血清中巨噬细胞移动抑制因子水平对急性ST段抬高心肌梗死的预后价值  

Prognostic value of serum macrophage migration inhibitory factor in patients with acute ST-segment elevation myocardial infarction

作　　者：李小琴[1] 石小燕[1] 李芳[1] 张晓[2] LI Xiaoqin;SHI Xiaoyan;LI Fang;ZHANG Xiao(Department of Cardiology,Jiyuan Second People's Hospital,Jiyuan,Henan 459000,China;Department of Cardiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China)

机构地区：[1]济源市第二人民医院心内科,河南济源459000 [2]郑州大学第一附属医院心内科,河南郑州450003

出　　处：《安徽医药》2021年第12期2420-2424,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的评估血清中巨噬细胞移动抑制因子(migration inhibitory factor,MIF)水平对急性ST段抬高心肌梗死(STEMI)病人预后的价值。方法收集2014年1月至2016年1月到济源市第二人民医院接受治疗的急性STEMI病人273例临床资料及常规检测指标的结果,随访36个月,根据随访结束时病人的生存状态将其分为死亡组和未死亡组;酶联免疫吸附测定检测急性STEMI病人外周血中MIF水平;自动生化分析仪检测肌酸激酶同工酶(CK-MB)和心脏高敏感性肌钙蛋白T(hs-TnT);受试者工作特征曲线检测MIF、hs-TnT和CK-MB判断急性STEMI病人预后的灵敏度和特异度,并根据MIF的截断值,将病人分为MIF高表达组和低表达组;检测MIF高表达组与MIF低表达组病人入院后hs-TnT和CK-MB水平的变化;分析MIF、hs-TnT和CK-MB不同表达水平对急性STEMI病人预后的影响。logistic多因素回归分析影响急性STEMI不良预后的独立危险因素。结果死亡组病人的肌酐[(9405±2086)μmol/L]、Gensini评分[(92.0±23.0)分],外周血中MIF[(234.5±32.5)μg/L]、hs-TnT[(6.3(0.2,12.3)mg/L]和CK-MB[253(95,318)U/L]水平均显著高于未死亡组肌酐[(7231±1352)μmol/L]、Gensini评分[(67.0±18.0)分],外周血中MIF[(156.2±19.7)μg/L]、hs-TnT[1.5(0.1,2.3)mg/L]和CK-MB[124(72,237)U/L]水平(P<0.001);MIF判断急性STE-MI病人预后的灵敏度和特异度均高于CK-MB,略低于hs-TnT;MIF高表达组hs-TnT水平在入院12 h时达高峰,且高于MIF低表达组。MIF高表达组CK-MB水平入院8 h时达高峰,且高于MIF低表达组;MIF、hs-TnT和CK-MB高表达组病人的存活率分别为80.5%、77.3%和79.8%,均低于MIF、hs-TnT和CK-MB低表达组81.4%、97.3%和95.2%(均P<0.05);MIF≥123.4μg/L、hs-TnT≥0.92 mg/L和CK-MB≥108 U/L为急性STEMI病人预后不良的独立危险因素。结论MIF评估急性STEMI病人预后的灵敏度略低于hs-TnT,其是否有望成为评估急性STEMI病人预后的有效指标,还需扩大样本量做进一步研究。Objective To evaluate the value of serum macrophage migration inhibitory factor(MIF)levels in the prognosis of pa-tients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 273 patients with acute STEMI who were treated in Second People's Hospital of Jiyuan City from January 2014 to January 2016 were collected.The clinical data and routine test results were collected.Followed up for 36 months,according to the survival status of patients at the end of follow-up,they were assigned into dead group and undead group.Enzyme-linked immunosorbent assay(ELISA)was used to detect MIF levels in peripheral blood of patients with acute STEMI.Automated biochemical analyzer was used to detect creatine kinase isoenzyme(CK-MB)and cardiac hyper-sensitive troponin T(hs-TnT).The receiver operating curve was used to detect the sensitivity and specificity of MIF,hs-TnT and CK-MB in predicting the prognosis of patients with acute ST-segment elevation myocardial infarction.According to the cutoff value of MIF,patients were assigned into MIF high expression group and low expression group.The changes of hs-TnT and CK-MB levels in patients with MIF high expression group and MIF low expression group after admission were detected.The effects of different expression levels of MIF,hs-TnT and CK-MB on the prognosis of patients with ST-segment elevation myocardial infarction were analyzed;logistic multi-variate regression analysis was an independent risk factor affecting the poor prognosis of ST segment elevation myocardial infarction.Re⁃sults The creatinine[(9405±2086)μmol/L vs.(7231±1352)μmol/L],Gensini score[(92.0±23.0)points vs.(67.0±18.0)points]and peripheral blood MIF[(234.5±32.5)μg/L vs.(156.2±19.7)μg/L],hs-TnT[6.3(0.2,12.3)mg/L vs.1.5(0.1,2.3)mg/L]and CK-MB[253(95,318)U/L vs.124(72,237)U/L]in the dead group were significantly higher than those in the non-dead group(P<0.001).The sensitiv-ity and specificity of MIF in predicting the prognosis of patients with acute STEMI were higher than CK-MB and sli

关 键 词：ST段抬高心肌梗死 标志物 巨噬细胞移动抑制因子 心脏高敏感性肌钙蛋白T 预后 

分 类 号：R542.22[医药卫生—心血管疾病]