生长分化因子15联合沉默信息调节因子1在老年急性心肌梗死患者介入治疗的预后预测价值分析

Predictive value of growth differentiation factor-15 combined with silent information regulator 1 for prognosis in elderly patients with acute myocardial infarction after interventional therapy

目的:探讨生长分化因子15(growth differentiation factor-15,GDF15)联合沉默信息调节因子1(silent information regulator 1,SIRT1)在老年急性心肌梗死(acute myocardial infarctio,AMI)患者PCI治疗后预后预测中的价值。方法:选取本院2019年1月至2021年8月收治的209例AMI行PCI老年患者纳入AMI组,另选同期健康体检人群90例纳入对照组,检测AMI患者术前、术后7d以及对照组血清GDF15、SIRT1表达水平,观察AMI术后3个月内AMI组主要不良心血管事件(major adverse cardiovascular events,MACE)发生情况,对比MACE发生与未发生患者血清GDF15、SIRT1表达差异,通过受试者工作曲线(ROC)评估其对患者MACE发生的预测价值。结果:AMI患者术前与术后血清GDF-15水平明显高于对照组,SIRT1水平明显低于对照组(P <0.05);血清GDF-15、SIRT1水平联合检测诊断AMI的发生ROC曲线下面积(AUC)显著高于两项指标单独评估的AUC(P <0.05);209例患者术后3个月内发生MACE者44例(21.1%),发生MACE患者术前及术后血清GDF-15水平高于未发生者,SIRT1水平低于未发生者(P <0.05);术前血清GDF-15、SIRT1水平联合检测评估老年PCI治疗AMI患者MACE的发生ROC曲线下面积为0.816,显著高于两项指标单独评估曲线下面积0.726、0.725(P <0.05);术后血清GDF-15、SIRT1水平联合检测评估老年PCI治疗AMI患者MACE的发生ROC曲线下面积为0.894,显著高于两项指标单独评估曲线下面积0.815、0.811(P <0.05);术后7d血清GDF-15、SIRT1水平检测评估老年PCI治疗AMI患者MACE的发生ROC曲线下AUC高于术前(P <0.05)。结论:AMI患者血清GDF-15呈高表达,SIRT1呈低表达,且其表达水平可在一定程度上预测患者PCI术后MACE的发生,反映患者预后状态。

Objective:To explore the predictive value of growth differentiation factor-15(GDF15)combined with silent information regulator 1(SIRT1)for prognosis in elderly patients with acute myocardial infarction(AMI)after interventional therapy.Methods:A total of 209 patients with AMI undergoing PCI in the hospital were enrolled as AMI group between January 2019 and August 2021,while 30 healthy controls during the same period were enrolled as control group.The expression levels of serum GDF15 and SIRT1 in AMI patients and control group were detected before and at 7d after surgery.The occurrence of major adverse cardiovascular events(MACE)within 3 months was observed.The differences in expressions of serum GDF15 and SIRT1 between patients with or without MACE were compared.And their predictive value for MACE was evaluated by receiver operating characteristic(ROC)curves.Results:Before and after surgery,level of serum GDF-15 in AMI patients was significantly higher than that in control group,and SIRT1 level was significantly lower than that in control group(P<0.05).The area under the ROC curve(AUC)of GDF15 combined with SIRT1 in the diagnosis of AMI was significantly greater than that of single index(P<0.05).In the 209 patients,there were 44 cases(21.1%)with MACE within 3 months after surgery.Before and after surgery,level of serum GDF-15 in patients with MACE was higher than that without MACE,and SIRT1 level was lower than that without MACE(P<0.05).AUC of GDF15 combined with SIRT1 before surgery for predicting MACE was 0.816,significantly greater than that of single index(0.726,0.725,P<0.05).AUC of GDF15 combined with SIRT1 after surgery for predicting MACE was 0.894,significantly greater than that of single index(0.815,0.811,P<0.05).AUC of combined detection at 7d after surgery was greater than that before surgery(P<0.05).Conclusions:The expression of serum GDF-15 is up-regulated,and SIRT1 is down-regulated in AMI patients.And their expression levels can predict MACE after PCI to certain extent and reflect prognosis of patients.