血浆巨噬细胞移动抑制因子水平变化与ST段拾高型心肌梗死患者多因素相关性分析及远期预后

Multivariate Correlation Analysis between Plasma Macrophage Migration Inhibitory Factor Levels and Long-Term Prognosis in Patients with ST-segment Elevation Myocardial Infarction

目的探讨血浆巨噬细胞移动抑制因子(macrophage migrationinhibitory factor,MIF)水平变化与ST段抬高型心肌梗死(ST-segment elevated myocardial infarction,STEMI)患者多因素相关性分析及远期预后。方法选择2013年3月-2015年3月内蒙古医科大学附属医院急诊内科收治的168例STEMI患者作为研究组,于术前、术后24h及72h采血测定血浆MIF水平,另选同期稳定性心绞痛(SAP)患者54例、健康体检者72名作为对照组,于就诊时采血测定血浆MIF水平,并分析STEMI患者血浆MIF水平与临床指标及远期预后的相关性。结果STEMI组术前血浆MIF水平显著高于SAP组及健康组(P<0.05);STEMI组术后72h血浆MIF水平与术前、术后24h比较有显著差异(P<0.05);术前MIF水平与高敏肌钙蛋白T(high-sensitive troponin T,hs-TnT)峰值、肌酸激酶同工酶MB(creatine kinase-MB,CK-MB)、高敏C反应蛋白(hs-CRP)、N末端B型利钠肽原(NT-proBNP)呈正相关(P<0.05),与左心室射血分数(LVEF)呈负相关(P<0.05);术前MIF高水平组患者发生前壁、下壁、后壁、侧壁心肌梗死和Kllp≥2级比例显著高于术前MIF低水平组患者(P<0.05);STEMI患者术前、术后24h、术后72h的MIF水平与术前、术后24h、术后72h的中性粒细胞数、白细胞数、单核细胞数呈正相关(P<0.05);STEMI患者术前、术后24h、术后72h的MIF水平与术前、术后24 h、术后72h的淋巴细胞数无相关性(P>0.05);术前MIF高水平(≥53.05 ng/mL)患者发生主要不良心脑血管事件(MACCE)风险显著高于术前MIF低水平(<53.05 ng/mL)患者,有统计学差异(P<0.05)。结论STEMI患者早期血浆MIF水平显著升高,与心功能指标及单核细胞数相关,且就诊时MIF高水平为STEMI患者远期预后不良的独立预测因素。

Objective To investigate the correlation between plasma macrophage migration inhibitory factor(MIF)levels and long-term prognosis in patients with ST-segment elevation myocardial infarction(STEMI)through the multivariate correlation analysis.Methods 168 cases of STEMI patients,54 cases of stable angina pectoris(SAP)and 72 cases of health examinees in our hospital from March 2013 to March 2015 were selected.The plasma levels of MIF were detected among all the selected subjects,and its correlation with clinical indexes and long-term prognosis was analyzed.Results The preoperative plasma MIF level in the STEMI group was significantly higher than that in the SAP group and the healthy group(P<0.05).Plasma MIF levels in the STEMI group at the postoperative 71 h were significantly different from those before surgery and 24 hours after surgery(P<0.05).Preoperative MIF levels was positively correlated with high-sensitivity troponin T(hs-TnT)peaks,creatine kinase isoenzyme MB(CK-MB),high-sensitivity C-reactive protein(hs-CRP)and N-terminal pro-B-type natriuretic peptide(NT-proBNP),and was negatively correlated with left ventricular ejection fraction(LVEF),with statistic difference(P<0.05).The preoperative MIF levels in patients with STEMI were positively correlated with the number of white blood cells,monocytes and preoperative neutrophils before operation and 24 h and 72 h after operation(P<0.05).The levels of MIF at 24 h and 72 h after operation were correlated with the number of monocytes before and 24 h and 72 h after surgery(P<0.05).Patients with high preoperative MIF(≥53.5 ng/mL)had significantly higher risk of major adverse cardiovascular events(MACCE)than those with low preoperative MIF(<53.05 ng/mL),with statistical differences(P<0.05).Conclusion The elevated level of MIF among STEMI patients is correlated with cardiac function and monocyte counts,which can be used as independent predictor of poor long-term prognosis in STEMI patients.