转化生长因子-β1与ST段抬高心肌梗死患者梗死范围冠状动脉内血栓负荷的相关性分析

Correlation analysis between transforming growth factorβ1 and coronary thrombus load in patients with acute myocardial infarction

目的探讨转化生长因子-β1(transforming growth factor-β1,TGF-β1)与ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者梗死范围冠状动脉内血栓负荷的关系。方法选取2019年1月至2020年8月于安徽医科大学第一附属医院行急诊经皮冠状动脉介入治疗的147例STEMI患者纳入研究组,依据心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血栓分级将其分为低血栓负荷组(0~3级,80例)和高血栓负荷组(4~5级,67例),另选取同期该院100例有胸痛症状,但经影像学检查证实完全正常者纳入对照组。收集所有受试者一般资料和实验室数据,采用二元Logistic回归分析评估影响STEMI患者冠状动脉内高血栓负荷的危险因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价心肌肌钙蛋白I(cardiac troponin I,cTnI)、C反应蛋白(C-reactive protein,CRP)、TGF-β1对STEMI患者冠状动脉内高血栓负荷的预测效能。结果研究组患者吸烟、合并高血压占比以及血红蛋白、肌酐、甘油三酯、低密度脂蛋白胆固醇、TGF-β1水平均显著高于对照组(均P<0.05),高密度脂蛋白胆固醇水平显著低于对照组(P<0.05);高血栓负荷组患者CRP、cTnI、TGF-β1水平均显著高于低血栓负荷组(均P<0.05);二元Logistic回归分析结果显示TGF-β1水平升高是STEMI患者发生冠状动脉内高血栓负荷的独立危险因素(P<0.05);ROC曲线显示,血清TGF-β1预测STEMI患者冠状动脉内高血栓负荷的曲线下面积为0.708(95%CI:1.254~7.642,P=0.003),灵敏度为80.34%,特异度为64.29%,界值为16.62 ng/ml。结论血清TGF-β1水平与STEMI患者冠状动脉内高血栓负荷关系密切,其能够协助临床进行风险预警,评估病情严重程度,进一步降低围手术期发生慢血流、无复流风险。

Objective To analyze the correlation between transforming growth factor-β1(TGF-β1)and coronary thrombotic load in patients with ST segment elevation myocardial infarction(STEMI).Method A total of 147 STEMI patients who underwent emergency percutaneous coronary intervention in the First Affiliated Hospital of Anhui Medical University from January 2019 to August 2020 were enrolled in study group.According to the thrombolysis in myocardial infarction(TIMI)thrombus classification,they were divided into low thrombus load group(TIMI thrombus classification 0~3,n=80)and high thrombus load group(TIMI thrombus classification 4~5,n=67),another 100 patients with chest pain symptoms but completely normal coronary angiography during the same period in that hospital were selected as control group.Record the general information and laboratory data of all subjects,binary Logistic regression was used to analyze the risk factors of high coronary thrombotic load in STEMI patients,and the receiver operating characteristic curve(ROC curve)was drawn to evaluate cardiac troponin I(cTnI)and C-reactive protein(CRP)and TGF-β1 in predicting coronary thrombosis load in STEMI patients.Result The proportion of smoking,hypertension and the levels of hemoglobin,creatinine,triglyceride,low density lipoprotein cholesterol and TGF-β1 in study group were significantly higher than those in control group(all P<0.05),while the level of high density lipoprotein cholesterol was significantly lower than that in control group(P<0.05).The levels of CRP,cTnI and TGF-β1 in high thrombotic load group were significantly higher than those in low thrombotic load group(all P<0.05).Binary Logistic regression provided that TGF-β1 was an independent risk factor for the occurrence of high thrombotic load in the STEMI patients(P<0.05).ROC curve showed that the area under the curve of serum TGF-β1 for predicting high thrombosis load in coronary artery of STEMI patients was 0.708(95%CI:1.254~7.642,P=0.003),the sensitivity was 80.34%,the specificity was 64.29%,and the cut-off was 16.62 ng/ml.Conclusion TGF-β1 has a certain relationship with coronary vascular high thrombotic load in STEMI patients.It can assist risk warning,assess the severity of the disease,and further reduce the risk of perioperative slow blood flow without relapse.