血清可溶性致癌抑制因子2水平与急性ST段抬高型心肌梗死患者近期临床预后的相关性研究

摘要

Objective: To preliminarily investigate the relationship between the baseline level of serum soluble ST2 (sST2) and 30-day MACE occurrence rate in patients with ST-elevation myocardial infarction (STEMI). Methods: A total of 121 patients with confirmed diagnosis of STEMI in our hospital from 2015-05-01 to 2015-07-30 were consecutively enrolled. According to baseline sST2 level, the patients were divided into 2 groups:Low sST2 group, the patients with sST2≤56.68 ng/ml, n=61 and High sST2 group, the patients with sST2>56.68 ng/ml, n=60. Clinical condition and 30-day MACE (defined as death and new onset of congestive heart failure) occurrence rate were compared between 2 groups. Results: ① The systolic blood pressure (SBP), Killip class≥II grade, blood levels of cTNI, NT-proBNP, hs-CRP and LVEF were different between 2 groups, all P<0.05. ② Baseline sST2 level was positively related to heart rate (r=0.271, P=0.003), Hs-CRP (r=0.359, P=0.000), cTNI (r=0.324, P=0.000) and NT-proBNP (r=0.425, P=0.000);negatively related to SBP (r=-0.226, P=0.013) and LVEF (r=-0.406, P=0.000).③30-day MACE occurrence rate was different between 2 groups (8.2%vs 30%, P=0.002). ④ Multivariate Cox regression analysis presented that sST2>56.68 ng/ml was the risk factor for 30-day MACE occurrence (HR=1.152, 95%CI 1.078-1.231, P=0.000). Conclusion: Increased baseline level of sST2 implied the higher incidence of death and new onset of congestive heart failure in STEMI patients.%目的：本研究初步探讨基线可溶性致癌抑制因子2（sST2）水平与急性ST段抬高型心肌梗死（STEMI）患者30 d主要不良心血管事件（MACE）发生的关系。　　方法：连续入组2015-05-01至2015-07-30期间就诊我院并明确诊断STEMI患者121例。依据基线sST2中位数水平分为sST2低值组（sST2≤56.68 ng/ml，n=61）、sST2高值组（sST2＞56.68 ng/ml，n=60）。比较两组患者的临床资料及30 d的MACE（定义为死亡、新发慢性心力衰竭）发生率。　　结果：（1）两组在收缩压、Killip心功能分级≥Ⅱ级、血清肌钙蛋白I峰值、N末端B型利钠肽原（NT-proBNP）、超敏C反应蛋白（hs-CRP）、左心室射血分数（LVEF）等方面差异均有统计学意义（P均<0.05）。（2）基线sST2水平与心率（r=0.271，P=0.003）、hs-CRP（r=0.359，P=0.000）、肌钙蛋白I（r=0.324，P=0.000）及NT-proBNP（r=0.425， P=0.000）均呈正相关；与收缩压（r=-0.226，P=0.013）及LVEF（r=-0.406，P=0.000）均呈负相关。（3）sST2低值组MACE发生率（8.2%）低于sST2高值组（30%），差异有统计学意义（P=0.002）。（4）多因素Cox回归分析显示sST2>56.68 ng/ml是STEMI患者30 d出现MACE的危险因素（危险比=1.152，95%可信区间：1.078~1.231，P=0.000）。　　结论：STEMI患者基线sST2水平升高提示近期死亡及新发心力衰竭风险增加。