血清鸢尾素水平与急型心肌梗死患者不良心血管预后的相关性

Correlation between serum irisin level and adverse cardiovascular outcome in patients with acute myocardial infarction

目的:探讨血清鸢尾素水平与ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)治疗后主要心血管不良事件(MACE)发生的相关性。方法:纳入200例接受急诊PCI治疗的STEMI患者,通过ELISA法检测患者PCI术前、术后8 h、16 h、3d、7 d及28 d的血清鸢尾素水平,并根据鸢尾素水平对患者进行分层评估PCI术后1年内MACE发生差异。结果:200例STEMI患者PCI介入前的基线血清鸢尾素水平为(0.47±0.23)mg/L。血清鸢尾素水平在PCI术后8 h达到峰值(0.59±0.17)mg/L,P=0.007,而在PCI术后3 d达到最低水平(0.31±0.10)mg/L,P<0.001。STEMI患者的基线血清鸢尾素水平呈偏态分布,中位数为0.48 mg/L,根据中位数和四分位间距,将STEMI患者分为四组,分别为Q1组(50例,<0.41 mg/L)、Q2组(50例,0.42~0.48 mg/L)、Q3组(50例,0.49~0.60 mg/L)和Q4组(50例,>0.60 mg/L)。其中Q4组患者的心源性死亡率和心力衰竭住院率显著高于其他组患者(均P<0.05);但再发心肌梗死率、脑卒中发生率、再次血运重建率等,差异无统计学意义(P>0.05)。总体上,Q4组患者的无MACE生存率显著低于其他组患者(P<0.001)。多因素Cox回归分析显示:Killip分级3~4级(HR=2.348,95%CI:1.240~5.301,P=0.021)和血清鸢尾素水平>0.60 mg/L(HR=3.892,95%CI:1.431~8.762,P=0.003)是影响MACE发生的危险因素。结论:STEMI患者血清鸢尾素水平的升高与PCI术后MACE发生风险增加独立相关,血清鸢尾素水平可作为预测STEMI患者发生MACE的有效标志物。

Objective:To investigate the correlation between serum irisin level and the major adverse cardiovascular events(MACE)occurrence in ST-elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention(PCI)treatmen.Methods:200 patients with STEMI who underwent emergency PCI were enrolled,and tested for serum irisin levels before PCI,8 h,16 h,3 d,7 d and 28 d after PCI by ELISA method.Patients were stratified according to the level of serum irisin,and compared the difference of the incidence for MACE within one year after PCI.Results:The baseline serum irisin levels in 200 patients with STEMI was(0.47±0.23)mg/L.Serum irisin levels reached peaks at 8 h after PCI(0.59±0.17)mg/L,P=0.007,but reached the lowest level in 3 d after PCI(0.31±0.10)mg/L,P<0.001.Baseline serum irisin levels in STEMI patients were showed skewed distribution,at a median of 0.48 mg/L.According to the median and interquartile range,all STEMI patients were divided into 4 groups,respectively,in the Q1 group(50 cases,<0.41 mg/L),Q2 group(50 cases,0.42-0.48 mg/L),Q3 group(50 cases,0.49-0.60 mg/L)and Q4 group(50 cases,>0.60 mg/L).The incidence of cardiac mortality and heart failure hospitalization rate in the Q4 group was significantly higher than that in the other groups(both P<0.05).However,there was no significant difference in the rate of AMI recurrence,incidence of stroke,and revascularization rate(P>0.05).Overall,the MACE-free survival rate was significantly lower in the Q4 group than in the other groups(P<0.001).Multivariate Cox regression analysis showed that Killip grades 3-4(HR=2.348,95%CI:1.240-5.301,P=0.021)and serum irisin levels>0.60 mg/L(HR=3.892,95%CI:1.431-8.762,P=0.003)both were independent risk factors affecting the occurrence of MACE.Conclusions:The increase of serum irisin levels in STEMI patients is independently associated with an increased risk of MACE after PCI.Serum irisin levels can be used as effective biomarkers for predicting MACE in STEMI patients.