血清COX-2、Gal-3与二尖瓣关闭不全患者MVR术后不良事件发生的相关性

Correlation between serum cyclooxygenase-2,galactose-lectin-3 and adverse events after mitral valve replacement in patients with mitral valve insufficiency

目的探讨血清环氧化酶-2(COX-2)、半乳糖凝集素-3(Gal-3)与二尖瓣关闭不全(MI)患者二尖瓣置换术(MVR)后不良事件发生的相关性。方法前瞻性选取2021年1月至2023年5月于郑州市第七人民医院拟接受MVR治疗的198例MI患者作为研究对象,所有患者均于术前通过酶联免疫吸附试验检测血清COX-2、Gal-3水平。所有患者术后随访1年,根据随访期间是否发生不良事件将其分为发生组163例和未发生组35例。比较两组患者的一般资料及血清COX-2、Gal-3水平,通过限制性立方样条模型(RCS)、交互作用及受试者工作特征(ROC)曲线分析血清COX-2、Gal-3与MI患者MVR术后不良事件发生的关系。结果发生组患者的年龄为(56.41±4.18)岁,明显高于未发生组的(54.53±4.25)岁,NYHA分级Ⅲ级占比为57.14%,明显高于未发生组的33.74%,差异均有统计学意义(P<0.05)。发生组患者的血清COX-2、Gal-3水平分别为(18.42±5.13)pg/mL、(13.03±3.43)ng/mL,明显高于未发生组的(15.27±4.18)pg/mL、(10.65±3.03)ng/mL,差异均有统计学意义(P<0.05)。经RCS分析结果显示,血清COX-2、Gal-3与MI患者MVR术后不良事件发生的关联均呈非线性曲线型剂量反应关系(P<0.05),当血清COX-2、Gal-3分别>15.53 pg/mL、>10.85 ng/mL时,MI患者MVR术后不良事件发生风险随血清COX-2、Gal-3升高而增加。调整混杂因素后,血清COX-2、Gal-3对MI患者MVR术后不良事件发生存在正向交互作用,两者均高表达时不良事件发生风险是均低表达时的25.78倍,两者同时高表达致不良事件发生风险是其他位置因子(如-/-、+/-、-/+)的7.58倍,协同效应为两者单独存在产生效应之和的1.44倍,在两者共存的发生风险中,有29.42%是由两者交互作用所致。绘制ROC曲线,提示血清COX-2、Gal-3单独及两者联合预测MI患者MVR术后不良事件发生的曲线下面积(AUC)分别为0.667、0.722、0.784,联合预测价值最高。结论血清COX-2、Gal-3与MI患者MVR术后不良事件发生存在密切关系,当血清COX-2>15.53 pg/mL、Gal-3>10.85 ng/mL,MI患者MVR后不良事件发生风险增加,且两者存在正向交互作用,临床可通过血清COX-2联合Gal-3预测MI患者MVR后不良事件发生风险。

Objective To explore the correlation between serum cyclooxygenase-2(COX-2),gallectin-3(Gal-3)and adverse events after mitral valve replacement(MVR)in patients with mitral valve insufficiency(MI).Methods A total of 198 MI patients who underwent MVR treatment from January 2021 to May 2023 in the 7th People's Hospital of Zhengzhou were prospectively selected as the study objects.All patients had serum COX-2 and Gal-3 levels detected by enzyme-linked immunosorbent assay before surgery,and they were followed up for 1 year.According to whether adverse events occurred during the follow-up,they were divided into occurrence group(163 cases)and non-occurrence group(35 cases).The general data and serum COX-2,Gal-3 levels of the two groups were compared,and the relationship between serum COX-2,Gal-3 and the occurrence of adverse events after MVR in MI patients was analyzed by restricted cubic spline(RCS)model,interaction,and receiver operating characteristic(ROC)curve.Results The age of patients in the occurrence group was(56.41±4.18)years,which was significantly higher than(54.53±4.25)years in the non-occurrence group(P<0.05),and the proportion of NYHA gradeⅢin the occurrence group was 57.14%,significantly higher than 33.74%in the non-occurrence group(P<0.05).The serum COX-2 and Gal-3 levels in the occurrence group were(18.42±5.13)pg/mL and(13.03±3.43)ng/mL,respectively,which were significantly higher than(15.27±4.18)pg/mL and(10.65±3.03)ng/mL in the non-occurrence group(P<0.05).The RCS analysis results showed that there was a non-linear dose-response relationship between serum COX-2,Gal-3 and the occurrence of adverse events after MVR in MI patients(P<0.05).When serum COX-2 and Gal-3 were greater than 15.53 pg/mL and 10.85 ng/mL,respectively,the risk of adverse events after MVR in MI patients increased with the increase of serum COX-2 and Gal-3.After adjusting for confounding factors,there was a positive interaction between serum COX-2 and Gal-3 on the occurrence of adverse events after MVR in MI patients.The risk of adverse events when both were highly expressed was 25.78 times that when both were lowly expressed.The risk of adverse events caused by high expression was 7.58 times that of other positional factors(such as-/-,+/-,-/+).The synergistic effect was 1.44 times that of the sum of the effects of the two alone.In the risk of coexistence of the two,29.42%was caused by the interaction between the two groups.ROC curve showed that the area under the curve(AUC)values of serum COX-2,Gal-3 alone and their combination in pre-dicting the occurrence of adverse events after MVR in MI patients were 0.667,0.722,and 0.784,respectively,and the predictive value of the combination was the highest.Conclusion Serum COX-2 and Gal-3 are closely related to the occurrence of adverse events after MVR in MI patients.At serum COX-2>15.53 pg/mL and Gal-3>10.85 ng/mL,the risk of adverse events after MVR in MI patients increases,and there is a positive interaction between the two.Clinically,the risk of adverse events after MVR in MI patients can be predicted by serum COX-2 combined with Gal-3.