可溶性ST2和半乳糖凝集素-3水平与室间隔心肌切除术后肥厚型梗阻性心肌病患者预后的相关性分析  

Relationship Between Soluble ST2, Galectin-3 and Clinical Prognosis of Ventricular Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy

作　　者：鲁洁[1] 黄晓红[1] 伍熙 崔颢[3] 王婧金 肖明虎[4] 郭颖[1] 宋昌鹏 郑欣馨[1] 房晓楠[1] 王水云[3] LU Jie;HUANG Xiao-hong;WU Xi;CUI Hao;WANG Jing-jin;XIAO Ming-hu;GUO Ying;SONG Chang-peng;ZHENG Xin-xin;FANG Xiao-nan;WANG Shui-yun(Center of Special Medical Care, National Center for Cardiovascular Disease and Fuwai Hospital, CAMS and PUMC, Beijing （100037）, China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院特需医疗中心,北京市100037 [2]中南大学湘雅三医院心内科 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,北京市100037 [4]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声科,北京市100037

出　　处：《中国循环杂志》2018年第2期166-171,共6页Chinese Circulation Journal

基　　金：国家自然科学基金(81570276)

摘　　要：目的:探讨可溶性ST2(s ST2)和半乳糖凝集素-3(Gal-3)水平与室间隔心肌切除术后肥厚型梗阻性心肌病(HOCM)患者临床预后的相关性。方法:纳入2011-03至2016-02期间在中国医学科学院阜外医院行改良Morrow手术的HOCM患者200例,采用酶联免疫吸附法(ELISA)检测其血浆s ST2与Gal-3水平。根据血浆s ST2水平进行三分位数分组:低s ST2组(<9.05 ng/ml)、中s ST2组(9.05~16.74 ng/ml)及高s ST2组(>16.74 ng/ml);根据血浆Gal-3水平进行三分位数分组:低Gal-3组(<6.19 ng/ml)、中Gal-3组(6.19~8.22 ng/ml)、高Gal-3组(>8.22 ng/ml)。另外收集了42例无心脏疾病的志愿者血液样本作为正常对照,并按照性别和年龄匹配了42例HOCM患者,比较两者血浆中sS T2与Gal-3水平的差异。使用Cox回归模型评估血浆sS T2和Gal-3水平对主要终点事件(全因死亡或心血管住院)的预测价值。结果:ELISA分析结果表明,与正常对照者相比,HOCM患者的血浆s ST2和Gal-3水平显著升高(P均<0.01)。中位随访26个月时,Kaplan-Meier生存分析显示,血浆s ST2及Gal-3不同水平组的复合终点事件发生率均无明显差异(log-rank P分别为0.06和0.68)。Cox回归分析表明,血浆sS T2和Gal-3水平都不能独立预测终点事件(P均>0.05),而年龄是复合终点事件的独立危险因素(HR=1.06,95%CI:1.02~1.11,P<0.01)。结论:尽管HOCM患者的血浆sS T2与Gal-3水平升高,但血浆sS T2和Gal-3水平与心肌切除术后HOCM患者临床预后无关。年龄增长是室间隔心肌切除术后HOCM患者全因死亡及心血管事件住院的复合终点事件的独立预测因子。Objective： To explore the relationship between plasma levels of soluble ST2（sS T2）, galectin-3（Gal-3） and clinical prognosis of ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy（HOCM）.Methods： A total of 200 consecutive HOCM patients received modified Morrow surgery in our hospital from 2011-03 to 2016-02 were studied. According to plasma levels of sS T2, patients were divided into 3 groups： Low sS T2 group（sS T29.05 ng/ml）, Middle sS T2 group（sS T2 9.05-16.74 ng/ml） and High sS T2 group（sS T2〉16.74 ng/ml）; based on plasma levels of Gal-3, patients were divided into another 3 groups： Low Gal-3 group（Gal-3〈6.19 ng/ml）, Middle group（Gal-3 6.19-8.22 ng/ml） and High Gal-3 group（Gal-3〉8.22 ng/ml）; in addition, Control group, n=42 volunteers without heart disease. Plasma levels of sS T2 and Gal-3 were measured by ELISA, compared between Control group and HOCM group（n=42 patients with matched gender and age to Control group）. The predictive value of sS T2 and Gal-3 on major endpoint events including all cause death or cardiovascular hospitalization were assessed by Cox regression analysis.Results： Compared with Control group, plasma levels of sS T2 and Gal-3 were increased in HOCM patients, P〈0.01. The patients were followed-up for the average of 26 months, Kaplan-meier survival analysis showed that the incidences of composite endpoint event were similar at different levels of sS T2 and Gal-3（log-rank P=0.06 and P=0.68）. Cox regression analysis indicated that either sS T2 or Gal-3 could not independently predict the endpoint events, both P〈0.05, while age was an independent risk factor for composite endpoint event occurrence（HR=1.06, 95% CI 1.02-1.11, P〈0.01）.Conclusion： Plasma levels of sS T2 and Gal-3 were not related to clinical prognosis of ventricular septal myectomy in HOCM patients even they had increased sS T2 and Gal-3; while advanced age was the independent predictor for endpoint event occurrence.

关 键 词：受体 白细胞介素1 半乳糖凝集素-3 心肌病 肥厚性 

分 类 号：R54[医药卫生—心血管疾病]