老年急性心肌梗死病人血清sST2、NT-proBNP、胰岛素抵抗水平与疾病严重程度及心功能的关系探讨

Relationship between Serum sST2,NT-proBNP,Insulin Resistance Levels and Disease Severity,Cardiac Function in Elderly Patients with Acute Myocardial Infarction

目的探讨老年急性心肌梗死(AMI)病人血清可溶性生长刺激表达因子2(sST2)、N-末端脑钠肽前体(NT-proBNP)、胰岛素抵抗水平与疾病严重程度及心功能的关系。方法选取珠海市中西医结合医院2018年1月—2019年4月收治的AMI病人128例作为AMI组,根据Killip心功能分级分为Ⅰ级组(52例)、Ⅱ级组(35例)、Ⅲ级组(25例)、Ⅳ级组(16例);收集同期、同年龄段、知情同意并自愿配合相关检查的健康体检人群50名作为对照组。受试人群均检测空腹血胰岛素(FINS)、血脂、肿瘤坏死因子-α(TNF-α)及超敏C反应蛋白(hs-CRP)、sST2、NT-proBNP、左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV),采用自我平衡模型分析法计算胰岛素抵抗指数(IRI),分析AMI病人血清sST2、NT-proBNP水平与疾病严重程度的相关性。结果与对照组比较,AMI组各心功能分级亚组病人总胆固醇(TC)、三酰甘油(TG)、低高密度脂蛋白胆固醇(LDL-C)明显升高(P<0.05),高密度脂蛋白胆固醇(HDL-C)明显降低(P<0.05);AMI组病人随着心功能分级上升血清TC、TG、LDL-C水平呈递增趋势(P<0.05),HDL-C水平呈递减趋势(P<0.05)。与对照组比较,AMI组各心功能分级亚组病人hs-CRP、TNF-α、白介素-6(IL-6)、sST2、NT-proBNP、FINS、IRI、LVESV、LVEDV明显升高(P<0.05),LVEF明显降低(P<0.05);AMI组病人随着心功能分级上升血清IL-6、hs-CRP、TNF-α、sST2、NT-proBNP、FINS、IRI、LVESV、LVEDV值呈递增趋势(P<0.05),LVEF值呈递减趋势(P<0.05)。Pearson相关性分析显示sST2、NT-proBNP、IRI、LVESV、LVEDV与Killip心功能分级呈正相关(P<0.05),LVEF与Killip心功能分级呈负相关(P<0.05);相关性分析显示血清sST2、NT-proBNP、IRI水平与LVEF呈负相关(P<0.05),与LVESV、LVEDV呈正相关(P<0.05)。结论老年急性心肌梗死病人Killip心功能分级越高,血清sST2、NT-proBNP、IRI水平越高,且血清sST2、NT-proBNP、IRI水平与左心室功能存在一定相关性。

Objective To study the relationship between serum sST2,NT-proBNP,insulin resistance levels and severity of disease,cardiac function in elderly patients with acute myocardial infarction(AMI).Methods A total of 128 AMI patients who were admitted to Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to April 2019 were enrolled as AMI group.According to Killip cardiac function grading,the patients were divided intoⅠlevel group(52 cases),Ⅱlevel group(35 cases),Ⅲlevel group(25 cases),andⅣlevel group(16 cases).Fifty health people were enrolled as control group.Fasting blood insulin(FIns),blood lipid,tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP),serum soluble growth stimulating express gene 2(sST2),NT-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)were detected.The insulin resistance index(IRI)was calculated by self-balancing model analysis method.The correlation between serum sST2,NT-proBNP levels and disease severity in AMI patients was analyzed.Results The levels of serum total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)were higher in AMI group than those in control group(P<0.05),while the level of high-density lipoprotein cholesterol(HDL-C)were lower than that in control group(P<0.05).In AMI group,the levels of TC,TG,and LDL-C showed incremental trend(P<0.05),while the level of HDL-C showed decline trend with increasing of cardiac function grading(P<0.05).Compared with control group,the hs-CRP,TNF-α,IL-6,sST2,NT-proBNP,FINS,IRI,LVESV,and LVEDV were increased,while LVEF was decreased in cardiac function subgroups.In AMI group,the levels of IL-6,hs-CRP,TNF-α,sST2,NT-proBNP,FINS,IRI,LVESV,and LVEDV showed incremental trend(P<0.05),while LVEF showed degressive trend(P<0.05).Person correlation analysis showed that sST2,NT-proBNP,IRI,LVESV,and LVEDV were significantly positively correlated with Killip cardiac function grading(P<0.05),while LVEF was significantly negatively correlated with Killip cardiac function grading(P<0.05).The analysis showed serum sST2,NT-proBNP,and IRI levels were negatively correlated with LVEF(P<0.05),while positively correlated with LVESV and LVEDV(P<0.05).Conclusion The higher the Killip cardiac function grading in elderly AMI patients,the higher the serum sST2,NT-proBNP,and IRI levels.There is certain correlation between serum sST2,NT-proBNP,IRI levels and left ventricular function.