可溶性生长刺激表达基因2蛋白浓度的动态变化对AMI患者半年MACE的预测价值

Predictive value of dynamic changes of soluble growth ST imulation expressed gene 2 concentration for 6-month major adverse cardiovascular events in patients with acute myocardial infarction

目的探讨血浆可溶性生长刺激表达基因2 蛋白(soluble growth ST imulation expressed gene 2,sST-2)浓度在急性心肌梗死(acute myocardial infarction,AMI)患者中的变化趋势及其对半年时主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法入选2017年6月至2018年5月在南京医科大学附属南京医院心脏监护病房(CCU)明确诊断为AMI的患者460例。入选的患者需满足在入院后每天或间隔几天清晨抽取患者空腹静脉血(抽血超过2次),用酶联免疫吸附法测定患者的血浆sST-2浓度,并于出院后随访半年,以发生MACE为研究终点,将患者根据受试者工作特征曲线(receiver operating characteristic curve,ROC)得出的临界值及基线sST-2浓度中位数进行分组,分为sST-2波动组及sST-2正常下降组。结果(1)sST-2波动组与sST-2正常下降组相比,各个时间点的sST-2浓度在sST-2波动组均高于sST-2正常下降组,但差异无统计学意义(P>0.05)。(2)ROC 分析显示,sST-2、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NTproBNP)、sST-2波动及sST-2联合NT-proBNP的ROC下面积分别为0.784、0.820、0.939、0.841。sST-2波动与其他3者相比,差异均有统计学意义(P 均<0.05)。(3)采用Kaplan-Meier 法比较两组生存率,sST-2正常下降组的无MACE发生率明显高于sST-2波动组,差异有统计学意义(98.6% vs. 1.4%,P<0.001)。(4)Cox回归分析显示,sST-2波动是AMI患者半年内是否发生MACE的独立危险因素(HR=103.302,95%CI:37.077~287.814,P<0.001)。结论sST-2是否出现波动是AMI患者半年内是否发生MACE的重要危险因素。

Objectives To investigate the predictive value of dynamic changes of soluble growth ST imulation expressed gene 2(sST-2)concentration for 6-month major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI). Methods A total of 460 patients with AMI were enrolled in Nanjing First Hospital cardiac care unit (CCU)from June 2017 to May 2018. Patients enrolled in the study were required to draw blood for more than 2 times to measure the plasma concentration of sST-2 by enzyme-linked immunosorbent assay(ELISA). The patients were followed up for half a year after discharge,and the primary endpoint was MACE. Patients were divided into sST-2 wave group and sST- 2 normal decline group according to the threshold value obtained by the receiver operating characteristic curve (ROC)and the median sST-2 concentration of the baseline. Results (1)Plasma concentration of sST-2 at each time point was significantly higher in sST-2 wave group than that in sST-2 normal decline group,but the differences between which were not significant(P>0.05).(2)ROC analysis showed that areas under the curve(AUC)of sST-2,N-terminal pro-brain natriuretic peptide(NT-proBNP),sST-2 wave and sST-2 combined with NT-proBNP were 0.784,0.820, 0.939,and 0.841,respectively. AUC in sST-2 wave was significantly greater than that in sST-2,NT-proBNP and sST-2 combined with NT-proBNP(all P<0.05).(3)Incidence of no MACE in sST-2 normal decline group was significantly higher than that in sST-2 wave group(98.6% vs. 1.4%,P<0.001).(4)Cox regression analysis showed that sST-2 wave was a risk factor for 6- months MACE in patients with AMI(HR=103.302,95% CI:37.077- 287.814,P<0.001). Conclusions sST-2 wave is an independent predictor for 6-month MACE in patients with AMI.