急性心肌梗死患者血清DHEA-S和VK2水平表达与心室重构的相关性研究

Study of the Correlation between the Expression of Serum DHEA-S and VK2 Levels and Ventricular Remodeling in Patients with Acute Myocardial Infarction

目的探究急性心肌梗死(acute myocardial infarction,AMI)患者血清硫酸脱氢表雄酮(dehydroepiandrosterone-sulfate,DHEA-S)和维生素K2(VK2)的表达及与心室重构的相关性。方法收集2021年5月~2023年5月武汉市第一医院首次确诊为AMI的患者103例为AMI组,收集患者病发后7天心室重构相关指标,包括B型脑利钠肽(BNP)、左心房内径(LAD)、左心室质量指数(LVMI)等,同时期体检健康者103例为对照组。以LVMI值为标准,将AMI组患者分为心室重构组(n=31)和非心室重构组(n=72)。酶联免疫吸附法(ELISA)测定血清DHEA-S和VK2表达。Pearson法分析血清DHEA-S,VK2间及DHEA-S,VK2与心室重构指标间相关性。Logistic回归分析AMI发生心室重构的影响因素。受试者特征工作(ROC)曲线分析血清DHEA-S和VK2预测AMI后心室重构发生的价值。结果AMI组患者血清DHEA-S(2.79±0.31μmol/L),VK2(2.08±0.19μg/L)明显低于对照组(3.85±0.42μmol/L,2.73±0.28μg/L),差异具有统计学意义(t=20.608,19.495,均P<0.05);心室重构组血清DHEA-S(2.25±0.26μmol/L),VK2(1.72±0.15μg/L)的表达水平明显低于非心室重构组(3.02±0.38μmol/L,2.23±0.31μg/L),差异具有统计学意义(t=10.280,8.713,均P<0.05)。血清DHEA-S与VK2之间存在正相关性(r=0.459,P<0.001)。心室重构指标中,非心室重构组BNP,LAD,LVPWT,LVEDV和LVMI明显低于心室重构组(t=10.641,2.591,8.022,5.996,6.819),LVEF显著升高(t=5.699),差异具有统计学意义(均P<0.05)。血清DHEA-S和VK2可负向影响心室重构指标BNP,LAD,LVPWT,LVEDV和LVMI的表达(r=-0.611~-0.427,均P<0.05),而与LVEF呈正相关(r=0.413,0.514,均P<0.05)。AMI患者发生不良心室重构的独立影响因素为BNP,LVEDV,DHEA-S和VK2(均P<0.05)。DHEA-S和VK2联合预测AMI后心室重构发生的效能显著高于各自单独预测(Z=2.635,2.074,P=0.008,0.038)。结论血清DHEA-S和VK2在AMI后心室重构患者中下调,两者均与心室重构的发生相关,且具有成为预测心室重构发生生物标志物的潜力。

Objective To investigate the expression of serum dehydroepiandrosterone sulfate(DHEA-S)and vitamin K2(VK2)in patients with acute myocardial infarction(AMI)and their correlation with ventricular remodeling.Methods A total of 103 patients who were diagnosed with AMI at Wuhan No.1 Hospital for thefirst time from May 2021 to May 2023 were collected as the AMI group.Relevant indicators of cardiac ventricular remodeling,such as B-type brain natriuretic peptide(BNP),left atrial diameter(LAD),and left ventricular mass index(LVMI),were collected 7 days after the onset of the disease.Meantime,103 healthy individuals who underwent physical examination were selected as the control group.Based on LVMI values,AMI patients were grouped into ventricular remodeling group(n=31)and non ventricular remodeling group(n=72).Enzyme-linked immunosorbent assay(ELISA)was applied to determine the expression of DHEA-S and VK2 in serum.Pearson method was applied to analyze the correlation between serum DHEA-S and VK2,and DHEA-S,VK2,and ventricular remodeling indicators.Logistic regression was applied to analyze the influencing factors of ventricular remodeling in AMI.Receiver operating characteristic(ROC)curve was applied to analyze the value of serum DHEA-S and VK2 in predicting ventricular remodeling after AMI.Results The serum DHEA-S(2.79±0.31μmol/L)and VK2 levels(2.08±0.19μg/L)in the AMI group were lower than those in the control group(3.85±0.42μmol/L,2.73±0.28μg/L),and the differences was statistically significant(t=20.608,19.495,all P>0.05).While the expression levels of serum DHEA-S(2.25±0.26μmol/L)and VK2(1.72±0.15μg/L)in the ventricular remodeling group were lower than those in the non ventricular remodeling group(3.02±0.38μmol/L,2.23±0.31μg/L),and the differences were statistically significant(t=10.280,8.713,all P<0.05).There was a positive correlation between serum DHEA-S and VK2(r=0.459,P<0.001).Among the indicators of ventricular remodeling,the BNP,LAD,LVPWT,LVEDV and LVMI in the non ventricular remodeling group were lower than those in the ventricular remodeling group(t=10.641,2.591,8.022,5.996,6.819),while LVEF was increased(t=5.699),with significant difference(all P<0.05).Serum DHEA-S and VK2 could negatively affect the expression of ventricular remodeling indicators,including BNP,LAD,LVPWT,LVEDV and LVMI(r=-0.611~-0.427,all P<0.05),while they were positively correlated with LVEF(r=0.413,0.514,all P<0.05).The independent influencing factors for adverse ventricular remodeling in AMI patients were BNP,LVEDV,DHEA-S and VK2(all P<0.05).The efficacy of combined prediction of DHEA-S and VK2 for ventricular remodeling after AMI were higher than their respective predictions(Z=2.635,2.074,P=0.008,0.038).Conclusion Serum DHEA-S and VK2 are down-regulated in patients with ventricular remodeling after AMI,and they are associated with the occurrence of ventricular remodeling.Both have the potential to become biomarkers for predicting ventricular remodeling.