血清可溶性生长刺激表达因子2水平与急性ST段抬高型心肌梗死患者冠状动脉病变程度及短期预后的相关性分析

Correlation analysis between serum soluble ST2 levels,and the degree of coronary disease and short-term prognosis in patients with acute ST-segment elevation myocardial infarction

目的探讨血清可溶性生长刺激表达因子2(sST2)与急性ST段抬高型心肌梗死(STEMI)患者冠状动脉病变程度及短期预后的相关性。方法选取2018年12月至2019年10月于中国医科大学附属第一医院心血管内科行急诊经皮冠状动脉介入治疗(PCI)的STEMI患者137例,根据PCI术前SNYTAX评分分为低分组(n=76)和中高分组(n=61)。比较2组临床资料的差异,采用多因素logistic回归模型分析中高分组的独立危险因素,绘制受试者操作特征(ROC)曲线以评估血清sST2对出院后3个月内发生主要心血管不良事件(MACE)的预测效能。结果SYNTAX评分中高分组血清sST2高于低分组(P<0.05)。血清sST2是中高分组的独立危险因素(P<0.05)。STEMI患者PCI术后发生MACE的独立影响因素是血清sST2、肌酸激酶同工酶-MB(CK-MB)、N末端B型脑钠肽前体(NT-proBNP)、室壁瘤形成(均P<0.05)。预测MACE事件的ROC曲线显示,血清sST2联合CK-MB后曲线下面积最大(P<0.05)。结论血清sST2水平越高,冠状动脉病变越严重,STEMI患者出院后3个月内发生MACE的风险越高。联合检测CK-MB对MACE的预测价值更高。

Objective To investigate the relationship between serum soluble growth stimulating express gene 2(sST2)levels,and the degree of coronary lesions and short-term prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI),by measuring the serum sST2 levels.Methods A total of 137 patients with STEMI who underwent emergency PCI from December 2018 to October 2019 in the Department of Cardiovascular Medicine of the First Hospital of China Medical University were selected and divided into low(n=76),and medium and high SYNTAX groups(n=61),according to their SYNTAX scores before PCI.The differences in clinical data between the two groups were compared,and multivariate logistic regression models were used to analyze the independent risk factors of the medium and high groups.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive power of serum sST2 for major adverse cardiovascular event(MACE)within 3 months after discharge.Results In the medium and high SYNTAX groups,serum sST2 levels were higher than in the low SYNTAX group(P<0.05).The multivariate logistic regression analysis results show that serum sST2 is an independent risk factor for medium and high SYNTAX coronary artery disease(P<0.05).It also showed that serum sST2,CK-MB,NT-proBNP,and ventricular aneurysm formation were the independent prediction factors for MACEs in STEMI after PCI treatment.The ROC curves which predict MACE showed that the area under the curve of serum sST2 combined with CK-MB was the largest(P<0.05).Conclusion High levels of serum sST2 indicate severe coronary artery disease.The higher the serum sST2 levels,the more likely the patients with STEMI were to develop MACEs within 3 months after discharge.This observation can be combined with CK-MB to improve its predictive value for MACE.