血清YKL-40、CCL18和hs-cTnT预测急性心肌梗死患者心血管不良事件的临床价值

Clinical value of serum YKL-40,CCL18 and hs-cTnT in predicting adverse cardiovascular events in patients with acute myocardial infarction

目的观察血清甲壳质酶蛋白(YKL)-40、趋化因子配体18(CCL18)和高敏心肌肌钙蛋白(hs-cTnT)在预测急性心肌梗死患者心血管不良事件中的临床价值。方法选择2016年1月至2018年6月在我院诊治的急性心肌梗死患者118例。采用酶联免疫吸附试验检测血清YKL-40、CCL18和hs-cTnT。观察急性心肌梗死患者血清YKL-40、CCL18和hs-cTnT水平与冠状动脉狭窄程度和发生主要不良事件的关系。结果急性心肌梗死患者血清YKL-40、CCL18和hs-cTnT水平随着Gensini评分升高而升高,事件组血清YKL-40、CCL18和hs-cTnT水平明显高于非事件组(P<0.01)。急性心肌梗死患者血清YKL-40、CCL18和hs-cTnT水平是发生主要不良事件的独立危险因素,在预测主要不良事件方面具有较高的灵敏度和特异度,联合检测对预测急性心肌梗死不良事件具有更高的诊断效能,其灵敏度为89.2%,特异度为86.4%,其曲线下面积(ACU)明显高于YKL-40(Z=3.397,P<0.01)、CCL18(Z=2.796,P<0.01)和hs-cTnT(Z=2.613,P<0.01)。结论血清YKL-40、CCL18和hs-cTnT是反映急性心肌梗死严重程度的指标,对急性心肌梗死不良事件的发生具有预测作用。

Objective To observe the clinical value of serum chitinase protein(YKL)-40,CC-chemokine ligand 18(CCL18)and high-sensitivity cardiac troponin(hs-cTnT)in predicting adverse cardiovascular events in patients with acute myocardial infarction(AMI).Methods Totally 118 patients with AMI from January 2016 to June 2018 were selected in our hospital.The serum YKL-40,CCL18 and hs-cTnT were detected by enzyme-linked immunosorbent assay.The relationship among the serum YKL-40,CCL18 and hs-cTnT levels in patients with AMI,the degree of coronary artery stenosis and adverse events were also observed.Results The serum YKL-40,CCL18 and hs-cTnT levels in AMI patients rose with the increase of Gensini score.And the serum YKL-40,CCL18 and hs-cTnT levels in event group were significantly higher than those in non-event group(P<0.01).The levels of serum YKL-40,CCL18 and hs-cTnT in patients with AMI were independent risk factors for major adverse events,and had higher sensitivity and specificity in predicting major adverse events.The combined detection in predicting major adverse events in patients with AMI had a higher diagnostic efficacy,with a sensitivity of 89.2%and a specificity of 86.4%,and the area under the curve(ACU)was significantly higher than that measured by the detection of YKL-40(Z=3.397,P<0.01),CCL18(Z=2.796,P<0.01),and hs-cTnT(Z=2.613,P<0.01),respectively.Conclusion The serum YKL-40,CCL18 and hs-cTnT are indicators reflecting the severity of AMI,and have predictive effects on the occurrence of adverse events in AMI.