摘要
目的分析H型高血压(HHT)合并急性心肌梗死(AMI)患者外周血弗林蛋白酶(Furin)、可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、中性粒细胞/淋巴细胞比值(NLR)与心肌损伤指标和预后不良的关系。方法选取2019年1月—2021年2月北京中医药大学房山医院心血管科收治的HHT合并AMI患者231例为HHT+AMI组,单纯HHT患者77例为HHT组,医院健康体检者52例为健康对照组。比较3组受试者外周血Furin、sTWEAK、NLR及血清心肌损伤指标[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)],并分析外周血Furin、sTWEAK、NLR与心肌损伤指标的相关性。随访1年统计HHT+AMI组患者主要不良心血管事件(MACE)发生情况,采用Logistic回归分析HHT合并AMI患者发生MACE的影响因素,绘制受试者工作特征曲线(ROC)分析三者对HHT合并AMI患者发生MACE的预测价值。结果外周血Furin、sTWEAK、NLR水平比较,HHT+AMI组>HHT组>健康对照组(F/P=981.029/<0.001、1032.486/<0.001、326.617/<0.001),MACE亚组高于非MACE亚组(t/P=19.498/<0.001、17.909/<0.001、2.507/<0.001);HHT+AMI组CK-MB水平高于HHT组和健康对照组,血清cTnI、NT-proBNP水平比较,HHT+AMI组>HHT组>健康对照组(F/P=580.966/<0.001、672.830/<0.001、463.233/<0.001);外周血Furin、sTWEAK、NLR与血清CK-MB、cTnI、NT-proBNP水平均呈显著正相关(Furin:r/P=0.713/<0.001、0.604/<0.001、0.515/<0.001;sTWEAK:r/P=0.412/0.002、0.533/<0.001、0.502/<0.001;NLR:r/P=0.513/<0.001、0.554/<0.001、0.481/<0.001);KillipⅢ/Ⅳ级、Gensini评分高、Furin高、sTWEAK高、NLR高均是导致HHT合并AMI患者MACE发生的独立危险因素[OR(95%CI)=1.725(1.178~2.524)、1.571(1.160~2.128)、2.412(1.527~3.806)、2.204(1.421~3.418)、1.784(1.213~2.624)]。外周血Furin、sTWEAK、NLR及三者联合检测预测HHT合并AMI患者发生MACE的曲线下面积(AUC)分别为0.740、0.715、0.693、0.841,三指标联合预测效能优于各指标单独检测(Z/P=2.038/0.042�
Objective To analyze the relationship between peripheral blood fulin(Furin),soluble tumor necrosis factor like weak apoptotic inducer(sTWEAK),neutrophil/lymphocyte ratio(NLR),myocardial injury indicators,and poor prognosis in patients with type H hypertension(HHT)and acute myocardial infarction(AMI).Methods Two hundred and thirty-one patients with HHT and AMI treated in the Cardiovascular Department of Fangshan Hospital,Beijing University of Chinese Medicine from January 2019 to February 2021 were selected as the HHT+AMI group,77 patients with HHT only were selected as the HHT group,and 52 healthy examinees from the hospital were selected as the healthy control group.The peripheral blood levels of Furin,sTWEAK,NLR,and serum myocardial injury indicators[creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-proBNP)]were compared among the three groups,and the correlation between peripheral blood levels of Furin,sTWEAK,NLR,and myocardial injury indicators was analyzed.The main adverse cardiovascular events(MACE)in the HHT+AMI group were recorded during a 1-year follow-up,and logistic regression was used to analyze the factors influencing the occurrence of MACE in HHT+AMI patients.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of the three factors for MACE in HHT+AMI patients.Results Comparison of peripheral blood Furin,sTWEAK,and NLR levels in HHT+AMI group>HHT group>healthy control group(F/P=981.029/<0.001,1032.486/<0.001,326.617/<0.001),and MACE subgroup was higher than non MACE subgroup(t/P=19.498/<0.001,17.909/<0.001,2.507/<0.001);The levels of CK-MB in HHT+AMI group were higher than those in HHT group and healthy control group,and the levels of serum cTnI and NT-proBNP in HHT+AMI group were higher than those in HHT group and healthy control group(F/P=580.966/<0.001,672.830/<0.001,463.233/<0.001);Peripheral blood Furin,sTWEAK,and NLR were significantly positively correlated with serum CK-MB,cTnI,and NT-proBNP(Furin:r/P=0
作者
刘红艳
杜玉杰
尤冉冉
孟祥慧
Liu Hongyan;Du Yujie;You Ranran;Meng Xianghui(Department of Cardiovascular,Fangshan Hospital of Beijing University of Traditional Chinese Medicine,Beijing 102400,China)
出处
《疑难病杂志》
CAS
2023年第4期343-349,372,共8页
Chinese Journal of Difficult and Complicated Cases
基金
北京市自然科学基金资助项目(7204278)。
