血浆CXCL12、CXCR4水平与急性心肌梗死患者严重程度及预后的相关性研究

Correlation between plasma CXCL12 and CXCR4 levels and the severity and prognosis of patients with acute myocardial infarction

目的 分析血浆CXC趋化因子配体12(CXCL12)、CXC趋化因子受体4(CXCR4)水平与急性心肌梗死(AMI)患者严重程度及预后的相关性。方法 选择2019年10月至2020年12月湖州市中心医院收治的AMI患者100例作为观察组,其中预后良好亚组68例,预后不良亚组32例;另择同期本院100名健康体检者作为对照组,检测血浆CXCL12、CXCR4、血脂指标、N末端脑钠肽前体(NT-proBNP)、超敏肌钙蛋白T(hs-cTnT)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)。采用Pearson相关分析血浆CXCL12、CXCR4水平与AMI患者冠脉病变程度、冠脉斑块性质、梗死类型的相关性。采用ROC曲线分析CXCL12、CXCR水平对AMI患者不良预后的预测效能。结果 观察组血浆CXCL12、CXCR4水平高于对照组,差异均有统计学意义(均P<0.05)。冠脉病变程度为重度的患者血浆CXCL12、CXCR4水平高于轻度、中度患者,中度患者高于轻度患者,易损斑块患者血浆CXCL12、CXCR4水平高于非易损斑块患者,差异均有统计学意义(均P<0.05)。预后不良亚组年龄、NT-proBNP、hs-cTnT、hs-CRP、TNF-α、CXCL12、CXCR4水平高于预后良好亚组,差异均有统计学意义(均P<0.05)。Pearson相关分析显示,CXCL12、CXCR4水平与冠脉病变程度均呈正相关(r=0.876、0.859,均P<0.05)。多因素logistic回归分析显示,年龄、NT-proBNP、hs-cTnT、hs-CRP、TNF-α、CXCL12、CXCR4均为AMI患者预后的影响因素(均P<0.05)。ROC曲线分析显示,入院1周CXCL12、CXCR4的AUC高于入院时,入院时和入院1周CXCL12、CXCR4联合预测的AUC均高于单独预测。结论 AMI患者血浆CXCL12、CXCR4水平升高,与病情严重程度及预后密切相关。

Objective To explore the correlation between plasma CXC chemokine ligand 12(CXCL12) and CXC chemokine receptor 4(CXCR4) levels and the severity and prognosis of patients with acute myocardial infarction(AMI).Methods A total of 100 AMI patients with in Huzhou Central Hospital from October 2019 to December 2020 were assigned to an observation group. Of them, 68 cases had good outcome and 32 cases had poor outcome. One hundred healthy subjects at the same time were assigned to a control group. CXCL12, CXCR4, lipid, N-terminal pro-brain natriuretic peptide(NT-proBNP), high sensitivity cardiac troponin T(hs-cTnT), high-sensitivity C-reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α) were measured. Pearson correlation was used to analyze the relation of CXCL12 and CXCR4 with the degree of coronary artery disease, plaque properties and myocardial infarction types. ROC was used to evaluate prediction ability of CXCL12 and CXCR4 for prognosis. Results CXCL12 and CXCR4 were significantly higher in the observation group than in the control group(all P<0.05). CXCL12 and CXCR4were significantly higher in patient with severe coronary lesions than in patients with mild and moderate lesions, and in patients with moderate lesions than in patients with mild lesions(all P<0.05). CXCL12 and CXCR4 were significantly higher in patients with vulnerable plaques than in patients with non-vulnerable plaques(all P<0.05). There was no significant difference of CXCL12 and CXCR4 between ASTEMI and NSTEMI patients. Age, NT-proBNP, hs-cTnT,hs-CRP, TNF, CXCL12 and CXCR4 were significantly higher in patients with poor outcome than in patients with good outcome(all P<0.05). Spearman correlation analysis showed CXCL12 and CXCR4 were positively correlated to the severity of coronary lesions(all P<0.05). ROC curve analysis showed the areas under the curve(AUC) of CXCL12 and CXCR4 were significantly higher 1 week later after admission than at admission for predicting poor prognosis. AUC of CXCL12 combined with CXCR4 was higher than AUC of CXCL12 or CXCR4 alone. Conclusion Plasma CXCL12 and CXCR4 increases in AMI patients and are closely related to the severity and prognosis of the disease.