非ST段抬高性急性冠脉综合征患者血浆可溶性生长刺激表达基因2蛋白与GRACE评分相关性的临床研究

Research on relationship between plasma soluble ST2 and global registry of acute coronary events score in patients with non-ST-segment elevation acute coronary syndrome

目的:探讨非ST段抬高性急性冠脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)患者血浆可溶性生长刺激表达基因2蛋白(soluble ST2,sST2)水平与GRACE评分的关系,为ACS患者早期的风险评估及随后的临床治疗提供帮助。方法:入选符合标准的NSTE-ACS患者121例,分为非ST段抬高性心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)组和不稳定性心绞痛(unstable angina pectoris,UA)组,入院后进行GRACE评分并分组,同时第2天清晨空腹采集肘静脉血,应用ELISA法测定血浆sST2水平,与60例稳定型冠心病患者进行对照比较。结果:与对照组相比,低危、中危、高危组的s ST2呈上升趋势,高危组sST2明显升高,差异有统计学意义(P<0.05);即sST2水平随GRACE危险程度增加而明显升高,差异有统计学意义(P<0.05);相关性分析显示NSTE-ACS患者s ST2与GRACE评分呈正相关(r=0.444,P<0.01);sST2和中性粒细胞与淋巴细胞的比值(neutrophil to lymphocyte ratio,NLR)呈正相关(r=0.442,P<0.01)。sST2诊断急性冠脉综合征的ROC曲线下面积为0.788,最佳临界点为44.5 ng/mL,灵敏度为66.3%,特异度为86.4%。结论:在NSTE-ACS患者中血浆可溶性ST2水平明显升高,与冠心病危险程度密切相关,联合运用对早期危险分层、评估预后及诊疗方案的选择有重要临床价值。

Objective:To evaluate the relationship between soluble ST2(sST2)and global registry of acute coronary events(GRACE)score in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS),so as to provide early risk assessment in the early stage and subsequent clinical treatment for patients with acute coronary syndrome(ACS).Methods:A total of 121 patients with NSTE-ACS who made a definite diagnosis were selected and were divided into the non-ST-segment elevation myocardial infarction(NSTEMI)group and the unstable angina pectoris(UA)group.After admission,patients’GRACE score was obtained and patients were grouped.Ulnar vein blood was collected on an empty stomach at the second day.The plasma expression level of soluble ST2 was detected with ELISA method.And 60 patients with stable coronary heart disease were taken as the control group.Results:Compared with the control group,the level of sST2 in the low-risk,medium-risk and high-risk groups showed an upward trend and the level of sST2 in the high-risk group showed a significant increase,with statistically significant differences(P<0.05);the sST2 level was increased with the increasing degree of GRACE risk,with statistically significant difference(P<0.05).Results of correlation analysis showed that sST2 had a positive correlation with GRACE scores(r=0.444,P<0.01);the level of s ST2 was positively associated with neutrophil-to-lymphocyte ratio(NLR)(r=0.442,P=0.000,P<0.01).The area under ROC curve of ST2 diagnosing ACS was 0.788,with the optimal critical point of 44.5 ng/mL,sensitivity of 66.3%and specificity of 86.4%.Conclusion:The level of plasma sST2 in patients with NSTE-ACS is significantly increased and is closely related.Combination of sST2 and GRACE score has vital clinical value on early risk classification,prognosis evaluation and selecting treatment.