血清Sulfatide、DcR3与急性ST段抬高型心肌梗死患者心肌损伤和出院后短期主要不良心血管事件的关系  

The relationship between serum Sulfatide, DcR3 and myocardial injury in patients with acute ST segment elevation myocardial infarction and short-term major adverse cardiovascular events after discharge

作　　者：奚春艳 杜佩珊 王琪 宋美思 陈素艳 Xi Chunyan;Du Peishan;Wang Qi;Song Meisi;Chen Suyan(Department of Internal Medicine-Cardiovascular,Zhangjiakou First Hospital,Hebei Province,Zhangjiakou 075000,China)

机构地区：[1]张家口市第一医院心血管内科,075000 [2]张家口市第一医院心电电生理科,075000

出　　处：《疑难病杂志》2023年第1期1-7,共7页Chinese Journal of Difficult and Complicated Cases

基　　金：国家卫生计生委医药卫生科技发展研究中心课题(W2019ZT317)。

摘　　要：目的 分析血清硫脑苷脂(Sulfatide)、诱骗受体3(DcR3)与急性ST段抬高型心肌梗死(STEMI)患者心肌损伤及出院后短期主要不良心血管事件(MACE)的关系。方法 选取2020年1月—2021年1月张家口市第一医院心血管内科行PCI的STEMI患者102例为研究对象(病例组),以同期医院健康体检者60例为健康对照组。STEMI患者PCI术后随访1年,根据患者是否出现MACE分为MACE亚组27例和非MACE亚组75例。检测2组血清Sulfatide、DcR3、肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)、N末端脑钠肽前体(NT-proBNP)水平;采用Pearson积矩相关分析血清Sulfatide、DcR3与cTnI、CK-MB、Mb、NT-proBNP的关系;多因素Logistic回归分析STEMI患者发生MACE的影响因素;绘制受试者工作特征曲线(ROC)评估血清Sulfatide、DcR3对STEMI患者发生MACE的预测价值。结果 病例组血清Sulfatide水平高于健康对照组,DcR3水平低于健康对照组(t/P=19.347/<0.001,18.537/<0.001);血清cTnI、CK-MB、Mb、NT-proBNP水平高于健康对照组(t/P=29.002/<0.001、69.953/<0.001、38.189/<0.001、28.937/<0.001);STEMI患者血清cTnI、CK-MB、Mb、NT-proBNP与Sulfatide呈正相关(r/P=0.683/0.006、0.762/0.001、0.736/0.001、0.720/0.001),与DcR3呈负相关(r/P=-0.637/0.008、-0.729/0.001、-0.715/0.001、-0.702/0.003)。多因素Logistic回归分析显示,cTnI高、CK-MB高、Mb高、NT-proBNP高、Sulfatide高是STEMI患者发生MACE的危险因素[OR(95%CI)=1.420(1.009~1.782)、1.346(1.016~1.624)、1.365(1.011~1.598)、1.493(1.112~1.890)、1.692(1.203~1.937)],DcR3高是其保护因素[OR(95%CI)=0.850(0.792~0.938)]。血清Sulfatide、DcR3及二者联合预测STEMI患者发生MACE的曲线下面积(AUC)分别为0.826、0.797、0.890,二者联合预测价值大于单一指标检测(Z/P=2.359/0.043、3.216/0.032)。结论 STEMI患者血清Sulfatide升高,血清DcR3下降,并与患者心肌损伤密切相关,二者可作为预测STEMI患者PCI术后短期发生MACE的辅助生化标志物。Objective To analyze the relationship between serum sulfatide, decoy receptor 3(DcR3) and myocardial injury and short-term major adverse cardiovascular events(MACE) in patients with acute ST segment elevation myocardial infarction(STEMI). Methods From January 2020 to January 2021, 102 patients with STEMI who underwent PCI in the Cardiovascular Department of Zhangjiakou First Hospital were selected as the study object(case group), and 60 health examinees in the same hospital were selected as the health control group. STEMI patients were followed up for 1 year after PCI, and were divided into MACE subgroup(27 cases) and non-MACE subgroup(75 cases) according to whether the patients had MACE. Serum levels of Sulfatide, DcR3, troponin I(cTnI), creatine kinase isoenzyme(CK-MB), myoglobin(Mb) and N-terminal pro brain natriuretic peptide(NT-proBNP) were measured in the two groups;Pearson product moment correlation was used to analyze the relationship between serum Sulfatide, DcR3 and cTnI, CK-MB, Mb, NT-proBNP. Multivariate logistic regression analysis was used to analyze the influencing factors of MACE in STEMI patients;The predictive value of serum Sulfatide and DcR3 on the occurrence of MACE in patients with STEMI was evaluated by drawing the receiver operating characteristic curve(ROC). Results The serum Sulfatide level in the case group was higher than that in the healthy control group, and the DcR3 level was lower than that in the healthy control group(t/P=19.347/<0.001, 18.537/<0.001). Serum cTnI, CK-MB, Mb, NT-proBNP levels were higher than those in the healthy control group(t/P=29.002/<0.001, 69.953/<0.001, 38.189/<0.001, 28.937/<0.001). Serum cTnI, CK-MB, Mb, NT-proBNP in STEMI patients were positively correlated with Sulfatide(r/P=0.683/0.006, 0.762/0.001, 0.736/0.001, 0.720/0.001), and negatively correlated with DcR3(r/P=-0.637/0.008,-0.729/0.001,-0.715/0.001,-0.702/0.003). Multivariate logistic regression analysis showed that high cTnI, CK-MB, Mb, NT-proBNP, and Sulfatide were risk factors for the occurrence

关 键 词：心肌梗死 急性ST段抬高型 心肌损伤 硫脑苷脂 诱骗受体3 主要不良心血管事件 相关性 

分 类 号：R542.22[医药卫生—心血管疾病]