血清内脏脂肪素水平对急性ST段抬高型心肌梗死患者院内预后的预测价值

The predictive value of serum visfatin level for in-hospital prognosis in patients with acute ST-segment elevation myocardial infarction

目的探究血清内脏脂肪素(内脂素)水平对急性ST段抬高型心肌梗死(STEMI)患者院内主要不良心血管事件(MACE)的预测价值。方法连续选取2015年1月至2017年12月于青海省第五人民医院就诊的STEMI患者382例,根据是否发生院内MACE将其分为MACE组(57例)和非MACE组(325例)。比较两组患者基本临床资料,并采用酶联免疫吸附法测定入院时血清内脂素水平。结果 MACE组患者年龄[(67.9±11.4)岁比(62.5±10.9)岁,P<0.001]、2型糖尿病比例(36.8%比24.0%,P=0.041)、收缩压[(129.0±24.7)mmHg比(121.6±22.5)mmHg(1 mmHg=0.133kPa),P=0.025]、Killip心功能Ⅱ～Ⅳ级比例(61.4%比43.7%,P=0.013)和前壁心肌梗死比例(57.9%比42.2%,P=0.027)均高于非MACE组患者,差异均有统计学意义。MACE组患者肌钙蛋白I峰值[(7.39±3.16)μg/L比(6.50±2.48)μg/L,P=0.017]、脑钠肽前体[(5911±2360)pg/ml比(2489±974)pg/ml,P<0.001]、入院血糖[(8.81±3.59)mmol/L比(7.94±2.52)mmol/L,P=0.026]、超敏C反应蛋白[(9.14±3.51)mg/L比(7.82±3.13)mg/L,P=0.004]和血清内脂素水平[(74.3±10.5)ng/ml比(59.8±11.3)ng/ml,P <0.001]均高于非MACE组患者,差异均有统计学意义。Pearson相关性分析表明,血清内脂素水平与肌钙蛋白I峰值(r=0.38,P<0.01)和超敏C反应蛋白(r=0.51,P<0.05)呈正相关,而与其他变量无相关性。logistic多因素回归模型分析显示,血清内脂素(OR1.83,95%CI 1.12～2.98,P=0.016)、年龄(OR1.22,95%CI1.02～1.47,P=0.033)、Killip心功能Ⅱ～Ⅳ级(OR2.37,95%CI1.25～4.49,P=0.008)和肌钙蛋白I峰值(OR1.39,95%CI1.07～1.81,P=0.014)是预测STEMI患者院内发生MACE的独立因素。ROC曲线分析表明,内脂素预测院内MACE的最佳截点为68.9 ng/ml,其敏感度为72%,特异度为81%。结论血清内脂素水平是STEMI患者院内发生MACE的一个良好预测指标。早期检测血清内脂素水平可能有助于STEMI患者的危险分层和管理。

Objective To determine the value of serum visfatin level in prediction of in-hospital major adverse cardiac events(MACE)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January2015to December2017,382patients with STEMI who admitted in the Fifth People's Hospital of Qinghai Province were consecutively included.According to the presence or absence of MACE,these patients were divided into the MACE(n=57)and non-MACE(n=325)groups.The baseline clinical data were compared between the two groups,and ELISA method was used to measure the serum visfatin levels.Results The level of serum visfatin was signifi cantly higher in the MACE group than in the non-MACE group[(74.3±10.5)ng/ml vs.(59.8±11.3)ng/ml,P<0.001].Age,rates of comorbidity type2diabetes,systolic blood pressure,proportion of Killip classⅡ-Ⅳ,proportion of anterior myocardial infarction,troponin I,N-terminal pro-brain natriuretic peptide,highsensitivity C-reactive protein and glucose level at admission were all signifi cantly higher in the MACE group than in the non-MACE groups(all P<0.05).Multivariate logistic analysis showed that serum visfatin level(OR1.83,95%CI1.12-2.98;P=0.016),age,Killip class and peak of troponin I were independent predictors for the occurrence of in-hospital MACE in STEMI patients.ROC curve analysis showed that the best cut-off value of visfatin for predicting in-hospital MACE was68.9ng/ml,and its sensitivity was72%and specifi city was81%.Conclusions Serum visfatin was a useful predictor of the occurrence of inhospital MACE in patients with STEMI.Early measurement of serum visfatin may be helpful for the risk classifi cation and management of STEMI.