急性ST段抬高型心肌梗死患者血清sTWEAK、MMP-9水平变化及临床意义

Changes and clinical significance of serum sTWEAK and MMP-9 levels in patients with acute ST-segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(STEMI)患者血清可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)及基质金属蛋白酶-9(MMP-9)的含量变化,及对患者预后的评估价值。方法选取2018年1—12月河北省沧州市人民医院收治的100例STEMI患者作为STEMI组,100例稳定性心绞痛患者作为稳定组、100例不稳定心绞痛患者作为不稳定组及100例无冠状动脉硬化性心脏病患者作为普通组。比较各组sTWEAK和MMP-9水平;根据随访6个月后是否发生主要不良心血管事件(MACE)将STEMI患者分为非MACE组(61例)与MACE组(39例),比较非MACE组与MACE组sTWEAK和MMP-9水平;分析STEMI患者发生MACE的相关因素;采用受试者工作曲线分析sTWEAK、MMP-9对STEMI患者预后的诊断价值。结果STEMI组血清sTWEAK和MMP-9水平高于其他组(P<0.05)。MACE组血清sTWEAK、MMP-9水平高于非MACE组(P<0.05)。logistic相关因素分析发现,sTWEAK[OR=2.159,95%CI(1.134,4.109),P=0.019]、MMP-9[OR=1.102,95%CI(1.018,1.193),P=0.017]是STEMI患者发生MACE的独立预测因素。sTWEAK预测STEMI患者发生MACE的曲线下面积(AUC)为0.985,95%CI(0.963,1.000),截断值为78.57 pg/mL,灵敏度、特异性为89.70%、100.00%。MMP-9对预测STEMI患者发生MACE的AUC为0.773,95%CI(0.684,0.863),截断值为644.13μg/L,灵敏度、特异性为100.00%、16.00%。结论STEMI患者血清sTWEAK、MMP-9均有较高水平的表达,且高水平的sTWEAK、MMP-9是预测其预后发生MACE的独立危险因素。

Objective To investigate the changes of soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)and matrix metalloproteinase-9(MMP-9)in serum in patients with acute ST-segment elevation myocardial infarction(STEMI),and to evaluate their prognostic value.Methods From January to December 2018,100 STEMI patients admitted to Cangzhou People’s Hospital,Hebei Province were selected as STEMI group,100 stable angina patients as stable group,100 unstable angina patients as unstable group and 100 patients without coronary atherosclerotic heart disease as the common group.The general data and the levels of sTWEAK and MMP-9 in each group were compared.STEMI patients were divided into a non-MACE group(61 cases)and MACE group(39 cases)according to whether major adverse cardiovascular events(MACE)occurred after 6 months of follow-up.sTWEAK and MMP-9 levels were compared between the non-MACE group and the MACE group.The related factors of MACE in STEMI patients were analyzed.The diagnostic value of sTWEAK and MMP-9 on prognosis of STEMI patients was analyzed by receiver operating characteristic.Results The STEMI group had higher serum sTWEAK and MMP-9 levels than the other groups(P<0.05).The serum levels of sTWEAK and MMP-9 in MACE group were higher than those in non-MACE group(P<0.05).Logistic analysis showed that sTWEAK(OR=2.159,95%CI[1.134,4.109],P=0.019)and MMP-9(OR=1.102,95%CI[1.018,1.193],P=0.017)were independent predictors of MACE in STEMI patients.The area under the curve(AUC)of predicting MACE in STEMI patients by sTWEAK was 0.985,95%CI(0.963,1.000),the cutoff value was 78.57 pg/mL,the sensitivity and specificity were 89.70%and 100.00%,respectively.The AUC of predicting MACE in STEMI patients by MMP-9 was 0.773,95%CI(0.684,0.863),the cutoff value was 644.13μg/L,the sensitivity and specificity were 100.00%and 16.00%,respectively.Conclusion The serum levels of sTWEAK and MMP-9 are high in patients with STEMI,and the high levels of sTWEAK and MMP-9 are independent risk factors for prognosis of MACE.