血清SFRP5、CTRP3水平对急性心肌梗死患者术后无复流现象的预测价值

Predictive value of secreted frizzled-related protein-5 and C1q/TNF-related protein-3 to postoperative no-reflow in patients with acute myocardial infarction

目的探讨血清分泌型卷曲相关蛋白5(SFRP5)、C1q/TNF相关蛋白3(CTRP3)水平对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后无复流现象的预测价值。方法收集2022年1月至2023年6月期间于新乡医学院第一附属医院接受PCI的AMI患者151例作为AMI组,并收集同期我院150例健康体检者作为对照组。其中AMI患者根据术后有无复流现象分为无复流组(n=31)和复流组(n=120)两组。采用ELISA法检测AMI患者与对照组血清SFRP5、CTRP3水平;采用Pearson法分析血清SFRP5、CTRP3水平与常见心肌梗死标志物的相关性;对比PCI术后的无复流组与复流组患者血清SFRP5、CTRP3水平。Logistic多因素回归分析AMI患者PCI术后无复流现象发生的影响因素。受试者工作特征(ROC)曲线评估血清SFRP5、CTRP3指标对AMI患者PCI术后无复流现象的预测价值。结果与对照组相比,AMI患者肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)水平均显著升高(P<0.05),而SFRP5、CTRP3水平显著降低(P<0.05)。Pearson相关分析提示AMI患者血清SFRP5、CTRP3水平与心肌梗死标志物cTnI、CK-MB、Mb水平均呈负相关系(P<0.05)。AMI患者PCI术后发生无复流31例(20.52%),与复流组相比,无复流组患者受Mb、cTnI、CK-MB等因素的影响(P<0.05),与患者的年龄、性别、既往史、吸烟史、血压、心率、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等因素无关(P>0.05)。Logistic多因素回归分析结果显示cTnI、Mb、CK-MB等水平升高是AMI患者PCI术后无复流现象的独立危险因素(P<0.05),SFRP5、CTRP3水平升高是AMI患者PCI术后无复流现象的独立保护因素(P<0.05)。血清SFRP5、CTRP3水平单独及联合预测AMI患者PCI术后无复流现象的曲线下面积(AUC)分别为0.881、0.876、0.950,两者联合预测价值高于单独预测(Z二者联合-SFRP5=3.082,P=0.021;Z二者联合-CTRP3=2.901,P=0.037)。结论AMI患者血清SFRP5、CTRP3水平升高,两者联合对PCI术后无复流现象的发生具有较好的预测价值。

Objective To investigate the predictive value of serum secreted frizzled-related protein-5(SFRP5)and C1q/TNF-related protein-3(CTRP3)to postoperative no-reflow in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods AMI patients(n=151)received PCI were chosen into AMI group,and healthy controls(n=150)were chosen into control group from the First Affiliated Hospital of Xinxiang Medical University from Jan 2022 to June 2023.AMI patients were further divided into no-reflow group(n=31)and reflow group(n=120).The levels of SFRP5 and CTRP3 were detected by using ELISA in AMI group and control group.The correlation among SFRP5,CTRP3 and common biomarkers of myocardial infarction(MI)by using Pearson method.The levels of SFRP5 and CTRP3 were compared between no-reflow group and reflow group.The influence factors of were analyzed by using multi-factor Logistic regression analysis in AMI patients after PCI.The predictive value of SFRP5 and CTRP3 to no-reflow was reviewed by using ROC curve.Results Compared with control group,the levels of cardiac troponin I(cTnI),creatine kinase-MB isoenzyme(CK-MB)and myoglobin(Mb)increased significantly(P<0.05),and levels of SFRP5 and CTRP3 decreased significantly(P<0.05)in AMI group.The results of Pearson correlation analysis showed that levels of SFRP5 and CTRP3 were negatively correlated to levels of cTnI,CK-MB and Mb(P<0.05)in AMI group.There were 31 cases(20.52%)of no-reflow in AMI group.Compared with reflow group,no-reflow group was affected by factors of cTnI,CK-MB and Mb(P<0.05),and was not correlated to age,gender,medical history,smoking history,blood pressure(BP),heart rate(HR),triglyceride(TG),total cholesterol(TC),high-density lipoprotein-cholesterol(HDL-C)and low-density lipoprotein-cholesterol(LDL-C,P>0.05).The results of multi-factor Logistic regression analysis showed that increased levels of cTnI,CK-MB and Mb were independent risk factor of no-reflow(P<0.05),and increased levels of SFRP5 and CTRP3 were independent protective factors of no-reflow(P<0.05).In detection of no-reflow,AUC of SFRP5 was 0.881,AUC of CTRP3 was 0.876 and AUC of SFRP5 combined with CTRP3 was 0.950.The predictive value of SFRP5 combined with CTRP3 was higher than that of single SFRP5 or single CTRP3(Zcombination-SFRP5=3.082,P=0.021;Zcombination-CTRP3=2.901,P=0.037).Conclusion The levels of serum SFRP5 and CTRP3 increase in AMI patients,and the combination of both has a higher predictive value to no-reflow after PCI.