血清FGF23、Fetuin-A检测对STEMI患者PCI术后发生MACE的预测价值  

Diagnostic value of serum FGF23 and Fetuin-A detection for MACE in patients with STEMI after PCI operation

作　　者：方子美[1] 陈小芳[1] 余向东[1] FANG Zimei;CHEN Xiaofang;YU Xiangdong(Huangshi Central Hospital of Eastern Hubei Medical Group,Huangshi 435000,China)

机构地区：[1]鄂东医疗集团黄石市中心医院

出　　处：《山东医药》2019年第25期22-26,共5页Shandong Medical Journal

基　　金：湖北省卫生计生委科研项目(WJ2016MB559)

摘　　要：目的探讨血清成纤维细胞生长因子23(FGF23)、胎球蛋白A(Fetuin-A)检测对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后发生主要不良心血管事件(MACE)的预测价值。方法选择127例STEMI患者,均于发病24h内完成PCI术,根据住院期间患者是否发生MACE分为MACE组(n=38)和非MACE组(n=89),以同期健康体检者50例为对照组。收集各组一般资料及实验室指标,采用酶联免疫吸附法测定血清FGF-23、Fetuin-A,用Logistic回归分析PCI术后STEMI患者住院期间发生MACE的影响因素,用受试者工作特征(ROC)曲线评估血清FGF-23、Fetuin-A预测MACE发生的价值。结果STEMI患者血清FGF23水平高于对照组,血清Fetuin-A水平低于对照组(P均<0.05);STEMI组血清FGF23水平高于非MACE组,血清Fetuin-A水平低于非MACE组(P均<0.05)。心功能Killip分级高及N末端B型利钠肽前体、FGF23水平升高是MACE发生的独立危险因素,左室射血分数、心指数、Fetuin-A水平升高是MACE发生的保护因素。FGF23预测MACE发生的ROC曲线下面积(AUC)为0.871,95%CI:0.808~0.934,最佳截断值为10.89pg/mL,灵敏度、特异度分别为0.86、0.82,准确性为0.85;Fetuin的AUC为0.852,95%CI:0.785~0.198,最佳截断值为976.82ng/mL,灵敏度、特异度分别为0.81、0.75,准确性为0.80;FGF23联合Fetuin预测MACE的AUC为0.934,95%CI:0.891~0.977,灵敏度、特异度分别为0.93、0.89,准确性为0.92。结论血清FGF23水平升高、Fetuin-A水平降低是STEMI患者PCI术后并发MACE的独立影响因素,二者可作为临床预测STEMI患者PCI术后发生MACE的指标。Objective To explore the diagnostic value of serum fibroblast growth factor-23 (FGF23) and Fetuin-A detection for main adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) operation.Methods Totally 127 patients with STEMI who completed PCI operation within 24 hours were selected.The patients were divided into MACE group ( n =38) and non-MACE group ( n =89) according to whether or not they had MACE during hospitalization.Meanwhile,50 healthy people in the same period were taken as the control group.The demographic data and laboratory indicators in each group were collected,and the serum FGF23 and Fetuin-A levels were measured by enzyme-linked immunosorbent assay.Logistic regression analysis was used to analyze the influencing factors of MACE in STEMI patients after PCI during hospitalization.The value of predicting MACE by FGF-23 and Fetuin-A was evaluated by receiver operating characteristic curve (ROC curve).Results Serum FGF23 level in STEMI patients was higher than that in the control group,and serum Fetuin-A level was lower than that in the control group (both P <0.05).Serum FGF23 level in the STEMI group was higher than that in the non-MACE group,and serum Fetuin-A level was lower than that in the non-MACE group ( P <0.05).High Killip classification of cardiac function and elevated levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and FGF23 were independent risk factors for MACE;the elevated levels of left ventricular ejection fraction (LVEF),cardiac index ( CI ),and Fetuin-A were protective factors for MACE.The area under the curve (AUC) of FGF23 in predicting MACE was 0.871,95% CI :0.808-0.934,the best cut-off was 10.89 pg/mL,the sensitivity and specificity were 0.86 and 0.82,respectively,and the accuracy was 0.85.The AUC of Fetuin in predicting MACE was 0.852,95% CI:0.785-0.198,and the best cut-off was 976.82 ng/mL,the sensitivity and specificity were 0.81 and 0.75,respectively,and the accur

关 键 词：心肌梗死 成纤维细胞生长因子23 胎球蛋白A 经皮冠状动脉介入 主要不良心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病]