5-甲氧基色氨酸和组蛋白去乙酰化酶3与急性心肌梗死患者心肌纤维化的关系  

Relationship of serum 5-MTP and HDAC3 levels with myocardial fibrosis in elderly patients with acute myocardial infarction

作　　者：田静霞 黄娜 黄晓城 吕雄胜 Tian Jingxia;Huang Na;Huang Xiaocheng;LYU Xiongsheng(Department of Geriatrics,Lishui Second People's Hospital,Lishui323000,Zhejiang Province,China)

机构地区：[1]丽水市第二人民医院老年科,323000 [2]丽水市第二人民医院呼吸与危重症医学科 [3]丽水市第二人民医院老年心血管内科

出　　处：《中华老年心脑血管病杂志》2024年第12期1409-1413,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：浙江省医学会临床医学专项资金项目(2023ZYC-A241)。

摘　　要：目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者血清5-甲氧基色氨酸(5-methoxytryptophan,5-MTP)和组蛋白去乙酰化酶3(histone deacetylase 3,HDAC3)水平与心肌纤维化的关系。方法前瞻性选择2021年1月至2024年3月丽水市第二人民医院老年科住院的老年AMI患者261例(观察组),另选择健康体检者60例(对照组)。观察组又根据心肌磁共振成像分为心肌纤维化组104例和非心肌纤维化组157例。收集患者基线资料,采用晚期钆增强成像(late gadolinium enhancement,LGE)积分评价心肌纤维化,分析血清5-MTP和HDAC3水平与LGE积分相关性。单因素及多因素logistic回归分析老年AMI患者心肌纤维化的影响因素。使用ROC曲线评估血清5-MTP和HDAC3水平对心肌纤维化的诊断效能。结果观察组血清5-MTP水平明显低于对照组,HDAC3水平明显高于对照组,差异有统计学意义(P<0.01)。Pearson相关性分析显示,心肌纤维化组血清5-MTP与LGE积分呈负相关(r=-0.891,P=0.000),HDAC3与LGE积分呈正相关(r=0.732,P=0.000)。心肌纤维化组血清5-MTP水平明显低于非心肌纤维化组,HDAC3水平明显高于非心肌纤维化组,差异有统计学意义(P<0.01)。logistic回归分析显示,5-MTP(OR=0.522,95%CI:0.361~0.754,P=0.001)和HDAC3(OR=2.024,95%CI:1.354~3.025,P=0.001)为老年AMI患者心肌纤维化的预测因素。ROC曲线分析显示,5-MTP临界值为14.45 ng/L时,敏感性和特异性分别为83.65%和78.98%,曲线下面积为0.755(95%CI:0.618~0.892);HDAC3临界值为150.40μg/L,敏感性和特异性分别为77.88%和75.16%,曲线下面积为0.809(95%CI:0.685~0.932);进一步回归分析显示,敏感性和特异性分别为95.17%和96.82%,曲线下面积为0.994(95%CI:0.977~1.000)。结论血清5-MTP和HDAC3在老年AMI患者中异常表达,可评估心肌纤维化发生、发展。Objective To investigate the relationship of serum levels of 5-methoxytryptophan(5-MTP)and histone deacetylase 3(HDAC3)with myocardial fibrosis in elderly patients with acute myocardial infarction(AMI).Methods A prospective study was conducted on 261 elderly AMI patients(observation group)admitted in our hospital from January 2021 to March 2024.Ano-ther 60 matched individuals who took physical examination in our hospital during same period served as control group.The AMI patients were further divided into myocardial fibrosis subgroup(104 cases)and non-myocardial fibrosis subgroup(157 cases)according to cardiac magnetic resonance imaging.The baseline data were collected for all participants,and late gadolinium enhancement(LGE)was used to evaluate myocardial fibrosis.The correlation of serum 5-MTP and HDAC3 levels and LGE score was analyzed.Univariate and multivariate logistic regression analyses were employed to identify the factors affecting myocardial fibrosis in elderly AMI patients.ROC curve was applied to evaluate the diagnostic performance of serum 5-MTP and HDAC3 levels for myocardial fibrosis.Results The observation group had significantly lower serum 5-MTP level and higher HDAC3 level than the control group(P<0.01).Pearson correlation analysis showed that serum 5-MTP(r=-0.891,P=0.000)was negatively,and HDAC3 was positively correlated with LGE score(r=0.732,P=0.000).The serum 5-MTP level was significantly lower,and the HDAC3 level was obviously higher in the myocardial fibrosis subgroup than the non-myocardial fibrosis group(P<0.01).Logistic regression analysis indicated that 5-MTP(OR=0.522,95%CI:0.361-0.754,P=0.001)and HDAC3(OR=2.024,95%CI:1.354-3.025,P=0.001)were predictors for myocardial fibrosis in elderly AMI patients.ROC curve analysis revealed that when the cutoff value of 5-MTP was 14.45 ng/L,the sensitivity and specificity were 83.65%and 78.98%,respectively,and the AUC value was 0.755(95%CI:0.618-0.892);when the cutoff value of HDAC3 was 150.40μg/L,the sensitivity and specificity were 77.88%and 7

关 键 词：心肌梗死 心内膜心肌纤维化症 5-甲氧基色氨酸 

分 类 号：R542.22[医药卫生—心血管疾病]