血清缺氧诱导因子1α和心型脂肪酸结合蛋白水平与急性心肌梗死患者发生心力衰竭的相关性  

Correlations of serum hypoxia-inducible factor-1α and heart-type fatty acid binding protein levels with heart failure after acute myocardial infarction

作　　者：高敏雁 吴红艳[1] 丁雪茹[1] 陈晓琴[1] 周欣荣[1] 刘兰燕 GAO Min-yan;WU Hong-yan;DING Xue-ru;CHEN Xiao-qin;ZHOU Xin-rong;LIU Lan-yan(Intensive Care Unit of Cardiovascular Disease Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830054,China;School of Public Health,Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830011,China)

机构地区：[1]新疆医科大学第一附属医院心血管病中心重症监护室,新疆维吾尔自治区乌鲁木齐830054 [2]新疆医科大学公共卫生学院,新疆维吾尔自治区乌鲁木齐830011

出　　处：《中华实用诊断与治疗杂志》2021年第2期147-150,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区自然科学基金(2017D01C164)。

摘　　要：目的探讨急性心肌梗死患者血清缺氧诱导因子1α(hypoxia-inducible factor-1α, HIF-1α)、心型脂肪酸结合蛋白(heart-type fatty acid binding protein, H-FABP)的表达情况及其与急性心肌梗死患者发生心力衰竭的关系。方法 113例急性心肌梗死患者,依据血运重建后是否发生心力衰竭分为心力衰竭组29例和无心力衰竭组84例;记录患者一般资料,采用ELISA法检测患者血清HIF-1α、H-FABP水平,并进行2组间比较。采用双变量Pearson直线相关性分析急性心肌梗死患者血清HIF-1α与H-FABP的相关性;采用多因素logistic回归分析急性心肌梗死患者发生心力衰竭的影响因素;绘制ROC曲线,评估血清HIF-1α、H-FABP水平预测急性心肌梗死患者发生心力衰竭的效能。结果心力衰竭组患者血清HIF-1α[(55.30±4.85)ng/L]、H-FABP[(78.26±10.17)pg/L]及C反应蛋白[(14.13±4.02)ng/L]、脑钠肽前体[(393.52±29.65)ng/L]水平高于无心力衰竭组[(48.39±4.36)ng/L、(52.22±13.96)pg/L、(8.14±2.16)ng/L、(351.12±21.03)ng/L](P<0.05);急性心肌梗死患者血清HIF-1α水平与H-FABP水平呈正相关(r=0.657,P<0.001)。血清C反应蛋白(OR=1.045,95%CI:1.012~1.596,P=0.023)、脑钠肽前体(OR=1.695,95%CI:1.342~1.967,P=0.013)、HIF-1α(OR=1.421,95%CI:1.203~1.869,P=0.039)、H-FABP(OR=1.213,95%CI:1.019~1.534,P=0.010)是急性心肌梗死患者发生心力衰竭的影响因素;当血清HIF-1α、H-FABP最佳截断值分为57.123 ng/L、81.031 pg/L时,预测急性心肌梗死患者发生心力衰竭的AUC分别为0.848(95%CI:0.756~0.939,P<0.001)、0.906(95%CI:0.847~0.964,P<0.001),血清HIF-1与H-FABP联合预测的效能(AUC=0.907,95%CI:0.845~0.970,P<0.001)高于HIF-1α、H-FABP单独预测,其灵敏度为95.2%,特异度为93.1%。结论血清HIF-1α、H-FABP过表达是急性心肌梗死患者发生心力衰竭的影响因素,对预测急性心肌梗死患者发生心力衰竭风险有一定价值。Objective To investigate the expressions of serum hypoxia-inducible factor-1α(HIF-1α) and heart-type fatty acid binding protein(H-FABP) in patients with heart failure after acute myocardial infarction, and their correlations with heart failure after acute myocardial infarction. Methods Totally 113 patients with acute myocardial infarction were divided into heart failure group(n=29) and non-heart failure group(n=84) according to whether heart failure occurred after revascularization. The general data were recorded, and the serum HIF-1α and H-FABP levels were detected by ELISA method, and compared between groups. Bivariate Pearson linear correlation was used to analyze the correlation between serum HIF-1α and H-FABP in patients with acute myocardial infarction. Multivariate logistic regression was used to analyze the influencing factors of heart failure after acute myocardial infarction. ROC was drawn to assess the efficiencies of HIF-1α and H-FABP on the prediction of heart failure after acute myocardial infarction. Results The levels of serum HIF-1α((55.30±4.85) ng/L), H-FABP((78.26±10.17) pg/L), C-reactive protein((14.13±4.02) ng/L) and pro-brain natriuretic peptide((393.52±29.65) ng/L) in heart failure group were higher than those in non-heart failure group((48.39±4.36) ng/L,(52.22±13.96) pg/L,(8.14±2.16) ng/L,(351.12±21.03) ng/L)(P<0.05). The serum HIF-1α level was positively correlated with H-FABP level in patients with acute myocardial infarction(r=0.657, P<0.001). The serum C-reactive protein(OR=1.045, 95%CI: 1.012-1.596, P=0.023), pro-brain natriuretic peptide(OR=1.695,95%CI:1.342-1.967,P=0.013),HIF-1α (OR=1.421,95%CI:1.203-1.869,P=0.039)and H-FABP(OR=1.213,95%CI:1.019-1.534,P=0.010)were the influencing factors of heart failure after acute myocardial infarction.When the optimal cut-offvalues of serum HIF-1αand H-FABP were 57.123 ng/L and81.031 pg/L,the AUCs for predicting heart failure after acute myocardial infarction were 0.848(95%CI:0.756-0.939,P<0.001)and 0.906(95%CI:0.847-0.964,P<0.00

关 键 词：急性心肌梗死 心力衰竭 缺氧诱导因子1Α 心型脂肪酸结合蛋白 相关性 

分 类 号：R541.6[医药卫生—心血管疾病] R542.22[医药卫生—内科学]