急性心肌梗死后血清FGF23、MMP-14、FIB、D-D表达对左心室重构的影响

The Effect of Serum FGF23,MMP-14,FIB,and D-D Expression on Left Ventricular Remodeling after Acute Myocardial Infarction

目的观察急性心肌梗死(Acute Myocardial Infarction,AMI)患者梗死后左心室重构(Left Ventricle Re-modeling,LVR)发生情况,分析基质金属蛋白酶-14(Matrix Metalloproteinase-14,MMP-14)、成纤维细胞生长因子23(Fibroblast Growth Factor 23,FGF23)、纤维蛋白原(Fibrinogen,FIB)、D-二聚体(D-dimer,D-D)的表达与LVR的关系。方法非随机选取2018年3月—2019年11月乌鲁木齐市第一人民医院接受经皮冠状动脉介入(Percutaneous Coronary Intervention,PCI)治疗且复流的59例AMI患者为研究对象,依据术后是否发生LVR,将其分为发生组(n=16)与未发生组(n=43),调查两组一般资料,比较两组PCI术前血清FGF23、MMP-14、FIB、D-D水平,采用Logistic回归模型分析术前血清上述指标水平对AMI患者PCI术后LVR的影响,并绘制受试者工作特征(Receiver Operating Characteristic,ROC)曲线、决策曲线,判断其预测价值。结果59例AMI患者中,PCI术后发生LVR16例,发生率为27.1%。发生组PCI治疗前血清FGF23、MMP-14、FIB及D-D水平均高于未发生组,差异有统计学意义(P均<0.05),两组其他资料比较,差异无统计学意义(P均>0.05)。Lo-gistic回归分析显示,PCI术前血清FGF23、MMP-14、FIB及D-D过表达是AMI患者PCI后LVR的独立危险因素(OR=22.750、1.239、2.998、2.447,95%CI=1.214~426.469、1.013~1.515、1.118~8.034、1.036~5.779,P均<0.05);ROC曲线显示,PCI术前上述指标单独及联合预测AMI患者PCI术后发生LVR的曲线下面积(Area Under Curve,AUC)均>0.70,预测价值较理想,且以联合预测效果最佳。绘制决策曲线,在阈值0.15~1.00范围内,联合预测的预测模型净受益率优于FIB、D-D、FGF23、MMP-14单独预测。结论AMI患者PCI术前血清FGF23、MMP-14、FIB及D-D过表达可能提示梗死后LVR高风险,可考虑在AMI患者PCI术前检测血清FGF23、MMP-14、FIB及D-D水平,以评估LVR风险并指导干预。

Objective To observe the occurrence of left ventricular remodeling(LVR)in patients with acute myocar-dial infarction(AMI),and analyze the relationship between the expression of matrix metalloproteinase-14(MMP-14),fibroblast growth factor 23(FGF23),fibrinogen(FIB),D-dimer(D-D)and LVR.Methods A total of 59 AMI patients who underwent percutaneous coronary intervention(PCI)treatment and had reflow at the First People's Hospital of Urumqi from March 2018 to November 2019 were non-randomly selected as the study objects.Based on whether LVR occurred after surgery,they were divided into an occurrence group(n=16)and a non occurrence group(n=43).General information was investigated between the two groups,and the serum levels of FGF23,MMP-14,FIB,and D-D were compared between the two groups before PCI.Logistic regression models were used to analyze the impact of preopera-tive serum levels of the above indicators on the postoperative LVR of AMI patients.Receiver operating characteristic(ROC)curve and decision curve were plotted to judge the predictive value.Results Among 59 AMI patients,there were 16 patients had LVR after PCI,with an incidence rate of 27.1%.The average levels of serum FGF23,MMP-14,FIB,and D-D levels before PCI treatment in the occurrence group were higher than those in the non occurrence group,and the differences were statistically significant(all P<0.05).There was no statistically significant difference in other data between the two groups(all P>0.05).Logistic regression analysis showed that overexpression of serum FGF23,MMP-14,FIB,and D-D before PCI was an independent risk factor for LVR in AMI patients after PCI(OR=22.750,1.239,2.998,2.447;95%CI=1.214~426.469,1.013~1.515,1.118~8.034,1.036~5.779;all P<0.05);The ROC curve shows that the area under curve(AUC)for predicting LVR in AMI patients before PCI,both individually and in combination,is greater than 0.70,indicating ideal predictive value,and the combined predictive effect is the best.Ac-cording to the decision curve,within the threshold range of 0.15~1.00,the net benefit rate of the joint prediction model is better than that of FIB,D-D,FGF23,and MMP-14 predicted separately.Conclusion Overexpression of se-rum FGF23,MMP-14,FIB,and D-D in AMI patients before PCI may indicate a high risk of post infarction LVR.It may be considered to test serum FGF23,MMP-14,FIB,and D-D levels in AMI patients before PCI to assess LVR risk and guide intervention.