急性心肌梗死4天时血清可溶性生长刺激表达基因2蛋白水平与6个月内心原性死亡关系的研究

Relationship Between Serum sST2 Level Within 4 Days After Symptom Onset and Six-month Cardiac Death in Patients With Acute Myocardial Infarction

目的:探讨急性心肌梗死患者症状出现第4天时血清可溶性生长刺激表达基因2蛋白(sST2)水平与6个月内心原性死亡的关系。方法:入选2017年6月至2018年5月入住我院冠心病重症监护室(CCU)的424例急性心肌梗死患者,用酶联免疫吸附法测定患者从症状开始出现至第4天时(如缺乏,以之后第一次数据代替)血清sST2的表达水平,并收集患者住院期间和出院后随访6个月的临床资料,对心原性死亡患者(心原性死亡组,n=45)和生存患者(生存组,n=379)进行比较分析。结果:(1)心原性死亡组症状出现第4天时血清sST2水平明显高于生存组[242.71(84.38～340.25)ng/ml vs 42.97(29.67～81.96)ng/ml,P<0.001];(2)二元Logistic回归分析显示,症状出现第4天时血清sST2水平与6个月内心原性死亡独立相关(P<0.001),在纳入N末端B型利钠肽原(NT-proBNP)后,对心原性死亡仍有独立预测价值(P<0.001);即使在校正相关危险因素后,这种预测价值仍然存在(P<0.001)。结论:急性心肌梗死患者症状发生4天时血清sST2水平可以预测心肌梗死患者短期不良预后。

Objectives:To investigate the relationship between serum sST2 level measured within 4 days after symptom onset and6-month cardiac death in patients with acute myocardial infarction(AMI).Methods:A total of 424 patients with AMI in our CCU ward from June 2017 to May 2018 were enrolled.Serum sST2 was tested by enzyme-linked immunosorbent assay within 4 days(sST2-day4)after admission.Patients received 6 months clinical follow-up after discharge.The primary endpoint was cardiac death at 6 months after discharge.The AMI patients were divided into cardiac death group(n=45)and survival group(n=379).Results:(1)Serum sST2-day4 level was significantly higher in the cardiac death group than those in the survival group(242.71[84.38-340.25]ng/ml vs 42.97[29.67-81.96]ng/ml,P<0.001);(2)Binary logistic regression analysis showed that sST2-day4 was independently associated with cardiac death at 6 months(P<0.001)in AMI patients,even with the addition of NT-proBNP.sST2-day4 level remained as the independent predictor for 6-month cardiac death after adjustment for conventional cardiovascular risk factors in this patient cohort(P<0.001).Conclusions:Serum sST2 level could be used as an independent predictor for 6-month cardiac death in patients with AMI.