血清Omentin-1、HCY水平对急性心肌梗死患者心室重构及预后的预测价值

Value of serum Omentin-1 and Hcy levels in evaluation of ventricular remodeling and prognosis in patients with acute myocardial infarction

目的探讨血清网膜素(Omentin)-1、同型半胱氨酸(Hcy)水平对急性心肌梗死患者心室重构及预后的预测价值。方法收集90例急性心肌梗死患者(病例组),根据患者经皮冠状动脉介入(PCI)术后6个月内是否有不良心血管事件分为预后良好者(n=67)和预后不良者(n=23),并于同期随机选取50例体检健康者为对照组,采用酶联免疫吸附法检测血清Omentin-1、HCY,超声心动图测定心室重构参数包括左心房内径(LAD)、左心室舒张末内径(LVEDD)、室间隔厚度(IVST)、左心室后壁舒张末期厚度(PWD)、左心室后壁收缩末期厚度(PWS)、左心室射血分数(LVEF),并计算左心室心肌质量指数(LVMI)。采用Pearson积矩相关分析急性心肌梗死患者血清Omentin-1、Hcy水平与心室重构参数的相关性,绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)评估血清Omentin-1、Hcy水平对急性心肌梗死患者不良预后的预测价值。结果病例组血清Omentin-1水平低于对照组,血清Hcy水平高于对照组(P均<0.05)。病例组心室重构参数LAD、LVEDD、IVST、PWD、PWS、LVMI水平均高于对照组,LVEF水平低于对照组(P均<0.05)。Pearson积矩相关分析结果显示,急性心肌梗死患者血清Omentin-1水平与心室重构参数LAD、LVEDD、IVST、PWD、PWS、LVMI呈负相关(r分别为-0.638、-0.571、-0.593、-0.568、-0.612、-0.614,P均<0.05),与LVEF呈正相关(r=0.649,P<0.05);血清Hcy水平与LAD、LVEDD、IVST、PWD、PWS、LVMI呈正相关(r分别为0.672、0.611、0.604、0.640、0.639、0.592,P均<0.05),与LVEF呈负相关(r=-0.651,P<0.05)。预后良好者血清Omentin-1水平高于预后不良者,Hcy水平低于预后不良者(P均<0.05)。ROC曲线分析结果显示,Omentin-1预测不良心血管事件的AUC为0.800,灵敏度、特异度分别为78.26%、82.09%,准确性为81.11%;Hcy预测不良心血管事件的AUC为0.777,灵敏度、特异度分别为69.57%、76.12%,准确性为74.44%;Omentin-1联合Hcy预测不良心血管事件的AUC为0.881,灵敏度、特异度分别为86.96%、92.54%,准确性为91.11%。结论急性心肌梗死患者血清Omentin-1水平下降,Hcy水平升高,两指标与心室重构严重程度密切相关;早期联合检测血清Omentin-1、HCY可辅助临床预测患者预后。

Objective To investigate the value of serum Omentin-1 and homocysteine(Hcy)levels in the evaluation of ventricular remodeling and prognosis in patients with acute myocardial infarction.Methods Ninety patients with acute myocardial infarction(case group)were collected and divided into the good prognosis(n=67)and poor prognosis(n=23)groups according to whether there were adverse cardiovascular events within 6 months after percutaneous coronary intervention(PCI).Meanwhile,50 healthy physical examination subjects were randomly selected as the control group during the same period.The serum Omentin-1 and Hcy levels were measured by enzyme-linked immunosorbent assay.The parameters of ventricular remodeling including left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),inter-ventricular septum thickness(IVST),posterior wall diastolic(PWD),posterior wall systolic(PWS),and left ventricular ejection fraction(LVEF)were measured by echocardiography,and left ventricular myocardium index(LVMI)was calculated.Pearson product moment correlation analysis was used to analyze the correlation between serum Omentin-1,Hcy and ventricular remodeling parameters in patients with acute myocardial infarction.Receiver operating characteristic(ROC)curve was drawn,and area under curve(AUC)was calculated to evaluate the predictive value of serum Omentin-1 and Hcy for poor prognosis in patients with acute myocardial infarction.Results The level of serum Omentin-1 in the case group was lower than that in control group,and serum Hcy level was higher than that in control group(both P<0.05).The LAD,LVEDD,IVST,PWD,PWS and LVMI in the case group were higher than those in the control group,and the level of LVEF was lower than that in the control group(all P<0.05).Pearson product moment correlation analysis showed that serum Omentin-1 was negatively correlated with LAD,LVEDD,IVST,PWD,PWS,and LVMI(r=-0.638,-0.571,-0.593,-0.568,-0.612,-0.614),and positively correlated with LVEF(r=0.649,P<0.05);the serum Hcy was positively correlated with LAD,LVEDD,IVST,PWD,PWS,and LVMI(r=0.672,0.611,0.604,0.640,0.639,0.592,all P<0.05),and was negatively correlated with LVEF(r=-0.651,P<0.05).The serum Omentin-1 level in the good prognosis group was higher than that in the poor prognosis group,and Hcy level was lower than that in the poor prognosis group(both P<0.05).ROC curve showed that the AUC of Omentin-1 in predicting adverse cardiovascular events was 0.800,the sensitivity and specificity were 78.26%and 82.09%,the accuracy was 81.11%.The AUC of Hcy in predicting adverse cardiovascular events was 0.777,the sensitivity and specificity were 69.57%and 76.12%,and the accuracy was 74.44%;the AUC of Omentin-1 combined with Hcy was 0.881,the sensitivity and specificity were 86.96%and 92.54%,and the accuracy was 91.11%.Conclusion The expression of serum Omentin-1 decreases and Hcy increases in patients with acute myocardial infarction,both of the two indexes are closely related to the severity of ventricular remodeling,and the early combined detection of Omentin-1 and Hcy can help to evaluate the poor prognosis of patients.