可溶性ST2与急性心肌梗死后心肌纤维化及主要不良心血管事件的相关性研究

发布时间：2018-03-04 11:29

  本文选题：可溶性ST2　切入点：急性心肌梗死　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探索接受经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者,其血清可溶性ST2(sST2)水平与心肌纤维化的关系以及对PCI术后主要不良心血管事件(MACE)的预测价值。方法:入选2015年1月1日至2016年1月31日就诊于兰州大学第一医院心脏中心的249例患者,AMI组为首次诊断急性心肌梗死的166例患者,对照组为冠状动脉造影阴性的83例患者。收集患者的临床基线资料、血常规、血生化及超声心动图中相关指标,测定患者血清可溶性ST2、III型前胶原氨端肽(PIIINP)及氨基末端脑钠肽前体(NT-pro BNP)水平,并对AMI组患者在PCI术后电话随访1年,依据随访的情况,将AMI组分为发生MACE事件组(含23人)与未发生MACE事件组(含143人)两个亚组,其后对数据进行统计学分析。结果:1.在AMI组,循环中可溶性ST2、PIIINP及NT-proBNP水平均高于对照组,而左室射血分数(LVEF)的值低于对照组,上述值在AMI组及对照组间均存在统计学差异(P值均0.05)。2.在AMI组中,血清可溶性ST2受到临床资料中的体质指数、高血压、甘油三酯、谷草转氨酶、左室收缩末容积(left ventricular end-systolic diameter,LVESV)及左室射血分数(left ventricular ejection fraction,LVEF)的影响,且血清可溶性ST2与MACE事件、PIIINP(type III procollagen amino terminal peptide,PIIINP))呈正相关,与NT-ProBNP无相关性。3.在AMI组中,循环中可溶性ST2、NT-proBNPP诊断AMI后出现心力衰竭的ROC曲线下面积分别为:0.608、0.683。4.发生MACE事件组血清可溶性ST2水平明显高于未发生MACE事件组[(44.50±5.32)ng/m L与(23.59±1.15)ng/m L,P=0.001];经logistic多因素分析显示:在行PCI术的AMI患者中,血清可溶性ST2水平(OR值:1.051,95%CI:1.016~1.087)是其发生MACE事件的预测因子。5.在行PCI术的AMI患者中,血清可溶性ST2水平预测MACE事件的ROC曲线下面积为0.787,大于NT-pro BNP,与NT-proBNP结合后曲线下面积可达到0.82。6.根据ROC曲线获得的可溶性ST2的最大切点(30ng/mL),做生存曲线可知:血清可溶性ST2水平≤30ng/mL组患者PCI术后1年的死亡率较可溶性ST2水平30ng/mL组患者低(0.81%vs 7.1%,P=0.04),且具有统计学意义。结论:1.血清可溶性ST2可能参与急性心肌梗死后心肌纤维化的过程,此外,与左心室的收缩功能有关,并对AMI患者出现心力衰竭具有诊断价值。2.对于PCI术后的AMI患者,血清可溶性ST2可作为其发生MACE事件的独立预测因子,与此同时和NT-proBNP联合后可提高对其MACE事件的预测价值。3.可溶性ST2水平越高其PCI术后1年的生存率越低。
[Abstract]:Objective: to explore patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). The relationship between serum soluble ST2s ST2 and myocardial fibrosis and its predictive value for major adverse cardiovascular events after PCI were selected from January 1st 2015 to January 31st 2016 at the first Hospital of Lanzhou University. There were 249 patients with AMI in the center of the viscera. 166 patients with acute myocardial infarction were diagnosed for the first time. The control group consisted of 83 patients with negative coronary arteriography. The clinical baseline data, blood routine, blood biochemical and echocardiographic parameters were collected. The serum levels of soluble ST2 + type III procollagen terminal peptide (PIIINP) and amino-terminal brain natriuretic peptide precursor (NT-pro BNPP) were measured. The patients in AMI group were followed up by telephone for one year after PCI. The AMI group was divided into two subgroups: the MACE event group (including 23 persons) and the non-occurrence MACE event group (including 143 people). The data were analyzed statistically. Results: 1. In the AMI group, the levels of soluble ST2PIIINP and NT-proBNP in the circulation were higher than those in the control group. The value of left ventricular ejection fraction (LVEF) was lower than that of control group (P < 0.05). In AMI group, serum soluble ST2 was affected by body mass index (BMI), hypertension and triglyceride. The effects of alanine aminotransferase, left ventricular end-systolic volume, left ventricular ejection fractionation (LVEF) and left ventricular ejection fraction (LVEF), and serum soluble ST2 were positively correlated with MACE event (PIIINP type III procollagen amino terminal peptide PIIINP), but not with NT-ProBNP. The area under the ROC curve of circulating soluble ST2nT-proBNPP in diagnosing AMI was: 0.608 卤0.683.4. The serum soluble ST2 level in the MACE event group was significantly higher than that in the non-#en4# event group [44.50 卤5.32 ng / mL and 23.59 卤1.15ngP / m LP0.001]. The results of logistic multivariate analysis showed that:. In AMI patients undergoing PCI, The OR value of serum soluble ST2 was 1.051 ~ 95% CI: 1.016 ~ 1.087) was the predictor of MACE events. 5. In AMI patients undergoing PCI surgery, The area under the ROC curve of serum soluble ST2 for predicting MACE events was 0.787, larger than that of NT-proBNP, and the area under the curve after combining with NT-proBNP could reach 0.82.6. The maximum tangent point of soluble ST2 obtained from ROC curve was 30 ng / mL, and the survival curve showed that the soluble serum was soluble. The mortality of patients with ST2 鈮，

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