指数、左心室射血分数显著低于MACCE未发生组,差异有统计学意义(P<0.05)。单因素、多因素Cox回归分析结果显示,最终TIMI血流分级<3级、sST2浓度>75.15 ng/mL、NT-proBNP浓度>400 pg/mL、血糖浓度>150 mg/dL会增加STEMI患者PCI治疗1年后MACCE发生风险(P<0.05)。PCI治疗1年后MACCE累积发生曲线显示,sST2浓度>75.15 ng/mL的STEMI患者MACCE累积发生率为80.25%,显著低于sST2浓度≤75.15 ng/mL的91.05%(P<0.05);sST2浓度>75.15 ng/mL联合NT-proBNP浓度>400 pg/mL的STEMI患者MACCE累积发生率为73.56%,显著低于其他组合(P<0.05)。结论血清sST2(或)联合NT-proBNP可预测PCI治疗后STEMI患者MACCE的发生。

Objectives Toinvestigate the value of soluble suppression of tumorigenicity2(sST2)combined with N-terminal pro-B-type brain natriuretic peptide(NT-proBNP)in the early risk stratification of patients with ST-segment elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI).Methods Totally180patients with STEMI accepted PCI in Central Hospital of Tongchuan Mining Bureau from January2012to December2015were selected as study subjects.The patients were divided into major adverse cardiovascular and cerebrovascular events(MACCE)occurrence group(n=36)and MACCE non-occurrence group(n=144)according to the occurrence of MACCE after one year of PCI.The differences of clinical characteristics,laboratory indexes,PCI and transthoracic echocardiography results between the two groups were compared.Cox proportional hazards regression was used to analyze the risk factors of MACCE after one year of PCI by univariate and multivariate analysis.Kaplan-Meier method was used to calculate the accumulative incidence of MACCE after one year of PCI,and then compared with Log-rank method.Results Age,blood glucose,hemoglobin A1c(HbA1c),C reactive protein(CRP),sST2,NT-proBNP,creatine kinase isoenzyme and troponin I,final TIMI blood flow was graded as grade3in MACCE occurrence group were significantly higher than those in MACCE non-occurrence group(P<0.05),while body mass index,left ventricular ejection fraction was significantly lower in MACCE acoccurrence group than in MACCE non-occurrence group(P<0.05).Univariate and multivariate Cox regression analysis showed that final TIMI blood flow classification<3,sST2>75.15ng/mL,NT-proBNP>400pg/mL,blood glucose>150mg/dL could increase the risk of MACCE in patients with STEMI after one year of PCI(P<0.05).A year after PCI,MACCE accumulative incidence curves showed that accumulative incidence of sST2>75.15ng/mL of STEMI patients was80.25%,significantly lower than that of sST2≤75.15ng/mL of91.05%(P<0.05).Accumulative incidence of MACCE in patients with sST2>75.15ng/mL combined with NT-proBNP>400pg/mL of STEMI was73.56%,significantly lower than that of other combinations(P<0.05).Conclusions sST2(or)combined with NT-proBNP can predict the occurrence of MACCE in patients with STEMI after PCI.