冠心病患者sST2、Gal-3水平与心肌纤维化的相关性研究  

Correlation of soluble growth stimulation expressed gene 2 and galectin-3 with myocardial fibrosis in patients with coronary artery disease

作　　者：张玉莲 邓玮[1] 王云会 陈诗语 郑芳 Zhang Yulian;Deng Wei;Wang Yunhui;Chen Shiyu;Zheng Fang(Department of General Medicine,The Second Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属第二医院全科医学科,重庆400010

出　　处：《重庆医科大学学报》2024年第1期37-43,共7页Journal of Chongqing Medical University

基　　金：重庆市科卫联合医学科研资助项目(编号:2021MSXM094)。

摘　　要：目的:探讨冠心病(coronary artery disease,CAD)患者可溶性生长刺激表达基因2蛋白(soluble growth stimulation ex‐pressed gene 2,s ST2)、半乳糖凝集素-3(galectin-3,Gal-3)与心肌纤维化(myocardial fibrosis,MF)的关系,指导临床缺血性MF的评估。方法:以顺序入选2021年9月至2022年9月在重庆医科大学附属第二医院科住院的冠心病受试者56例非冠心病患者31例为研究对象,根据心血管磁共振-延迟钆增强(cardiovascular magnetic resonance-late gadolinium enhancement,CMR-LGE)将冠心病组分为心肌纤维化(LGE阳性)亚组和非心肌纤维化(LGE阴性)亚组。收集所有受试者的一般临床资料。所有受试者均通过酶联免疫吸附法测定血清s ST2、Gal-3水平。分析s ST2、Gal-3与CMR-LGE结果的相关性。结果:(1)CAD组患者s ST2、Gal-3、血压、肌酐、尿酸、室间隔厚、糖化血红蛋白、CAS评分高于非CAD组患者(P<0.05),而肾小球滤过率、高密度脂蛋白低于非CAD患者(P<0.05)。(2)LGE阳性亚组s ST2、Gal-3、B型利钠肽原水平较LGE阴性亚组高(P<0.05),高密度脂蛋白较LGE阴性亚组低(P<0.05)。(3)LGE与s ST2(rs=0.338,P=0.011)、Gal-3(rs=0.428,P=0.001)、B型利钠肽原(rs=0.364,P=0.006)呈正相关,与高密度脂蛋白(rs=-0.339,P=0.011)呈负相关,纳入控制变量进行偏相关分析得出LGE与s ST2(r=0.312,P=0.037)、Gal-3(r=0.419,P=0.004)独立相关。(4)s ST2、Gal-3以及两者联合检测心肌纤维化的敏感度分别是65%、87%、70%,特异度分别是81%、56%、87%,s ST2、Gal-3预测有无心肌纤维化的最佳临界值分别是36.01 ng/m L、13.04 ng/m L。结论:s ST2、Gal-3可用于预测缺血性心肌纤维化,与CMR-LGE评估心肌纤维化具有高度一致性。Objective:To investigate the correlation of soluble growth stimulation expressed gene 2(sST2)and galectin-3(Gal-3)with myocardial fibrosis(MF)in patients with coronary artery disease(CAD),and to guide the evaluation of ischemic MF in clinical practice.Methods:A total of 56 patients with CAD and 31 patients without CAD who were hospitalized in our department from Septem-ber 2021 to September 2022 were enrolled as subjects,and according to the results of cardiovascular magnetic resonance-late gado-linium enhancement(CMR-LGE),the CAD group was further divided into MF(LGE positive)subgroup and non-MF(LGE negative)subgroup.General clinical data were collected from all subjects,and ELISA was used to measure the serum levels of sST2 and Gal-3.The correlation of sST2 and Gal-3 with CMR-LGE results was analyzed.Results:Compared with the non-CAD group,the CAD group had significantly higher levels of sST2 and Gal-3,blood pressure,creatinine,uric acid,interventricular septum thickness,glycosylated hemoglobin,and CAS score(P<0.05)and significantly lower glomerular filtration rate and high-density lipoprotein(P<0.05).Com-pared with the LGE-negative subgroup,the LGE-positive subgroup had significantly higher levels of sST2,Gal-3,and pro-B-type na-triuretic peptide(P<0.05)and a significantly lower level of high-density lipoprotein(P<0.05).LGE was positively correlated with sST2(rs=0.338,P=0.011),Gal-3(rs=0.428,P=0.001),and pro-B-type natriuretic peptide(rs=0.364,P=0.006)and was negatively corre-lated with high-density lipoprotein(rs=-0.339,P=0.011),and the partial correlation analysis with control variables showed that LGE was independently correlated with sST2(r=0.312,P=0.037)and Gal-3(r=0.419,P=0.004).The analysis showed that sST2 or Gal-3 used alone or in combination had a sensitivity of 65%,87%,and 70%,respectively,and a specificity of 81%,56%,and 87%,respec-tively,in detecting MF,and sST2 and Gal-3 had an optimal cut-off value of 36.01 ng/mL and 13.04 ng/mL,respectively,in predicting the presence or absence of ischemic MF.C

关 键 词：心肌纤维化 冠心病 可溶性生长刺激表达基因2蛋白 半乳糖凝集素-3 

分 类 号：R542[医药卫生—心血管疾病]