血浆中性粒细胞明胶酶相关脂质运载蛋白水平与急性ST段抬高型心肌梗死病变严重程度的关系

摘要

目的:探讨无肾脏疾病的急性ST段抬高型心肌梗死(STEMI)患者血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与基质金属蛋白酶-9(MMP-9)、高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-1β和冠状动脉(冠脉)狭窄程度的关系,及其识别冠脉病变严重程度的能力.方法:收集2014-01至2017-03在我院住院的STEMI患者124例(STEMI组),同期纳入没有明显冠脉狭窄的对照患者124例(对照组).再根据SYNTAX积分将STEMI患者分为高积分亚组(≥33分,n=26)和低积分亚组(<33分n=98).采用Spearman相关系数分析STEMI患者血浆NGAL水平与MMP-9水平、IL-1β水平和冠脉狭窄程度的关系.采用受试者工作特征(ROC)曲线评价血浆NGAL水平识别严重冠脉狭窄的能力.用Logistic回归分析影响SYNTAX积分的相关因素.结果:STEMI组患者血浆NGAL、MMP-9和hs-CRP水平显著高于对照组(P均<0.01),IL-1β水平在两组间差异无统计学意义(P=0.272).血浆NGAL水平与MMP-9水平(r=0.757,P<0.01)、SYNTAX积分(r=0.616,P<0.01)和IL-1β水平(r=0.185,P<0.05)均呈正相关.高积分亚组患者血浆NGAL和MMP-9水平显著高于低积分亚组(P均<0.01),而左心室射血分数明显低于低积分亚组(P<0.01).ROC曲线分析显示,在识别严重冠状动脉狭窄的STEMI患者能力方面,血浆NGAL(曲线下面积=0.881,95%Cl:0.813~0.949,P<0.01)大于血浆MMP-9(曲线下面积=0.799, 95%Cl:0.709~0.890,P<0.01)和hs-CRP(曲线下面积=0.446,95%Cl:0.306~0.587,P=0.400).多因素回归分析显示, STEMI患者血浆NGAL水平与高SYNTAX积分存在独立相关性(OR=1.115,95%Cl:1.107~1.123,P<0.01).结论:STEMI组患者血浆NGAL、MMP-9和hs-CRP水平较对照组显著增高,血浆NGAL水平与MMP-9水平、IL-1β水平和冠脉病变严重程度均呈正相关,在识别严重冠脉狭窄的STEMI患者能力方面NGAL优于MMP-9和hs-CRP.NGAL作为新的心脏领域的标志物有助于STEMI患者的危险分层.%Objective: To study the relationship between plasma levels of Neutrophil gelatinase- associated lipocalin (NGAL), matrix metalloproteinase (MMP-9), hs-CRP, IL-1β and the severity of coronary stenosis in acute ST-elevation myocardial infarction (STEMI) patients without kidney disease; to explore the ability for NGAL discriminating severe coronary stenosis. Methods: Our research included in 2 groups: STEMI group, n=124 patients admitted in our hospital from 2014-01 to 2017-03 and Control group, n=124 subjects without obvious coronary stenosis. According to SYNTAX score, the patients were divided into another set of 2 groups: High score group, patients with SYNTAX score ≥ 33, n=26 and Low score group, patients with SYNTAX score < 33, n = 98. Relationship between plasma levels of NGAL, MMP-9, hs-CRP, IL-1β and the severity of coronary stenosis were studied by Spearman correlation analysis; the ability for NGAL discriminating severe coronary stenosis was examined by ORC curve; the influencing factors for SYNTAX score were determined by Logistic regression analysis. Results: Compared with Control group, STEMI group had increased plasma levels of NGAL, MMP-9, hs-CRP, all P < 0.01,while IL-1β was similar between 2 groups, P=0.272. NGAL was positively related to MMP-9 (r=0.757, P<0.01), SYNTAX score (r=0.616, P<0.01) and IL-1β (r=0.185, P<0.05). Compared with Low score group, High score group showed the higher plasma levels of NGAL, MMP-9, both P<0.01, while the lower LVEF, P<0.01. The area under ROC curve for NGAL discriminating severe coronary stenosis was 0.881 (95% Cl 0.813-0.949, P<0.01) which was greater than MMP-9 [0.799 (95% Cl 0.709-0.890, P<0.01)] and hs-CRP [0.446 (95% Cl 0.306-0.587, P=0.400)]. Multivariate regression analysis presented that plasma NGAL level was independently related to high SYNTAX score [OR=1.115, 95% Cl (1.107-1.123), P<0.01]. Conclusion: STEMI patients had increased plasma levels of NGAL, MMP-9 and hs-CRP; NGAL had better ability for discriminating severe coronary stenosis than MMP-9 and hs-CRP. NGAL as a new biomarker should be helpful for risk stratification in STEMI patients.