急性ST段抬高型心肌梗死患者血清Sirt4水平与左心室重构及预后的关系  

Relationship between serum Sirt4 level and left ventricular remodeling and prognosis in patients with acute ST-segment elevation myocardial infarction

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作  者:崔晓敬 赵春梅 杨博 CUI Xiao-jing;ZHAO Chun-mei;YANG Bo(Department of Cardiovascular Medicine,Langfang Traditional Chinese Medicine Hospital,Langfang 065000,Hebei,China)

机构地区:[1]廊坊市中医医院心血管病科,河北廊坊065000

出  处:《广东医学》2025年第2期289-294,共6页Guangdong Medical Journal

基  金:廊坊市科学技术研究与发展计划项目(2022013047)。

摘  要:目的探究急性ST段抬高型心肌梗死(ASTEMI)患者血清沉默信息调节因子4(Sirt4)表达水平与左心室重构(VR)及预后的关系,为ASTEMI患者做好VR防治提供参考。方法收集接受PCI诊治的162例ASTEMI患者为对象。依据患者出院前24 h内血清Sirt4中位数值(3.10 ng/mL)将其分为高表达组(n=83例)和低表达组(n=79例)。分析Sirt4表达水平与氧化应激水平[超氧化物歧化酶(SOD)、8-羟基脱氧鸟苷(8-OHdG)、谷胱甘肽过氧化物酶(GSH-Px)]、心功能[左心室舒张末期容积(LVEDV)和左室射血分数(LVEF)]、VR及不良心血管事件(MACE)发生情况的关系。结果高表达组患者血清SOD[(62.94±8.69)nU/mL比(72.88±9.48)nU/mL]、GSH-Px[(593.05±102.34)U/L比(703.10±83.81)U/L]水平均明显低于低表达组,8-OHdG[(0.88±0.19)ng/mL比(0.72±0.23)ng/mL]水平明显高于低表达组(P均<0.01)。高表达组患者出院时[(103.4±16.9)mL比(95.6±20.77)mL]和术后12个月[(98.58±21.95)mL比(83.53±21.62)mL]时的LVEDVI均明显大于低表达组,LVEF水平[(44.00±4.52)%比(50.20±5.18)%、(51.85±3.60)%比(59.97±4.50)%]均明显低于低表达组(均P<0.05)。高表达组VR(27.1%比10.1%)和MACE(14.5%比3.8%)发生率均明显高于低表达组(P均<0.05)。血清Sirt4表达水平对术后VR和MACE发生具有一定预测价值(AUC=0.649、0.807,95%CI:0.556~0.741、0.690~0.925),敏感度90.3%和80.0%,特异度50.4%和74.8%,且预测价值与LVEF相当(均P>0.05)。结论血清Sirt4表达水平与ASTEMI患者机体氧化应激水平和VR、MACE发生存在一定相关性,其高表达可能通过促进心肌细胞线粒体氧自由基形成,抑制线粒体内抗氧化水平,参与VR发生。Objective To investigate the relationship between the expression level of Sirt4 and left ventricular remodeling(VR)and prognosis in patients with acute ST-segment elevation myocardial infarction(ASTEMI).Methods A total of 162 ASTEMI patients who received PCI treatment were collected.The patients were divided into high expression group(n=83)and low expression group(n=79)according to the median value of serum Sirt4(3.10 ng/mL)within 24 h before discharge.The correlations between the Sirt4 expression levels and oxidative stress levels,including superoxide dismutase(SOD),8-hydroxydeoxyguanosine(8-OHdG),and glutathione peroxidase(GSH-Px);cardiac function,including left ventricular end-diastolic volume(LVEDV)index and left ventricular ejection fraction(LVEF);VR,and adverse cardiovascular events(MACE),were analyzed.Results The high-expression group had significantly lower serum levels of SOD[(62.94±8.69)nU/mL vs.(72.88±9.48)nU/mL),GSH-Px(593.05±102.34)U/L vs.(703.10±83.81)U/L],and higher levels of 8-OHdG[(0.88±0.19)ng/mL vs.(0.72±0.23)ng/mL]compared to the low-expression group(P<0.01 for all).At discharge,the high-expression group had significantly higher LVEDV index[(103.4±16.9)mL vs.(95.6±20.77)mL]and at 12 months post-operation[(98.58±21.95)mL vs.(83.53±21.62)mL]compared to the low-expression group,while their LVEF levels[(44.00±4.52)%vs.(50.20±5.18)%,(51.85±3.60)%vs.(59.97±4.50)%]were significantly lower(P<0.05 for all).The incidence of VR(27.1%vs.10.1%)and MACE(14.5%vs.3.8%)was significantly higher in the high-expression group than in the low-expression group(P<0.05 for all).Serum Sirt4 levels showed predictive value for postoperative VR and MACE occurrence(AUC=0.649 and 0.807,95%CI:0.556-0.741,0.690-0.925;sensitivity 90.3%and 80.0%,specificity 50.4%and 74.8%),with predictive value comparable to LVEF(P>0.05 for both).Conclusion Serum Sirt4 expression levels are correlated with oxidative stress levels,left ventricular remodeling,and the occurrence of major adverse cardiovascular events in patients with

关 键 词:急性心肌梗死 ST段抬高 心室重构 不良心血管事件 沉默信息调节因子4 

分 类 号:R541.6[医药卫生—心血管疾病] R446.1[医药卫生—内科学]

 

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