血浆中游离中性粒细胞胞外诱捕网水平与急性心肌梗死患者短期预后的关系研究

Relationship between peripheral serum cell-free neutrophil traps and short-term prognosis in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者外周血游离中性粒细胞胞外诱捕网(NETs)水平与短期预后的关系。方法选择2018年1月至2018年7月期间发病并于发病后12 h内入院的AMI患者121例为研究对象,随访30 d,按照主要心血管事件(MACE)的发生情况,将患者分为MACE组(n=20)和非MACE组(n=101)。收集患者住院的一般资料,入院后次日清晨采集患者空腹肘静脉血,检测血清心肌肌钙蛋白Ⅰ(cTnⅠ)、脑钠肽(BNP)、肌酸激酶同工酶MB(CK-MB)水平。应用免疫荧光染色及免疫酶标法检测NETs水平。采用受试者工作特征(ROC)曲线确定血浆游离NETs对AMI患者短期发生MACE的预测价值。结果两组患者BNP、CK-MB、cTnⅠ水平以及糖尿病史相比,差异有统计学意义(P<0.05)。MACE组患者血浆游离NETs水平高于非MACE组患者,差异有统计学意义(P<0.05)。经多因素Logistic回归分析,游离NETs水平升高(OR=6.902,95%CI:3.724~9.085)是AMI患者30 d内发生MACE的独立危险因素(P<0.05)。经ROC曲线分析,游离NETs水平预测AMI患者30 d内发生MACE的敏感性和特异性分别为89.0%和75.0%。结论外周血浆游离NETs水平与AMI患者短期预后相关,有望成为评估AMI患者预后的辅助参考指标。

Objective To investigate the relationship between peripheral serum cell-free neutrophil traps(NETs) and short-term prognosis in patients with acute myocardial infarction(AMI). Methods 121 AMI patients in our hospital were selected from January 2018 to July 2018 and divided, according to occurrence of major adverse cardiovascular events(MACE), into MACE group and non-MACE group. The blood samples of AMI patients were obtained after hospitalization. The levels of plasma cardiac troponin Ⅰ(cTnⅠ), brain natriuretic peptide(BNP) and creatine kinase-MB(CK-MB) were detected. Immunofluorescence was performed to the NETs and dsDNA as well as their correlation with short-term prognosis of AMI patients. The predictive values of serum NETs to MACE were reviewed by using receiver operating characteristic curve(ROC). Results There were 20 patients with MACE during 30 d after AMI and 101 patients without MACE. There was statistical significance of BNP, CK-MB, cTnⅠ and diabetes mellitus history between patients in MACE group and in non-MACE group(P<0.05). And the peripheral blood NETs levels of AMI patients in MACE group were higher than that of patients in non-MACE group(P<0.05). The results of Logistic regression analysis showed that NETs(OR=6.902, 95%CI: 3.724-9.085) was an independent risk factor for MACE within 30 days of AMI patients(P<0.05). The results of ROC analysis showed that the sensitivity and specificity of NETs for predicting MACE were 89.0% and 75.0%. Conclusion It’s suggested that the peripheral serum cell-free NETs level be correlated to short-term prognosis and can provide reference for prognosis review in AMI patients.