血清可溶性生长刺激表达基因2蛋白和低氧诱导因子-1α与非ST段抬高型心肌梗死并发慢性心力衰竭患者预后的关系  

Relationship between serum soluble growth stimulation gene 2 protein and hypoxia inducible factor-1αand prognosis of non-ST segment elevation myocardial infarction complicated with chronic heart failure

作　　者：王东元 汤祥瑞 王科程 刘建建 王汝涛 Wang Dongyuan;Tang Xiangrui;Wang Kecheng;Liu Jianjian;Wang Rutao(Department of Cardiovascular Medicine,Shaanxi Provincial 3201 Hospital,Hanzhong Shaanxi 723000,China;Department of Cardiology,Xingyuan Hospital,Yulin Shaanxi 719000,China;Chinese People’s Liberation Army Air Force Medical University,Xi’an Shaanxi,710032,China)

机构地区：[1]陕西省三二〇一医院心血管内科,陕西汉中723000 [2]陕西省榆林市星元医院心血管内科,陕西榆林719000 [3]中国人民解放军空军军医大学,陕西西安710032

出　　处：《中国医刊》2024年第12期1312-1315,共4页Chinese Journal of Medicine

基　　金：陕西省重点研发计划(2023-GHYB-12)。

摘　　要：目的 探讨血清可溶性生长刺激表达基因2蛋白(sST2)、低氧诱导因子(HIF)-1α水平与非ST段抬高型心肌梗死(NSTEMI)并发慢性心力衰竭患者预后的关系。方法 选取2020年6月至2023年5月在陕西省三二〇一医院就诊的NSTEMI并发慢性心力衰竭患者167例为研究对象。随访1年,根据预后情况分为死亡组(n=43)和生存组(n=124)。比较两组一般资料及血清sST2、HIF-1α水平,采用多因素logistic回归分析探讨NSTEMI并发慢性心力衰竭患者预后(死亡/生存)的影响因素,采用受试者操作特征(ROC)曲线分析sST2、HIF-1α对NSTEMI并发慢性心力衰竭患者死亡的预测价值。结果 死亡组患者心功能分级Ⅲ~Ⅳ级占比、白细胞计数(WBC)及血清超敏C反应蛋白(hs-CRP)、N末端B型钠尿肽前体(NT-proBNP)、sST2、HIF-1α水平高于生存组,而左心室射血分数(LVEF)低于生存组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,心功能分级Ⅲ~Ⅳ级占比及血清NT-proBNP、sST2、HIF-1α水平是NSTEMI并发慢性心力衰竭患者预后的独立影响因素(P<0.05)。ROC曲线分析显示,血清sST2、HIF-1α单独预测NSTEMI并发慢性心力衰竭患者死亡的曲线下面积(AUC)为0.734(95%CI0.649~0.812)、0.765(95%CI 0.681~0.847),两者联合预测的AUC为0.889(95%CI 0.792~0.938)。基于logistic回归分析的危险因素建立联合诊断模型,其AUC为0.920(95%CI 0.865~0.958)。联合诊断模型的预测效能较血清sST2、HIF-1α单独预测及两者联合预测均有所提高。结论 血清sST2、HIF-1α水平在NSTEMI并发慢性心力衰竭患者中异常升高,二者可作为预测患者预后的重要参考依据。Objective To investigate the relationship between serum soluble growth stimulation gene 2 protein(sST2),hypoxia inducible factor(HIF-1α)and prognosis of non-ST elevation myocardial infarction(NSTEMI)complicated with chronic heart failure.Method 167 NSTEMI patients with chronic heart failure were selected from 3201 Hospital of Shaanxi Province from June 2020 to May 2023.The patients were followed up for 1 year and divided into death group(n=43)and survival group(n=124).General data and serum sST2 and HIF-1αlevels were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors of death in NSTEMI patients with chronic heart failure.The predictive value of the two serum indicators in NSTEMI patients with chronic heart failure was analyzed by receiver operating characteristic(ROC)curve.Result The proportion of gradeⅢtoⅣ,white blood cell count(WBC),hypersensitive C-reactive protein(hs-CRP),N-terminal B-type natriuretic peptide precursor(NT-proBNP),sST2 and HIF-1αlevels in the death group were higher than those in the survival group,while the left ventricular ejection fraction(LVEF)was lower than that in the survival group,with statistical significance(P<0.05).Multivariate logistic regression model showed that cardiac function gradeⅢ~Ⅳ,high level of NT-proBNP,sST2 and HIF-1αwere independent risk factors for death in NSTEMI patients complicated with chronic heart failure(P<0.05).ROC curve showed that the AUC(95%CI)of serum sST2 and HIF-1αalone in predicting death of NSTEMI patients with chronic heart failure were 0.734(0.649~0.812)and 0.765(0.681~0.847).The combined forecast AUC(95%CI)is 0.889(0.792~0.938).The combined diagnosis model was established based on the risk factors of Logistic regression analysis model.The AUC(95%CI)predicted by the combined model was 0.920(0.865~0.958),and the prediction efficiency of the combined model was higher than that of serum sST2 and HIF-1αalone or combined.Conclusion The expression of serum sST2 and HIF-1αis abnormally eleva

关 键 词：非ST段抬高型心肌梗死 慢性心力衰竭 可溶性生长刺激表达基因2蛋白 低氧诱导因子-1Α 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]