血清腱糖蛋白-C水平对急性ST段抬高性心肌梗死患者远期预后的影响  

Impact of serum tenascin-C level on the long-term prognosis of patients with acute ST-segment elevation myocardial infarction

作　　者：丁怀玉[1] 徐鸣悦 陈乐 吕浩[1] 魏明丽[1] 王俊杰[1] 张波[1] 黄榕翀 Ding Huaiyu;Xu Mingyue;Chen Le;Lyu Hao;Wei Mingli;Wang Junjie;Zhang Bo;Huang Rongchong(Department of Cardiology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]大连医科大学附属第一医院心内科,大连116011 [2]首都医科大学附属北京友谊医院心内科,北京100050

出　　处：《中华检验医学杂志》2022年第8期859-864,共6页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(81770340)。

摘　　要：目的探讨急性ST段抬高性心肌梗死(STEMI)患者血清腱糖蛋白-C(TN-C)水平变化规律及其对远期预后的影响。方法选择2015年6月至2016年6月大连医科大学附属第一医院心内科收治的113例成功行急诊PCI的STEMI患者进行前瞻性研究,测定血清Tenascin-C水平,根据血清Tenascin-C水平分为TN-C≥120μg/L组和TN-C<120μg/L组,随访5年,观察2组患者主要不良心血管事件(MACE)发生情况。并根据MACE发生情况分为MACE组与非MACE组,分析MACE发生的预测因素。用受试者工作特征(ROC)曲线分析血清TN-C水平预测STEMI患者发生MACE的价值。采用Kaplan-Meier生存曲线分析MACE发生率,并采用Cox比例风险回归模型分析5年MACE发生的危险因素。结果STEMI患者血清TN-C在发病后第1天内开始升高,为(46.5±24.8)μg/L,第3天达到峰值,为(97.5±41.2)μg/L,随后逐渐下降。STEMI患者全部完成5年随访,其中37例发生MACE,包括心源性死亡4例(3.5%)、心力衰竭14例(12.4%)、再发心肌梗死或再次血运重建14例(12.4%)、卒中5例(4.4%)。TN-C预测MACE的ROC曲线下面积为0.953(95%CI 0.918~0.988,P<0.05)。TN-C≥120μg/L组MACE发生率高于TN-C<120μg/L组[86.4%(19/22)比19.8%(18/91)],Kaplan-Meier生存分析显示差异有统计学意义(P<0.05)。Cox比例风险回归分析显示,血清TN-C水平(HR=1.007,95%CI 1.001~1.012,P<0.05)、超敏C反应蛋白(HR=1.028,95%CI 1.007~1.049,P<0.05)、心肌肌钙蛋白Ⅰ(HR=1.004,95%CI 1.000~1.008,P<0.05)是STEMI患者5年随访发生MACE的独立预测因子。结论STEMI患者血清TN-C水平明显升高,并随时间发生变化,其对MACE发生具有很好的预测价值,是STEMI患者5年发生MACE的独立预测因子。Objective To explore the serum tenascin-C levels in patients with acute ST-segment elevation myocardial infarction(STEMI)and its impact on the long-term prognosis.Methods One hundred and thirteen STEMI patients who were admitted to the Department of Cardiology of the First Affiliated Hospital of Dalian Medical University and successfully underwent emergency PCI from June 2015 to June 2016 were included in this prospective study.The serum tenascin-C levels were measured during hospitalization,and the patients were divided into tenascin-C≥120μg/L group and tenascin-C<120μg/L group according to the serum tenascin-C level.Major adverse cardiovascular events(MACE)were observed during the 5 years follow up in all patients.According to the incidence of MACE,the patients were divided into MACE group and non-MACE group,and the predictive factors of MACE were analyzed.Continuous variables were presented as the mean±standard deviation and compared with the Student′s t-test.Categorical variables were presented as percentages and compared with the Chi-square test or Fisher′s exact test.Receiver operating characteristic(ROC)curve was used to analyze the value of serum tenascin-C level in predicting MACE in STEMI patients.Kaplan Meier survival analysis was used to compare the incidence of MACE between two groups.Cox proportional hazards regression model was used to analyze the risk factors of MACE during the 5 years follow up.Results The serum tenascin-C levels in the STEMI patients increased on the first day after the onset of disease(46.5±24.8μg/L),peaked on the third day(97.5±41.2μg/L),and then gradually decreased.All patients were followed up for 5 years.There were 37 cases of MACE,including 4 cases of cardiac death(3.5%),14 cases of heart failure(12.4%),14 cases of recurrent myocardial infarction or revascularization(12.4%),and 5 cases of stroke(4.4%).For prediction of MACE,the area under the curve of the serum TN-C level was 0.953(95%CI 0.918-0.988,P<0.05),which was thus a valuable biomarker in predicting MAC

关 键 词：心肌梗死 血清腱糖蛋白-C 预后 

分 类 号：R542.22[医药卫生—心血管疾病]