血清Cystatin C、MMP-2及hs-CRP/PAB对急性心肌梗死患者PCI术后并发心衰的预测价值
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摘要
目的探究血清胱抑素C(Cystatin C)、基质金属蛋白酶-2(MMP-2)及超敏C-反应蛋白/前白蛋白(hsCRP/PAB)比值联合应用对急性心肌梗死(AMI)患者术后并发心衰(HF)的预测价值。方法回顾性分析143例AMI行PCI术患者和32例健康体检者的临床资料(正常对照组),将AMI患者分为2组,其中术后无HF患者65例(无HF组),术后并发HF患者78例(HF组),检测所有受试者血清中Cystatin C、MMP-2水平及hs-CRP/PAB比值。结果HF组血清中Cystatin C、MMP-2、hs-CRP水平以及hs-CRP/PAB显著高于正常对照组和无HF组(P <0. 05),HF组血清中PAB的水平显著低于正常对照组和无HF组(P <0. 05); AMI术后并发HF患者血清中Cystatin C、MMP-2以及hs-CRP/PAB与尿酸、Scr、Bun、SBP、DBP、c Tn T、CK-MB呈正相关(P <0. 05);且Cystatin C、MMP-2、hs-CRP/PAB、SBP、DBP、c Tn T、CK-MB是AMI术后并发HF的独立危险因素; ROC曲线分析表明,Cystatin C、MMP-2、hs-CRP/PAB以及3项联合检测对AMI术后并发HF预测的曲线下面积(AUC)为分别为0. 672、0. 687、0. 692、0. 854。结论 Cystatin C、MMP-2及hs-CRP/PAB比值联合检测在预测AMI术后并发HF中具有较高的应用价值,因此可以作为AMI术后并发HF诊断和治疗的血清标志物。
Objective To investigate the predictive value of combined detection of serum cystatin C( Cystatin C),matrix metalloproteinase 2( MMP-2) and hypersensitivity C reactive protein/prealbumin( hs-CRP/PAB) ratio in patients with acute myocardial infartion complicated by heart failure after percutanous coronary intervention( PCI). Methods The clinical data about 143 patients with AMI complicated by HF after PCI and 32 healthy subjects( control group) were retrospectively analyzed. The patients with AMI were divided into non-HF group( n = 65) and HF group( n = 78). The serum levels of Cystatin C,MMP-2 and the ratio of hs CRP/PAB were detected for all the subjects. Results The serum levels of Cystatin C,MMP-2 and hs CRP and hs-CRP/PAB ratio in HF group were significantly higher than those in control group and non-HF group( P < 0. 05),however,the serum levels of PAB were significantly lower than those in control group and non-HF group( P < 0. 05). Moreover,the serum levels of Cystatin C,MMP-2 and hs CRP/PAB in HF group were positively correlated with those of uric acid,Scr,Bun,SBP,DBP,c Tn T and CK MB( P < 0. 05),and Cystatin C,MMP-2,hs-CRP/PAB,SBP,DBP,c Tn T,CKMB were independent risk factors for patients with AMI complicated by HF after PCI. In addition,the ROC curve analysis showed that the area under the predicted curve( AUC) of Cystatin C,MMP-2,hs-CRP/PAB ratio and the combination detection of the three indexes were 0. 672,0. 687,0. 692 and 0. 854,respectively. Conclusion The combined detection of Cystatin C,MMP-2 and hs-CRP/PAB rato is highly valuable in predicting incidence of HF in patients with AMI after PCI,therefor,which can be regarded as the serum markers for diagnosis and treatment of HF in patients with AMI after PCI.
Objective To investigate the predictive value of combined detection of serum cystatin C( Cystatin C),matrix metalloproteinase 2( MMP-2) and hypersensitivity C reactive protein/prealbumin( hs-CRP/PAB) ratio in patients with acute myocardial infartion complicated by heart failure after percutanous coronary intervention( PCI). Methods The clinical data about 143 patients with AMI complicated by HF after PCI and 32 healthy subjects( control group) were retrospectively analyzed. The patients with AMI were divided into non-HF group( n = 65) and HF group( n = 78). The serum levels of Cystatin C,MMP-2 and the ratio of hs CRP/PAB were detected for all the subjects. Results The serum levels of Cystatin C,MMP-2 and hs CRP and hs-CRP/PAB ratio in HF group were significantly higher than those in control group and non-HF group( P < 0. 05),however,the serum levels of PAB were significantly lower than those in control group and non-HF group( P < 0. 05). Moreover,the serum levels of Cystatin C,MMP-2 and hs CRP/PAB in HF group were positively correlated with those of uric acid,Scr,Bun,SBP,DBP,c Tn T and CK MB( P < 0. 05),and Cystatin C,MMP-2,hs-CRP/PAB,SBP,DBP,c Tn T,CKMB were independent risk factors for patients with AMI complicated by HF after PCI. In addition,the ROC curve analysis showed that the area under the predicted curve( AUC) of Cystatin C,MMP-2,hs-CRP/PAB ratio and the combination detection of the three indexes were 0. 672,0. 687,0. 692 and 0. 854,respectively. Conclusion The combined detection of Cystatin C,MMP-2 and hs-CRP/PAB rato is highly valuable in predicting incidence of HF in patients with AMI after PCI,therefor,which can be regarded as the serum markers for diagnosis and treatment of HF in patients with AMI after PCI.
引文
1曹慧丽,白子良,杨滨.阿托伐他汀联合替罗非班治疗急性心肌梗死的疗效分析.中国药物与临床,2017,17:1034-1035.
2李慧,周静,万招飞,等.急性心肌梗死患者直接经皮冠状动脉介入术后心血管事件发生的影响因素研究现状.心肺血管病杂志,2017,36:785-788.
3李小荣,李新立.老年心力衰竭的诊断与治疗.中国实用内科杂志,2017,37:277-281.
4孔巴提·沙提别克,孟岩,王红.急性心肌梗死并发初诊心力衰竭住院患者的急性期生存率分析.中国医学前沿杂志:电子版,2016,8:59-62.
5邓伏雪,王小娟,胡云凤,等.急性心肌梗死并发首次心力衰竭患者在院死亡率及临床预后分析.西安交通大学学报(医学版),2015,36:135-140.
6 Rapaport E.Nomenclature and criteria for diagnosis of ischemic heart disease.Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature.Circulation,1979,59:607-609.
7急性心力衰竭诊断和治疗指南专家组.急性心力衰竭诊断和治疗指南.中国心血管病研究,2011,9:81-97.
8常丽萍,魏聪,贾振华.复方中药防治慢性心力衰竭的发展浅析.中国老年学,2016,36:4102-4105.
9姚丽,胡晨萍,吕旺,等.个体化心理干预对老年慢性心力衰竭患者的疗效观察.中国中西医结合急救杂志,2015,22:213-214.
10董磊,马红雨,孙立美,等.血清胱抑素C与β2-微球蛋白在诊断慢性肾病中的临床价值.标记免疫分析与临床,2017,24:8-11.
11李冠兰,彭涛,祝伶俐,等.血清Cys-C水平在不稳定型心绞痛患者中的临床意义.心脑血管病防治,2017,17:105-107.
12 Lassus J,Harjola VP.Cystatin C:a step forward in assessing kidney function and cardiovascular risk.Heart Failure Reviews,2012,17:251-261.
13吴敏,韩素霞.血清胱抑素C与心力衰竭.国际心血管病杂志,2014,41:356-358.
14刘丽丽.血清胱抑素C在急性心肌梗死并心力衰竭患者中的诊断价值.南昌大学,2016.
15沈伟伟,于俊民.心肌梗死后心肌纤维化分子机制研究进展.医学综述,2017,23:1249-1253.
16李飞,牛田,刘志刚,等.MMP-2及MMP-9与主动脉疾病相关性的研究进展.现代生物医学进展,2015,15:3577-3580.
17陈新军,刘洁琳,刘雅,等.瓣膜性心脏病患者血浆基质金属蛋白酶-2,9明胶酶谱与心力衰竭的相关性.心肺血管病杂志,2012,31:569-572.
18王红.血清C反应蛋白与心力衰竭相关性观察与分析.中西医结合心脑血管病杂志,2012,10:156-157.
19童桂兰,杨沛华,刘春文,等.血清前白蛋白的临床应用价值.中国中西医结合消化杂志,2012,20:232-234.
20 Chen D,Xu F,Lu S,et al.The relationship between serum C-reactive protein and pre-albumin and the acute heart failure during,the early stage of acute myocardial infarction patients.Chinese Journal of Emergency Medicine,2014,23:75-78.
21周兵,赵湛元.hs-CRP/PAB对急性心肌梗死患者发生心力衰竭的预测效果.河北医学,2015,21:1429-1433.
2李慧,周静,万招飞,等.急性心肌梗死患者直接经皮冠状动脉介入术后心血管事件发生的影响因素研究现状.心肺血管病杂志,2017,36:785-788.
3李小荣,李新立.老年心力衰竭的诊断与治疗.中国实用内科杂志,2017,37:277-281.
4孔巴提·沙提别克,孟岩,王红.急性心肌梗死并发初诊心力衰竭住院患者的急性期生存率分析.中国医学前沿杂志:电子版,2016,8:59-62.
5邓伏雪,王小娟,胡云凤,等.急性心肌梗死并发首次心力衰竭患者在院死亡率及临床预后分析.西安交通大学学报(医学版),2015,36:135-140.
6 Rapaport E.Nomenclature and criteria for diagnosis of ischemic heart disease.Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature.Circulation,1979,59:607-609.
7急性心力衰竭诊断和治疗指南专家组.急性心力衰竭诊断和治疗指南.中国心血管病研究,2011,9:81-97.
8常丽萍,魏聪,贾振华.复方中药防治慢性心力衰竭的发展浅析.中国老年学,2016,36:4102-4105.
9姚丽,胡晨萍,吕旺,等.个体化心理干预对老年慢性心力衰竭患者的疗效观察.中国中西医结合急救杂志,2015,22:213-214.
10董磊,马红雨,孙立美,等.血清胱抑素C与β2-微球蛋白在诊断慢性肾病中的临床价值.标记免疫分析与临床,2017,24:8-11.
11李冠兰,彭涛,祝伶俐,等.血清Cys-C水平在不稳定型心绞痛患者中的临床意义.心脑血管病防治,2017,17:105-107.
12 Lassus J,Harjola VP.Cystatin C:a step forward in assessing kidney function and cardiovascular risk.Heart Failure Reviews,2012,17:251-261.
13吴敏,韩素霞.血清胱抑素C与心力衰竭.国际心血管病杂志,2014,41:356-358.
14刘丽丽.血清胱抑素C在急性心肌梗死并心力衰竭患者中的诊断价值.南昌大学,2016.
15沈伟伟,于俊民.心肌梗死后心肌纤维化分子机制研究进展.医学综述,2017,23:1249-1253.
16李飞,牛田,刘志刚,等.MMP-2及MMP-9与主动脉疾病相关性的研究进展.现代生物医学进展,2015,15:3577-3580.
17陈新军,刘洁琳,刘雅,等.瓣膜性心脏病患者血浆基质金属蛋白酶-2,9明胶酶谱与心力衰竭的相关性.心肺血管病杂志,2012,31:569-572.
18王红.血清C反应蛋白与心力衰竭相关性观察与分析.中西医结合心脑血管病杂志,2012,10:156-157.
19童桂兰,杨沛华,刘春文,等.血清前白蛋白的临床应用价值.中国中西医结合消化杂志,2012,20:232-234.
20 Chen D,Xu F,Lu S,et al.The relationship between serum C-reactive protein and pre-albumin and the acute heart failure during,the early stage of acute myocardial infarction patients.Chinese Journal of Emergency Medicine,2014,23:75-78.
21周兵,赵湛元.hs-CRP/PAB对急性心肌梗死患者发生心力衰竭的预测效果.河北医学,2015,21:1429-1433.