血浆RIPK3水平对急性心肌梗死患者PCI术后远期预后的影响  

Effect of plasma RIPK3 levels on long-term prognosis in patients with acute myocardial infarction undergoing percutaneous coronary intervention

作　　者：王泽源 芦阳 张文佳 张俊霞 张舒媛 任笑雨 柏瑞莲 顾呈英 吴家博 刘震宇 田庄 张抒扬[1] Wang Zeyuan;Lu Yang;Zhang Wenjia;Zhang Junxia;Zhang Shuyuan;Ren Xiaoyu;Bai Ruilian;Gu Chengying;Wu Jiabo;Liu Zhenyu;Tian Zhuang;Zhang Shuyang(Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,National Key Laboratory of Complex Disease and Rare Disorders,Beijing 100730,China;State Key Laboratory of Vascular Homeostasis and Remodeling,Peking University Basic Medical Sciences,Beijing 100191,China;Department of Cardiology,Peking University Third Hospital,State Key Laboratory of Vascular Homeostasis and Remodeling,Beijing 100191,China)

机构地区：[1]中国医学科学院北京协和医院心内科疑难重症及罕见病全国重点实验室,北京100730 [2]北京大学基础医学院血管稳态与重构全国重点实验室,北京100191 [3]北京大学第三医院心内科血管稳态与重构全国重点实验室,北京100191

出　　处：《中华心血管病杂志》2025年第3期268-273,共6页Chinese Journal of Cardiology

基　　金：中央高校基本科研业务费专项资金(3332024124);国家高水平医院临床研究基金(2022-PUMCH-D-002);中国医学科学院医学与健康科技创新工程(2021-I2M-1-003)。

摘　　要：目的 探讨急性心肌梗死患者(AMI)经皮冠状动脉介入治疗(PCI)术后受体相互作用蛋白激酶3(RIPK3)对主要不良心血管事件(MACE)的影响, 以及RIPK3联合传统心血管危险因素的预测效能。方法 本研究为单中心前瞻性队列研究。纳入2017年9至11月在北京协和医院接受PCI治疗的AMI患者。收集患者的基本临床资料, 在术后6 h采集血浆样本, 测定RIPK3水平。出院后通过门诊或电话进行随访, 记录患者MACE发生情况, 包括心血管死亡、因心力衰竭住院和血管事件(再发AMI或卒中)。通过受试者工作特征曲线比较RIPK3、传统心血管因素及二者联合对MACE的预测效能, 并根据RIPK3最佳截断值将患者分为RIPK3低水平组和高水平组。采用多因素Cox比例风险回归模型分析RIPK3水平对AMI患者PCI术后MACE的影响。绘制Kaplan-Meier生存曲线, 采用log-rank法比较RIPK3低水平组和高水平组的MACE发生率。结果 纳入103例接受PCI的AMI患者, 年龄为63.0(56.0, 69.0)岁, 男性83例(80.6%)。随访时间为5.17(2.81, 5.17)年, 共44例(42.7%)发生MACE。受试者工作特征曲线显示传统心血管危险因素的曲线下面积(AUC)为0.68(95%CI:0.58~0.78), PCI术后6 h血浆RIPK3的AUC为0.72(95%CI:0.62~0.82)。上述两者联合的AUC为0.75(95%CI:0.65~0.85)。多因素Cox比例风险回归模型分析显示, 在调整了传统心血管危险因素后,RIPK3≥最佳截断值440.9 μg/L(HR=3.31, 95%CI:1.53~8.30, P=0.005)是AMI患者PCI术后发生MACE的独立危险因素。Kaplan-Meier生存分析显示RIPK3高水平组的AMI患者PCI术后发生MACE的风险高于RIPK3低水平组(log-rankP=0.006)。结论 RIPK3升高是AMI患者PCI术后发生MACE的独立危险因素。RIPK3水平联合传统心血管危险因素可以更有效地预测AMI患者PCI术后MACE的发生。RIPK3≥440.9 μg/L的AMI患者PCI术后发生MACE的风险高于RIPK3低水平者。Objective To investigate the impact of receptor-interacting protein kinase 3(RIPK3)on major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),as well as the predictive performance of RIPK3 combined with traditional cardiovascular risk factors.Methods This study was a single-center prospective cohort study.It included patients with AMI who underwent PCI at Peking Union Medical College Hospital between September 2017 and November 2017.Baseline clinical data were collected,and plasma samples were obtained 6 hours after PCI to measure RIPK3 levels.Follow-up was conducted via outpatient visits or phone calls to record the occurrence of MACE,including cardiovascular death,hospitalization for heart failure,and vascular events(recurrent AMI or stroke).The predictive performance of RIPK3,traditional cardiovascular risk factors and their combination for MACE was compared using receiver operating characteristic(ROC)curves.Patients were divided into low-and high-RIPK3 level groups based on the optimal cutoff value of RIPK3.Multivariate Cox proportional hazards regression analysis was used to assess the impact of RIPK3 levels on MACE after PCI in AMI patients.Kaplan-Meier survival curves were plotted,and the log-rank test was used to compare MACE incidence between the low-and high-RIPK3 groups.Results A total of 103 AMI patients who underwent PCI were included,aged 63.0(56.0,69.0)years,and 83(80.6%)were male.The follow-up time was 5.17(2.81,5.17)years,during which 44 patients(42.7%)experienced MACE.The ROC curve analysis showed that the area under the curve(AUC)for traditional cardiovascular risk factors was 0.68(95%Cl:0.58-0.78),while the AUC for plasma RIPK3 was 0.72(95%CI:0.62-0.82).The combined AUC for traditional risk factors and RIPK3 was 0.75(95%Cl:0.65-0.85).Multivariate Cox proportional hazards regression analysis indicated that plasma RIPK3 level is greater than or equal to the optimal cutoff value of 440.9μg/L(HR=3.31,95%CI:1.53-8.30,P

关 键 词：心肌梗死 受体相互作用蛋白激酶3 经皮冠状动脉介入治疗 预后 危险因素 

分 类 号：R54[医药卫生—心血管疾病]