血清硫脑苷脂与心肌梗死患者经皮冠状动脉介入术后不良心血管事件的关系

Relationship between serum sulfatide and major adverse cardiovascular events after PCI in patients with myocardial infarction

目的探讨入院时血清硫脑苷脂(sulfatide)与ST段抬高型心肌梗死(STEMI)患者急诊PCI术后主要不良心血管事件(MACE)风险的关系。方法选取2018年1月至2020年4月在我院接受PCI的STEMI患者317例为STEMI组,同期因胸痛行冠状动脉造影的患者80例为对照组,根据血清sulfatide中位值,将STEMI患者分为低sulfatide组158例和高sulfatide组159例。ELISA检测冠状动脉造影前血清sulfatide水平。PCI术后随访STEMI患者MACE发生情况,至少随访24个月。结果入院时STEMI组血清sulfatide水平显著高于对照组(P<0.01)。高sulfatide组LDL-C、肌钙蛋白I(cTnI)、N末端B型钠尿肽前体(NT-proBNP)、高敏C反应蛋白、TNF-α、白细胞介素6、Gensini评分、左心室收缩末期内径、左心室收缩末期容积高于低sulfatide组(P<0.05,P<0.01)。MACE患者血清sulfatide水平高于非MACE患者(P<0.01)。cTnI、NT-proBNP、sulfatide是STEMI患者急诊PCI术后MACE发生风险的独立危险因素(P<0.05,P<0.01);3项联合诊断MACE的曲线下面积为0.913(95%CI:0.881~0.944)。结论血清sulfatide水平可作为STEMI患者急诊PCI术后MACE预测的分子生物学指标。

Objective To investigate the relationship between serum sulfatide at admission and risk of MACE after emergency PCI in patients with STEMI.Methods A total of 317 STEMI patients who underwent PCI in our Emergency and Critical Care Center from January 2018 to April 2020 were enrolled as STEMI group,and 80 patients undergoing coronary angiography due to chest pain served as the control group.Serum sulfatide level was determined by ELISA before angiography.And according to the median serum sulfatide value,the STEMI patients were divided into low sulfatide group(158 cases)and high sulfatide group(159 cases).The incidence of MACE was observed in the STEMI patients in at least 24 months of follow-up.Results Serum sulfatide level was significantly higher in the STEMI group than the control group(P<0.01).The patients with high sulfatide had obviously elevated levels of laboratory indicators,Gensini score,LVESD and LVESV than those with low sulfatide(P<0.05,P<0.01).The serum sulfatide level was also higher in the MACE patients than the non-MACE patients(P<0.01).cTnI,N-terminal B-type brain natriuretic peptide and sulftide were independent influencing factors for the risk of MACE after emergency PCI in STEMI patients(P<0.05,P<0.01).The AUC value of three joint diagnosis of MACE was 0.913(95%CI:0.881-0.944).Conclusion The serum sulfatide level can be used as a molecular biological indicator to predict MACE in STEMI patients after emergency PCI.