摘要
目的探讨血清人软骨糖蛋白39(YKL-40)和可溶性生长刺激表达基因2蛋白(sST2)在老年急性心肌梗死患者中的表达及其与心肌纤维化和心肌损伤的关系。方法选择2020年1月至2023年4月东莞市中医院收治的急性心肌梗死患者212例(疾病组);收集同期本院健康志愿者80例为对照组。采集2组入院血清YKL-40和sST2以及心肌纤维化指标和心肌损伤指标,包括透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅲ型前胶原氨基端肽(PⅢNP)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和N末端B型钠尿肽前体(NT-proBNP)。分析血清YKL-40和sST2与心肌纤维化和心肌损伤的相关性。随访28d,疾病组又根据是否发生主要不良心血管事件(MACE)分为MACE组68例和非MACE组144例。多因素logistic回归分析血清YKL-40、sST2、心肌纤维化和心肌损伤对MACE的影响因素。结果疾病组血清YKL-40、sST2、PCⅢ、HA、PⅢNP、cTnI、CK-MB和NT-proBNP水平明显高于对照组,差异有统计学意义(P<0.01)。血清YKL-40、sST2均与PCⅢ、HA、PⅢNP、cTnI、CK-MB和NT-proBNP呈正相关。与非MACE组比较,MACE组YKL-40、sST2、PCⅢ、HA、PⅢNP、cTnI、CK-MB和NT-proBNP水平明显升高,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,YKL-40(OR=1.964,95%CI:1.643~2.348,P=0.000)、sST2(OR=2.457,95%CI:2.020~2.989,P=0.000)、PCⅢ(OR=1.654,95%CI:1.312~2.084,P=0.000)、HA(OR=1.505,95%CI:1.185~1.912,P=0.001)、PⅢNP(OR=1.483,95%CI:1.120~1.963,P=0.006)、cTnI(OR=1.365,95%CI:1.102~1.690,P=0.004)、CK-MB(OR=1.514,95%CI:1.009~2.272,P=0.045)和NT-proBNP(OR=1.824,95%CI:1.011~3.290,P=0.046)是老年急性心肌梗死患者MACE发生的影响因素。结论血清YKL-40和sST2在老年急性梗死患者中异常高表达,且与心肌纤维化和心肌损伤密切相关。
Objective To investigate the expression of serum human cartilage glycoprotein 39(YKL-40)and soluble growth stimulating gene 2protein(sST2)in elderly patients with acute myocardial infarction(AMI)and their relationship with myocardial fibrosis and myocardial injury.Methods From January 2020to April 2023,a cohort of 212AMI patients admitted in Department of Cardiovascular Diseases of Dongguan Hospital of Traditional Chinese Medicine were enrolled and assigned into the patient group,and another 80ostensibly healthy volunteers taking physical examinations during the same period were subjected and served as control group.Serum levels of YKL-40and sST2and the indicators related myocardial fibrosis and injury[including hyaluronic acid(HA),typeⅢprocollagen(PCⅢ),typeⅢprocollagen amino terminal peptide(PⅢNP),cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),and N-terminal B-type natriuretic peptide precursor(NT-proBNP)]at admission were detected,and the correlation of serum YKL-40 and sST2levels with myocardial fibrosis and injury was analyzed.According the occurrence of major adverse cardiovascular events(MACE)during 28-day follow-up,the patients were stratified into MACE(68cases)and non-MACE(144cases)subgroups.Multivariate logistic regression analysis was employed to analyze the determinants of serum YKL-40,sST2,myocardial fibrosis,and myocardial injury to the occurrence of MACE.Results The patients had significantly higher serum levels of YKL-40,sST2,PCⅢ,HA,PⅢNP,cTnI,CK-MB and NT-proBNP than the control group(P<0.01).Both serum YKL-40and sST2levels were positively correlated with the levels of PCⅢ,HA,PⅢNP,cTnI,CK-MB and NT-proBNP.The serum levels of YKL-40,sST2,PCⅢ,HA,PⅢNP,cTnI,CK-MB and NT-proBNP were obviously higher in the MACE sub group than the non-MACE sub group(P<0.01).Multivariate logistic regression analysis indicated that YKL-40(OR=1.964,95%CI:1.643-2.348,P=0.000),sST2(OR=2.457,95%CI:2.020-2.989,P=0.000),PCⅢ(OR=1.654,95%CI:1.312-2.084,P=0.000),HA(OR=1.505,95%CI:1.185-1.912,P=0.001
作者
伦柱斌
叶健烽
Lun Zhubin;Ye Jianfeng(First Clinical College of Guangdong Medical University,Dongguan 523808,Guangdong Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第5期499-503,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
东莞市社会发展科技项目(20231800935442)。
