sST2在经皮冠状动脉介入治疗ACS患者危险分层及预后评估中的价值

doi:10.3969/j.issn.1673-8640.2021.010.007

摘要/Abstract

摘要：

目的探讨可溶性生长刺激表达基因2（sST2）在不同类型急性冠状动脉综合征（ACS）患者危险分层及经皮冠状动脉介入治疗（PCI）术预后评估中的价值。方法选取ACS患者285例（ACS组）,包括不稳定型心绞痛（UA）患者84例（UA组）、非ST段抬高型心肌梗死（NSTEMI）患者86例（NSTEMI组）、ST段抬高型心肌梗死（STEMI）患者115例（STEMI组）,以排除ACS的胸痛患者80例作为对照组。所有患者均为发病12 h内行急诊PCI术,采用Gensini评分评估血管病变程度,采用全球急性冠状动脉事件注册（GRACE）评分进行风险评估。收集所有患者入院时的一般资料及生化项目检测结果,同时检测其血清sST2水平。对所有患者随访6个月,记录随访过程中是否发生主要不良心血管事件（MACE）。结果 ACS组血清sST2水平高于对照组（P<0.001）,且UA组、NSTEMI组、STEMI组之间差异均有统计学意义（P<0.05）。二分类Logistic回归分析结果显示,血清sST2、氨基末端B型钠尿肽原（NT-ProBNP）、心肌肌钙蛋白I（cTnI）、左室射血分数（LVEF）及GRACE评分是ACS患者近期发生MACE的独立危险因素[比值比（OR）值分别为1.004、1.019、0.995、0.898、1.009]。根据sST2水平和GRACE评分进行分组后,采用Kaplan-Meier生存曲线分析,结果显示sST2中低水平+GRACE评分低危的ACS患者总生存率最高,sST2高水平+GRACE评分中高危的ACS患者总生存率最低。结论血清sST2水平与心肌缺血和坏死的严重程度有关,是ACS患者发生MACE的独立危险因素。sST2或可作为心脏损伤的新型标志物。

关键词: 可溶性生长刺激表达基因2, 急性冠状动脉综合征, 全球急性冠状动脉事件注册评分, 主要不良心血管事件

Abstract:

Objective To analyze the role of risk stratification and prognosis of soluble growth stimulating express gene 2（sST2） in patients with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI）. Methods A total of 285 patients with ACS were enrolled,which included 84 cases of unstable angina（UA）,86 cases of non-ST-segment elevation myocardial infarction（NSTEMI） and 115 cases of ST-segment elevation myocardial infarction（STEMI）. The control group consisted of 80 patients with suspected ACS due to chest pain. All the patients underwent emergency PCI within 12 h of onset. The Gensini scoring system was used to score the degree of vascular lesions. Risk assessment was performed using the Global Registry of Acute Coronary Events（GRACE） scoring system upon admission. The sST2 and other biomarkers were determined. All the patients were followed for 6 months to record whether major adverse cardiovascular events（MACE） occurred or not during the follow-up period. Results The level of serum sST2 in ACS group was higher than that in control group（P<0.001）,and there was statistical significance among UA,NSTEMI and STEMI groups（P<0.05）. The results of binary Logistic regression analysis showed that serum sST2,amino-terminal pro-B-type natriuretic peptide（NT-proBNP）,cardiac troponin I（cTnI）,left ventricular ejection fraction（LVEF） and GRACE score were independent risk factors of MACE in ACS patients [odds ratios（OR） were 1.004,1.019,0.995,0.898 and 1.009]. The results of Kaplan-Meier survival curve showed that ACS patients with low expression of sST2 combined with low GRACE score had the highest overall survival rate,and those with high expression of sST2 combined with high GRACE score had the lowest overall survival rate. Conclusions Serum sST2 level in patients with ACS is related to the severity of myocardial ischemia and necrosis. It at admission is an independent risk factor for MACE in ACS patients. The indicator,sST2,may be a new biomarker for cardiac injury.

Key words: Soluble growth stimulating express gene 2, Acute coronary syndrome, Global Registry of Acute Coronary Events scoring system, Major adverse cardiovascular event

中图分类号:

R446.1

杜坤, 严健华, 陈铭, 杨俊瑶, 张广慧. sST2在经皮冠状动脉介入治疗ACS患者危险分层及预后评估中的价值[J]. 检验医学, 2021, 36(10): 1020-1025.

DU Kun, YAN Jianhua, CHEN Ming, YANG Junyao, ZHANG Guanghui. Role of risk stratification and prognosis of sST2 in acute coronary syndrome patients after percutaneous coronary intervention[J]. Laboratory Medicine, 2021, 36(10): 1020-1025.

图/表 5

参考文献 15

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组别	例数	BMI/ （kg/m²）	高血压史/ [例（%）]		吸烟史/ [例（%）]	饮酒史/ [例（%）]	糖尿病史/ [例（%）]	NT-proBNP/ （pg/mL）
UA组	84	25.2±3.6	48（57.1）		46（54.8）	44（52.4）	33（39.3）	1 457.6±238.53
NSTEMI组	86	24.8±3.4	47（54.6）		49（57.0）	45（52.3）	35（40.7）	1 349.7±194.65
STEMI组	115	26.1±3.5	71（61.7）		70（60.9）	63（54.8）	44（38.2）	1 531.6±227.92
对照组	80	25.3±3.6	26（32.5）		37（46.2）	43（53.7）	13（16.2）	134.4±37.65
统计值		0.384	4.152		12.236	4.539	2.563	7.420
P值		0.317	0.001		0.005	0.211	0.024	<0.001
组别		hs-CRP/ （mg/L）	cTnI/ （ng/mL）		HbA_1c/%	TC/ （mmol/L）	TG/ （mmol/L）	HDL-C/ （mmol/L）
UA组		10.4±3.2	0.09±0.04		7.58±2.34	4.65±0.80	1.63±0.83	1.24±0.42
NSTEMI组		9.6±3.7	1.33±0.42		7.86±2.47	4.67±0.70	1.58±0.81	1.18±0.37
STEMI组		11.2±4.6	1.56±0.52		7.38±2.19	4.78±0.86	1.57±0.76	1.17±0.64
对照组		5.6±4.2	0.015±0.01		5.74±1.43	4.58±0.90	1.53±0.67	1.23±0.53
统计值		9.225	13.218		1.854	1.664	0.783	2.112
P值		<0.001	<0.001		0.023	0.678	0.233	0.885
组别		LDL-C/（mmol/L）		eGFR/[mL（min·1.73 m²）]		LVEF/%	Gensini评分/分	GRACE评分/分
UA组		2.71±0.78		81.57±17.32		56.24±6.83	36.58±6.73	97.78±13.63
NSTEMI组		2.74±0.57		76.84±21.37		51.73±10.2	39.36±9.39	113.47±16.48
STEMI组		2.76±0.69		78.42±18.24		54.38±8.43	46.53±8.23	126.21±12.85
对照组		2.74±0.77		86.32±16.78		61.24±6.22
统计值		2.431		4.157		9.724	8.543	10.231
P值		0.845		0.438		<0.001	0.043	<0.001

组别	例数	BMI/ （kg/m²）	高血压史/ [例（%）]		吸烟史/ [例（%）]	饮酒史/ [例（%）]	糖尿病史/ [例（%）]	NT-proBNP/ （pg/mL）
UA组	84	25.2±3.6	48（57.1）		46（54.8）	44（52.4）	33（39.3）	1 457.6±238.53
NSTEMI组	86	24.8±3.4	47（54.6）		49（57.0）	45（52.3）	35（40.7）	1 349.7±194.65
STEMI组	115	26.1±3.5	71（61.7）		70（60.9）	63（54.8）	44（38.2）	1 531.6±227.92
对照组	80	25.3±3.6	26（32.5）		37（46.2）	43（53.7）	13（16.2）	134.4±37.65
统计值		0.384	4.152		12.236	4.539	2.563	7.420
P值		0.317	0.001		0.005	0.211	0.024	<0.001
组别		hs-CRP/ （mg/L）	cTnI/ （ng/mL）		HbA_1c/%	TC/ （mmol/L）	TG/ （mmol/L）	HDL-C/ （mmol/L）
UA组		10.4±3.2	0.09±0.04		7.58±2.34	4.65±0.80	1.63±0.83	1.24±0.42
NSTEMI组		9.6±3.7	1.33±0.42		7.86±2.47	4.67±0.70	1.58±0.81	1.18±0.37
STEMI组		11.2±4.6	1.56±0.52		7.38±2.19	4.78±0.86	1.57±0.76	1.17±0.64
对照组		5.6±4.2	0.015±0.01		5.74±1.43	4.58±0.90	1.53±0.67	1.23±0.53
统计值		9.225	13.218		1.854	1.664	0.783	2.112
P值		<0.001	<0.001		0.023	0.678	0.233	0.885
组别		LDL-C/（mmol/L）		eGFR/[mL（min·1.73 m²）]		LVEF/%	Gensini评分/分	GRACE评分/分
UA组		2.71±0.78		81.57±17.32		56.24±6.83	36.58±6.73	97.78±13.63
NSTEMI组		2.74±0.57		76.84±21.37		51.73±10.2	39.36±9.39	113.47±16.48
STEMI组		2.76±0.69		78.42±18.24		54.38±8.43	46.53±8.23	126.21±12.85
对照组		2.74±0.77		86.32±16.78		61.24±6.22
统计值		2.431		4.157		9.724	8.543	10.231
P值		0.845		0.438		<0.001	0.043	<0.001

变量	β值	标准误	Wald值	OR值（95%CI）	P值
sST2	0.007	0.003	8.439	1.004（1.004~1.011）	<0.001
NT-ProBNP	0.014	0.003	7.885	1.019（1.011~1.022）	0.001
cTnI	0.007	0.003	3.576	0.995（0.958~1.044）	0.034
LVEF	-0.043	0.004	5.304	0.898（0.879~0.966）	0.026
GRACE评分	0.033	0.032	4.677	1.009（0.998~1.025）	0.017
Gensini评分	0.008	0.009	1.984	1.002（0.993~1.056）	0.116

变量	β值	标准误	Wald值	OR值（95%CI）	P值
sST2	0.007	0.003	8.439	1.004（1.004~1.011）	<0.001
NT-ProBNP	0.014	0.003	7.885	1.019（1.011~1.022）	0.001
cTnI	0.007	0.003	3.576	0.995（0.958~1.044）	0.034
LVEF	-0.043	0.004	5.304	0.898（0.879~0.966）	0.026
GRACE评分	0.033	0.032	4.677	1.009（0.998~1.025）	0.017
Gensini评分	0.008	0.009	1.984	1.002（0.993~1.056）	0.116