急性ST段抬高型心肌梗死患者经皮冠脉介入术后血清分泌型卷曲相关蛋白5水平与早期心功能恢复的关系

Relationship between Serum Secreted Frizzled Related Protein 5 Level and Early Cardiac Function Recovery after Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction Patients

目的探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠脉介入术(PCI)后血清分泌型卷曲相关蛋白5(SFRP5)对早期心功能的影响。方法选择2017年6月至2018年5月收治的首次出现STEMI且PCI治疗成功的患者104例作为STEMI组,另选取同期出现胸痛症状并疑似冠状动脉粥样硬化性心脏病,但没有明显的冠状动脉狭窄的患者50例作为对照组。比较两组患者心功能指标及血清SFRP5水平。采用单因素及多因素logistic回归分析STEMI患者左心室射血分数(LVEF)改善的影响因素。结果STEMI组患者血清SFRP5基线水平高于对照组(P<0.05)。STEMI组患者入院时、入院后24 h、72 h血清SFRP5水平逐渐降低(P<0.05),但均高于对照组(P<0.05)。根据STEMI组患者基线血清SFRP5水平中位值(26.8 ng/ml),将其分为低水平亚组(<26.8 ng/ml,n=51)和高水平亚组(≥26.8 ng/ml,n=53)。两个亚组STEMI患者入院时LVEF、左心室舒张末期容积(LVEDV)差异均无统计学意义(P>0.05),但是PCI术后3个月,高水平亚组STEMI患者LVEF高于低水平亚组,且差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,STEMI患者入院时、入院后24 h血清SFRP5水平与PCI术后3个月LVEF呈正相关(r=0.353、0.263,P<0.05),但与PCI术后3个月LVEDV、峰值超敏心肌肌钙蛋白I及峰值超敏C反应蛋白无相关性(P>0.05)。经单因素和多因素logistic回归分析,入院时血清SFRP5水平是影响STEMI患者LVEF改善情况的独立相关因素(P<0.05)。结论高SFRP5水平对于促进STEMI患者PCI术后的心功能恢复有重要价值,是STEMI患者LVEF改善的独立预测因子。

Objective To investigate the effect of serum secreted frizzled related protein 5(SFRP5)on early cardiac function after percutaneous coronary intervention(PCI)in acute ST-segment elevation myocardial infarction(STEMI).Methods From June 2017 to May 2018,patients admitted to the emergency department of our hospital with STEMI for the first time and successfully treated with PCI were recruited as STEMI group(n=104),and patients with chest pain and suspected coronary heart disease but no significant coronary artery stenosis were selected as the control group(n=50).Univariate and multivariate logistic regression were used to analyze the factors influencing left ventricular ejection fraction(LVEF)improvement in STEMI patients.Results The serum SFRP5 level at baseline in STEMI group was higher than that in control group(P<0.05),and the serum SFRP5 level decreased with time(P<0.05),and the serum SFRP5 level at each time point in STEMI group was significantly higher than that in control group(P<0.05).STEMI patients were divided into low subgroup(<26.8 ng/ml,n=51)and high subgroup(≥26.8 ng/ml,n=53)according to the median baseline serum SFRP5 level(26.8 ng/ml).There were no statistically significant differences in LVEF and left ventricle end-diastolic volume(LVEDV)values between the two subgroups at T0(P>0.05),but after 3 months,LVEF values in the high subgroup were higher than those in the low subgroup(P<0.05).Spearman rank correlation coefficient analysis showed that serum SFRP5 level at T0 and T1 of STEMI patients were positively correlated with LVEF 3 months later(r=0.353,0.263,P<0.05).However,there was no significant correlation with LVEDV,peak value of high-sensitivity cardiac troponin I(hs-cTnI)and peak value of hypersensitive C-reactive protein(hs-CRP).Multivariate logistic regression analysis showed that serum SFRP5 level at T0 was an independent clinical factor of LVEF improvement in STEMI patients(P<0.05).Conclusion High SFRP5 level are of important value in promoting cardiac function recovery after PCI and is an independent predictor of LVEF improvement in STEMI patients.