急性心肌梗死患者血清学指标水平与PCI术后预后的关系

Relationship between Serological Index Level and Prognosis of Patients with AMI after PCI

摘要

目的 探讨急性心肌梗死（AMI）患者血清半乳糖凝集素-3（Gal-3）、高迁移率组蛋白1（HMGB1）水平及与经皮冠状动脉介入治疗（PCI）术后预后的关系。方法 本研究共纳入115例AMI患者作为研究对象,所有患者均接受PCI治疗,治疗结束后均进行为期半年的随访,分别将发生和未发生不良心血管事件的患者分别设为MACE组(35例)和参照组(80例)。对患者手术前后血清Gal-3、HMGB1指标及cTnⅠ、CRP等指标进行检测并对比,将MACE组、参照组患者cTnⅠ、CRP、血清Gal-3及HMGB1指标水平进行对比,采用受试者工作特征（ROC）曲线对上述指标预测AMI患者预后不良的价值进行分析。结果 术后患者血清Gal-3、HMGB1指标水平相较于术前升高（P<0.05）;MACE组患者心功能指标、炎症因子等均相较于参照组升高,而左室射血分数（LVEF）指标水平则相较于参照组下降（均P<0.05）;MACE组患者血清Gal-3、HMGB1指标水平相较于参照组升高（P<0.05）;血清Gal-3、HMGB1指标预测AMI患者预后不良的AUC值分别为0.723、0.708,灵敏度分别为61.40%、54.55%,而联合预测的AUC值为0.791,灵敏度为82.43%,均相较于各项指标单项检测升高。结论 AMI患者血清Gal-3、HMGB1指标水平均呈异常升高趋势,将上述指标联合检测应用于AMI患者发生MACE的预测中临床价值较高。

Abstract

Objective To investigate the relationship between serum galactin-3 (Gal-3) and high mobility histone 1 (HMGB1) levels and prognosis after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods A total of 115 patients with AMI were included in this study. All patients received PCI and were followed up for half a year after treatment. Patients with and without adverse cardiovascular events were divided into MACE group (35 cases) and reference group (80 cases), respectively. Serum Gal-3, HMGB1 and cTnⅠ, CRP and other indexes were detected and compared before and after operation, and the levels of cTnⅠ, CRP, serum Gal-3 and HMGB1 were compared between the MACE group and the reference group. Receiver operating characteristic (ROC) curve was used to analyze the value of the above indexes in predicting the poor prognosis of patients with acute myocardial infarction. Results The levels of serum Gal-3 and HMGB1 after operation were higher than those before operation (P<0.05). Compared with the reference group, the indexes of cardiac function and inflammatory factors in MACE group were increased, while the indexes of left ventricular ejection fraction (LVEF) were decreased in MACE group (all P<0.05). Serum Gal-3 and HMGB1 levels in MACE group were higher than those in reference group (P<0.05). The AUC values of serum Gal-3 and HMGB1 indexes for predicting poor prognosis in patients with acute myocardial infarction were 0.723 and 0.708, respectively, and the sensitivity were 61.40% and 54.55%, respectively, while the AUC values of combined prediction were 0.791 and the sensitivity was 82.43%, both of which were higher than the single detection of each indicator. Conclusion The levels of serum Gal-3 and HMGB1 indexes in patients with acute myocardial infarction showed an abnormal increase trend, and the combined detection of these indexes is of high clinical value in predicting the occurrence of MACE in patients with acute myocardial infarction.

关键词

急性心肌梗死 / 半乳糖凝集素-3 / 高迁移率组蛋白1 / 经皮冠状动脉介入治疗 / 预后

Key words

Acute myocardial infarction / Galectin-3 / High mobility histone 1 / Percutaneous coronary intervention / Prognosis

[1] 李文武,欧阳艳红. 瑞舒伐他汀强化治疗老年急性心肌梗死的临床疗效及其对血清炎症因子水平的影响[J]. 医学临床研究,2018,35(6):1210-1213.
[2] 李文霞,刘文举,陈漠水,等. 经皮冠状动脉介入治疗对急性心肌梗死患者胶原Ⅰ、Ⅲ和Fibulin-5的影响[J]. 国际心血管病杂志,2018,45(3):183-185.
[3] 陈洁琼,杨洋,谢楚珊,等. 营养控制状态评分对老年急性心肌梗死患者行急诊PCI术后1年内主要不良心血管事件的预测价值[J]. 现代消化及介入诊疗,2020,25(8):1080-1083.
[4] 廉铮,吕峰峰,王佳旺,等. RDW联合SYNTAXⅡ积分对急性心肌梗死患者行PCI后发生不良心血管事件的预测价值[J]. 山东医药,2020,60(4):66-69.
[5] 杜发旺,冉燕,陈丹丹,等. 急诊PCI术前血清半乳糖凝集素-3水平对急性心肌梗死患者术后急性肾损伤的预测效能[J]. 山东医药,2019,59(21):7-10.
[6] 梁春芳,陈子辉,董艳章. 血清HMGB1、sTLT-1水平与急性心肌梗死患者经皮冠状动脉介入术后不良心血管事件的关系[J]. 中国医药导报,2020,17(2):56-60.
[7] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会. 急性心肌梗死诊断和治疗指南[J]. 中华心血管病杂志,2001,29(12):710-725.
[8] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会. 中国经皮冠状动脉介入治疗指南(2016)[J]. 中华心血管病杂志,2016,44(5):382-400.
[9] 柳万千,殷锡虎,张吉龙,等. 心脉隆联合艾司洛尔对急性心肌梗死患者左室功能指标和炎症水平的影响[J]. 中国中西医结合急救杂志,2019,26(6):674-677.
[10] 陈芳,孙黎博. 瑞舒伐他汀与替罗非班联合冠脉介入治疗急性心肌梗死疗效及对患者心功能、循环内皮祖细胞数量的影响[J]. 陕西医学杂志,2020,49(10):1244-1248.
[11] 崔蕊,赵云凤,于琪力,等. 血清ST2、PLA2、血小板活化物对急性心肌梗死患者PCI术后MACE事件的预测价值[J]. 中国循证心血管医学杂志,2023,15(5):605-608.
[12] 邢尔克,贾军正,周红娟. 合并心房颤动的急性非ST段抬高型心肌梗死患者血清半乳糖凝集素3和高敏C反应蛋白与临床预后的关系[J]. 中国心血管杂志,2019,24(1):62-66.
[13] 莫秋萍,卓柳安,廖致红,等. 急性心肌梗死并发恶性室性心律失常患者血清半乳糖凝集素-3、生长分化因子15水平及其临床意义[J]. 广西医学,2020,42(11):1373-1376.
[14] 赵斌,严鸣光. CTRP3、HMGB1在冠心病合并急性心肌梗死患者中的表达水平及临床意义[J]. 临床医学工程,2022,29(3):321-322.
[15] 刘曙杰,孙立娜,韩丹丹,等. 血清miR-132、miR-214、HMGB1表达与急性心肌梗死患者经皮冠脉介入术后MACE发生的关系研究[J]. 中国分子心脏病学杂志,2023,23(5):5657-5662.