血清前白蛋白与急性心肌梗死患者细胞炎症因子及心功能的关系

The relationship between serum prealbumin and cytokines and cardi-ac function in patients with acute myocardial infarction

目的研究血清前白蛋白(PA)与急性心肌梗死(AMI)患者细胞炎症因子及心功能的关系。方法纳入2017年4月-2019年4月常州市第四人民医院78例AMI患者作为研究对象,检测患者血清PA.超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)及肿瘤坏死因子α(TNF-α)水平,记录患者左心室射血分数(IVEF)、左室舒张末期内径(LVEDd)及左心室舒张末期容积(LVEDV)心功能指标。随访记录出院后半年内心力衰竭发生情况,并根据不.同预后分为观察组(发生心力衰竭,14例)和对照组(未发生心力衰竭,64例)。比较两组患者细胞炎性因子和心功能指标水平。分析PA与炎性因子、心功能指标的相关性,分析PA对预测心力衰竭的应用价值。结果观察组血清PA水平显著低于对照组(P<0.05),观察组患者LVEF显著低于对照组,LVEDd和LVEDV显著高于对照组(P<0.05)。观察组患者血清hs-CRP、IL-6及TNF-α水平显著高于对照组(P<0.05)。Spearman相关性分析显示AMI患者血清PA与血清hs-CRP、IL-6及TNF-a呈显著负相关性(r=-0.197.-0.291、-0.187;P<0.05)。血清PA与LVEF呈显著正相关性(r=0.626,P<0.05),与LVEDd、LVEDV呈显著负相关性(r=-0.521,-0.257,P<0.05)。受试者工作曲线(ROC)分析结果显示血清PA判断AMI发生心力衰竭的AUC为0.745(S.E.=0.075,95%CL=0.597-0.893,p=0.004)。结论AMI患者血清PA与炎性细胞因子和心功能水平相关,监测PA有助于预测近期心力衰竭的发生。

Objective To study the relationship between serum prealbumin(PA)and cytokines and cardiac function in patients with acute myocardial infarction(AMI).Methods 78 patients wih AMI were included as the research objects,the serum levels of PA,hypersensitive C-reactive protein(hs-CRP),Interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were measured.The level of cardiac function indexes such as left ventricular ejection fraction(LVEF),1eft ven-tricular end diastolic diameter(LVEDd)and left ventricular end diastolic volume(LVEDV)were recorded.The inci-dence of heart failure in half year after discharge was recorded,the patients were divided into observation group(14 cas-es with heart failure)and control group(64 cases without heart failure),which accorded to different prognosis.The levels of cytokines and cardiac function indexes were compared between the two groups.The correlation between PA and in-flammatory factors,cardiac function indexes were analyzed,and the application value of PA in predicting heart failure were analyzed.Results The serum PA level in the observation group was significantly lower than that in the control group(P<0.05),the LVEF in the observation group was significantly lower than that in the control group,and the LVEDd and LVEDV were significantly higher than those in the control group(P<0.05).The levels of serum hs-CRP,IL-6 and TNF-αin the observation group were significantly higher than those in the control group(P<0.05).The Spear-man correlation analysis showed that there were significant negative corelation between PA and hs CRP,IL-6 and TNF-αin patients with AMI(r=-0.197,-0.291,-0.187;P<0.05).There were significant positive correlation between PA and LVEF(r=0.626,P<0.05),and there were significant negative correlation between PA and LVEDd,LVEDV(r=-0.521,-0.257;P<0.05).The re-ceiver operator characteristic(ROC)'analysis showed that the area under the curve(AUC)of PA in AMI to judge the heart failure was 0.745(S.E.=0.075,95%CL=0.597-0.893,P=0.004).Conclusion The PA is related to inflammatory cytokines and cardiac function in patients with AMI.It is helpful to predict the occurrence of heart failure in the near future by monitoring PA.