血清SFRP5、KLK1联合检测对ST段抬高心肌梗死患者PCI术后无复流的预测价值

doi:10.3969/j.issn.1673-8640.2025.01.015

摘要/Abstract

摘要：

目的探讨血清分泌型卷曲相关蛋白5（SFRP5）、组织激肽释放酶1（KLK1）对ST段抬高心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后无复流的预测价值。方法选取2022年1月—2023年7月南宁市第八人民医院行PCI术的STEMI患者156例（STEMI组）和健康体检者156名（正常对照组）。收集所有研究对象的临床资料和实验室常规项目检测结果，并检测血清SFRP5、KLK1水平。根据STEMI患者PCI术后3个月的心肌梗死溶栓治疗（TIMI）分级分为复流组（132例，TIMI 3级）和无复流组（24例，TIMI 0~2级）。采用Pearson相关分析评估各项指标之间的相关性。采用多因素Logistic回归分析评估STEMI患者PCI术后无复流的影响因素。采用受试者工作特征（ROC）曲线评价血清SFRP5、KLK1判断STEMI患者PCI术后无复流的效能。结果与正常对照组比较，STEMI组PCI术前、术后血清SFRP5、KLK1水平均降低（P<0.05）。复流组血清SFRP5、KLK1水平高于无复流组（P<0.001），肌酸激酶MB同工酶（CK-MB）、心肌肌钙蛋白I（cTnI）、血小板（PLT）计数和Gensini积分、急性冠状动脉综合征风险评分（GRACE）均低于无复流组（P<0.05）。血清SFRP5、KLK1与CK-MB、cTnI、PLT计数、Gensini积分、GRACE评分均呈负相关（P<0.05）。SFRP5、KLK1水平降低是STEMI患者PCI术后无复流的危险因素[比值比（OR）值分别为0.514、0.601，95%可信区间（CI）分别为0.374~0.707、0.435~0.831，P<0.05]。血清SFRP5、KLK1单项检测和联合检测判断STEMI患者PCI术后无复流的曲线下面积（AUC）分别为0.881、0.885、0.949。结论 PCI术后无复流的STEMI患者血清SFRP5、KLK1水平降低，二者联合检测对STEMI患者PCI术后无复流有较好的预测价值。

Abstract:

Objective To analyze the predictive value of combined determination of serum secreted frizzled-related protein-5（SFRP5） and Kallikrein 1（KLK1） for myocardial no-reflow after percutaneous coronary intervention（PCI） in patients with ST-segment elevation myocardial infarction（STEMI）. Methods A total of 156 STEMI patients underwent PCI and 156 healthy subjects in Nanning Eighth People's Hospital from January 2022 to July 2023 were enrolled. The clinical data and laboratory routine determination results of all the patients were collected，and serum SFRP5 and KLK1 levels were determined. STEMI patients were classified into reflow group [132 cases，the Thrombolysis in Myocardial Infarction（TIMI） grade 3] and no-reflow group（24 cases，TIMI grade 0-2） according to TIMI grades 3 months after PCI. Pearson correlation analysis was used to evaluate the correlation among the indicators. Multivariate Logistic regression was used to analyze the influencing factors of no-reflow after PCI in STEMI patients. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of serum SFRP5 and KLK1 in determining no-reflow after PCI in STEMI patients. Results Compared with healthy control group，serum SFRP5 and KLK1 levels in STEMI group were decreased before and after PCI（P<0.05）. Serum levels of SFRP5 and KLK1 in reflow group were higher than those in no-reflow group（P<0.001）. The creatine kinase-MB isoenzyme（CK-MB），cardiac troponin I（cTnI），platelet（PLT）count，Gensini scores and the Global Registry of Acute Coronary Events（GRACE）scores in reflow group were lower than those in no-reflow group（P<0.05）. Serum SFRP5 and KLK1 were negatively correlated with CK-MB，cTnI，PLT count，Gensini score and GRACE score（P<0.05）. Decreased SFRP5 and KLK1 were risk factors for STEMI patients without reflow after PCI [odds ratios（OR） were 0.514 and 0.601，95% confidence intervals（CI） were 0.374-0.707 and 0.435-0.831，respectively，P<0.05]. The areas under curves（AUC） of serum SFRP5 and KLK1 without reflow after PCI in STEMI patients were 0.881，0.885 and 0.949，respectively. Conclusions Serum levels of SFRP5 and KLK1 are lower in STEMI patients with myocardial no-reflow after PCI，and SFRP5 and KLK1 have certain predictive values for myocardial no-reflow in STEMI patients after PCI.

Key words: Secreted frizzled-related protein-5, Kallikrein 1, Acute myocardial infarction, Percutaneous coronary intervention, Myocardial no-reflow

中图分类号:

R446.1

陈定中, 杨雯, 冯燕菊, 梁先, 张小珍. 血清SFRP5、KLK1联合检测对ST段抬高心肌梗死患者PCI术后无复流的预测价值[J]. 检验医学, 2025, 40(1): 84-89.

CHEN Dingzhong, YANG Wen, FENG Yanju, LIANG Xian, ZHANG Xiaozhen. Predictive value of combined determination of serum SFRP5 and KLK1 for myocardial no-reflow after PCI in patients with ST-segment elevation myocardial infarction[J]. Laboratory Medicine, 2025, 40(1): 84-89.

图/表 7

参考文献 21

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组别	例数	SFRP5/（ng·mL^-1）	KLK1/（ng·L^-1）
正常对照组	156	43.83±4.12	35.26±3.04
STEMI组	156
术前		32.71±3.85^*	24.77±2.93^*
术后		33.18±3.97^*	25.34±3.06^*

组别	例数	SFRP5/（ng·mL^-1）	KLK1/（ng·L^-1）
正常对照组	156	43.83±4.12	35.26±3.04
STEMI组	156
术前		32.71±3.85^*	24.77±2.93^*
术后		33.18±3.97^*	25.34±3.06^*

组别	例数	SFRP5/（ng·mL^-1）	KLK1/（ng·L^-1）
复流组	132	33.72±4.07	25.68±3.47
无复流组	24	27.16±2.42	19.75±2.51
t值		7.642	7.991
P值		<0.001	<0.001

组别	例数	SFRP5/（ng·mL^-1）	KLK1/（ng·L^-1）
复流组	132	33.72±4.07	25.68±3.47
无复流组	24	27.16±2.42	19.75±2.51
t值		7.642	7.991
P值		<0.001	<0.001

组别	例数	性别			年龄/岁		BMI/（kg·m^-2）			基础疾病
组别	例数	男/[例（%）]	女/[例（%）]		年龄/岁		BMI/（kg·m^-2）			高血压/ [例（%）]			糖尿病/ [例（%）]	高脂血症/[例（%）]
复流组	132	105（79.55）	27（20.45）		54.74±7.91		24.32±2.56			45（34.09）			33（25.00）	34（25.76）
无复流组	24	18（75.00）	6（25.00）		54.82±7.98		24.41±2.71			11（45.83）			7（29.17）	9（37.50）
统计值		0.252			0.046		0.157			1.217			0.185	1.402
P值		0.616			0.964		0.875			0.270			0.667	0.236
组别	发病至手术时间/h	吸烟史/ [例（%）]		饮酒史/ [例（%）]		GRACE评分/分		Gensini积分/分			CK-MB/（U·L^-1）			cTnI/ （μg·L^-1）
复流组	6.11±0.85	42（31.82）		49（37.12）		118.56±13.85		69.83±13.25			172.36±37.15			10.75±2.73
无复流组	6.13±0.93	9（37.50）		8（33.33）		127.05±15.17		91.47±14.38			191.47±41.63			12.13±3.15
统计值	0.105	0.298		0.126		2.722		7.264			2.275			2.224
P值	0.917	0.585		0.723		0.007		<0.001			0.024			0.028
组别	Myo/ （μg·L^-1）	BNP/（pg·mL^-1）	PLT计数/（×10⁹·L^-1）		WBC计数/（×10⁹·L^-1）				SCr/（μmol·L^-1）			Cys C/（mg·L^-1）	Hcy/（μmol·L^-1）	DD/ （μg·L^-1）
复流组	186.12±20.14	1122.75±214.32	214.75±32.56		10.42±3.72				121.28±31.51			4.49±1.26	35.32±5.39	325.71±50.76
无复流组	187.25±20.23	1140.53±223.57	232.47±33.61		10.53±3.75				130.15±27.29			5.02±1.41	37.21±5.28	328.43±52.51
统计值	0.253	0.371	2.441		0.133				1.293			1.861	1.585	0.240
P值	0.801	0.711	0.016		0.894				0.198			0.065	0.115	0.810