组织蛋白酶D在急性ST段抬高型心肌梗死后心血管事件中的作用

Role of cathepsin D in cardiovascular events following acute ST-segment elevation myocardial infarction

目的探讨全血组织蛋白酶D(CTSD)表达量在急性ST段抬高型心肌梗死(STEMI)患者心肌损伤及经皮冠状动脉介入术(PCI)后6个月心血管事件中的作用。方法选取2022年11月至2023年7月沈阳医学院附属第二医院心血管内科收治的96例STEMI患者作为STEMI组,另选20例同期住院的冠状动脉造影正常患者作为对照组。2组均抽取冠状动脉血,采用实时定量PCR检测动脉血CTSD的相对表达水平,并进行比较。再根据CTSD表达量三分位数将STEMI组分为低、中、高CTSD组,随访PCI治疗后6个月内主要不良心血管事件(MACE)。结果STEMI组动脉全血CTSD表达量[1.31(1.03~1.75)]高于对照组[1.02(0.67~1.48)],差异有统计学意义(P<0.05)。低、中、高CTSD组患者血小板计数、肌钙蛋白T、N末端B型利尿钠肽、高密度脂蛋白胆固醇比较,差异有统计学意义(P<0.05)。低、中、高CTSD组间MACE发生率呈递减趋势,低CTSD组MACE发生率(65%)高于高CTSD组(10%,P<0.05)。受试者操作特征(ROC)曲线分析CTSD预测STEMI患者PCI治疗后6个月内MACE的截断值为1.214,灵敏度为75.0%,特异度为70.8%,ROC曲线下面积为0.765(95%CI:0.658~0.872,P<0.001)。结论STEMI患者全血CTSD表达异常。CTSD可能成为判断STEMI预后的指标及防治STEMI的药物靶点。

Objective To determine the role of cathepsin D(CTSD)in cardiovascular events after acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 96 patients with STEMI admitted to the Department of Cardiovascular Medicine of Second Hospital Affiliated to Shenyang Medical College from November 2022 to July 2023 were selected as the STEMI group.In addition,20 patients with normal coronary angiography hospitalized during the same period were selected as the control group.Coronary blood was collected from both groups,and the relative expression levels of CTSD in the arterial blood were detected and compared using realtime quantitative polymerase chain reaction.The STEMI group was divided into low,medium,and high CTSD groups based on CTSD expression,and major adverse cardiovascular events(MACE)that occurred within 6 months following percutaneous coronary intervention(PCI)were monitored.Results Arterial blood CTSD expression(1.31[1.03-1.75])in the STEMI group was higher than that in the control group(1.02[0.67-1.48])(P<0.05).Statistically significant differences in platelet count as well as troponin T,N-terminal pro-B natriuretic peptide,and high-density lipoprotein cholesterol levels were observed among the three groups(P<0.05).The incidence of MACE was significantly higher in the low CTSD group(65%)than in the high CTSD group(10%,P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve for predicting MACE within 6 months after PCI in patients with STEMI was 0.765(95%CI:0.658-0.872,P<0.001).Conclusion Whole blood CTSD expression level is abnormal in STEMI patient.CTSD may be an indicator for predicting the prognosis of STEMI and,therefore,a drug target for preventing and treating STEMI.