急性心肌梗死再血管化成功后预测左心室重构相关生物标志物的分析
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摘要
目的·探讨急性心肌梗死(acute myocardial infarction,AMI)后预测左心室重构(left ventricular remodeling,LVR)的相关生物标志物。方法·连续纳入2015年1月1日至2016年1月1日上海交通大学附属第六人民医院心脏中心收治的AMI并成功接受急诊经皮冠状动脉介入治疗(排除右冠状动脉相关AMI)的患者220例,采集入院和AMI后1年的超声心动图,定义AMI后1年左心室舒张末期容积(left ventricular end diastolic volume,LVEDV)较入院时增加大于20%为LVR。将AMI患者分为LVR组与non-LVR组,比较2组患者在院的心肌损伤标志物及炎症因子间的差别,分析其与LVR的相关性。结果·与non-LVR组相比,LVR组患者入院即刻及峰值血清肌钙蛋白I(serum cardiac troponin I,cTnI)、MB型磷酸肌酸(creatine kinase MB,CKMB)、肌红蛋白、中性粒细胞与单核细胞比值、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)均显著升高(均P<0.05),但是2组间脑钠肽前体(brain natriuretic peptide precursor,proBNP)和脑钠肽(brain natriuretic peptide,BNP)水平的差异无统计学意义。Logistic回归分析显示即刻c TnI及NLR与LVR显著相关。ROC曲线显示入院即刻cTnI曲线下面积(AUC)为0.704,截断点为9.14μg/L时,预测LVR的灵敏度和特异度分别为69.2%和64.3%;NLR的AUC为0.664,截断点为5.87%时,预测LVR的灵敏度和特异度分别为70.6%和60.2%。结论·AMI患者入院时血清即刻cTnI及NLR水平升高是预测LVR的独立因子,具有较好的诊断价值。
Objective · To investigate the correlation between the biomarkers and left ventricular remodeling(LVR) in patients after acute myocardial infarction(AMI). Methods · 220 patients with AMI who were admitted in the Department of Cardiology of the Shanghai Sixth People's Hospital from January1 st, 2015 to January 1 st, 2016 and received successful primary percutaneous coronary intervention were included in this study sequentially. AMI patients due to right coronary artery were excluded. LVR after AMI was defined as more than 20% increase of the left ventricular end diastolic volume(LVEDV) measured by echocardiogram in 1-year-follow-up compared with LVEDV at admission. Patients were divided into LVR group and non-LVR group. The differences of myocardial injury markers and inflammatory factors between the two groups were compared, and the correlation between LVR and the biomarkers was analyzed. Results · Compared with the non-LVR group, the cTnI(serum cardiac troponin I), CKMB(creatine kinase MB) and myoglobin levels at admission and peaks, as well as neutrophil to monocyte ratio and neutrophil to lymphocyte ratio(NLR) in the LVR group were increased significantly(all P<0.05). There was no significant difference in proBNP(brain natriuretic peptide precursor) and BNP levels between the two groups. Logistic regression analysis showed that c Tn I and NLR at admission were correlated well with LVR. ROC curve analysis showed that the area under the cTnIadmission curve(AUC) was 0.704, and the sensitivity and specificity of cTnIadmission to predict LVR after AMI were 69.2% and 64.3% respectively, when 9.14 μg/L was chosen as the cut-off point. The area under the NLR curve(AUC) was 0.664, and the sensitivity and specificity of NLR were 70.6% and 60.2% respectively, when 5.87% was chosen as the cut-off point. Conclusion · The increased levels of cTnI and NLR at admission in patients with AMI are independent predictors of LVR.
Objective · To investigate the correlation between the biomarkers and left ventricular remodeling(LVR) in patients after acute myocardial infarction(AMI). Methods · 220 patients with AMI who were admitted in the Department of Cardiology of the Shanghai Sixth People's Hospital from January1 st, 2015 to January 1 st, 2016 and received successful primary percutaneous coronary intervention were included in this study sequentially. AMI patients due to right coronary artery were excluded. LVR after AMI was defined as more than 20% increase of the left ventricular end diastolic volume(LVEDV) measured by echocardiogram in 1-year-follow-up compared with LVEDV at admission. Patients were divided into LVR group and non-LVR group. The differences of myocardial injury markers and inflammatory factors between the two groups were compared, and the correlation between LVR and the biomarkers was analyzed. Results · Compared with the non-LVR group, the cTnI(serum cardiac troponin I), CKMB(creatine kinase MB) and myoglobin levels at admission and peaks, as well as neutrophil to monocyte ratio and neutrophil to lymphocyte ratio(NLR) in the LVR group were increased significantly(all P<0.05). There was no significant difference in proBNP(brain natriuretic peptide precursor) and BNP levels between the two groups. Logistic regression analysis showed that c Tn I and NLR at admission were correlated well with LVR. ROC curve analysis showed that the area under the cTnIadmission curve(AUC) was 0.704, and the sensitivity and specificity of cTnIadmission to predict LVR after AMI were 69.2% and 64.3% respectively, when 9.14 μg/L was chosen as the cut-off point. The area under the NLR curve(AUC) was 0.664, and the sensitivity and specificity of NLR were 70.6% and 60.2% respectively, when 5.87% was chosen as the cut-off point. Conclusion · The increased levels of cTnI and NLR at admission in patients with AMI are independent predictors of LVR.
引文
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[14]代佩灵,张翠丽,富路.急性心肌梗死早期生化标志物的研究进展[J].医学综述,2013,7(19):1228-1231.
[15]Türko?lu C,Gür M,?eker T,et al.The predictive value of M30 and oxidative stress for left ventricular remodeling in patients with anterior ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention[J].Coron Artery Dis,2016,27(8):690-695.
[16]Liu X,Yuan L,Chen F,et al.Circulating miR-208b:a potentially sensitive and reliable biomarker for the diagnosis and prognosis of acute myocardial infarction[J].Clin Lab,2017,63(1):101-109.
[17]Grufman H,Yndigegn T,Gon?alves I,et al.Elevated IL-27 in patients with acute coronary syndrome is associated with adverse ventricular remodeling and increased risk of recurrent myocardial infarction and cardiovascular death[J].Cytokine,2018.DOI:10.1016/j.cyto.2017.11.002.
[18]刘恩华,陈怀敏,孔丽清,等.急性心肌梗死患者心肌损伤标志物动态监测价值的比较[J].标记免疫分析与临床,2010,17(2):65.
[19]马依彤,霍勇,杨毅宁,等.心脏标志物临床应用进展[M].北京:人民卫生出版社,2009:1-14.
[20]Hallén J,Jensen JK,Fagerland MW,et al.Cardiac troponin I for the prediction of functional recovery and left ventricular remodelling following primary percutaneous coronary intervention for ST-elevation myocardial infarction[J].Heart,2010,96(23):1892-1897.
[21]Bassan R,Potsch A,Maisel A,et al.B-type nartiuretic peptide:a novel early blood marker of acute myocardial infarction in patients with chest pain and non ST-segment elevation[J].Eur Heart J,2005,26(3):234-240.
[22]Inoue T,Sakuma M,Yaguchi I,et al.Early recanalization and plasma brain natriuretic peptide as an indicator of left ventricular function after acute myocardial infarction[J].Am Heart J,2002,143(5):790-796.
[23]Duffy BK,Gurm HS,Rajagopal V,et al.Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous conranry intervention[J].Am J Cardiol,2006,97(7):933-996.
[24]Arbel Y,Finkelstein A,Halkin A,et al.Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography[J].Atherosclerosis,2012,225(2):456-460.
[25]Tanlndl A,Erkan AF,Ekici B,et al.Neutrophil to lymphocyte ratio is associated with more extensive,severe and complex coronary artery disease and impaired myocardial perfusion[J].Turk Kardiyol Dern Ars,2014,42(2):125-130.
[26]B?rek?i A,Gür M,Türko?lu C,et al.Neutrophil to lymphocyte ratio predicts left ventricular remodeling in patients with ST elevation myocardial infarction after primary percutaneous coronary intervention[J].Korean Circ J,2016,46(1):15-22.
[2]祝善俊.心肌梗死后心肌重构防治进展[J].岭南心血管病杂志,2001,7(5):321-323.
[3]Ryabova TR,Sokolov AA,Dudko VA,et al.Dynamics of left ventricular remodeling in patients with acute myocardial infarction[J].Kardiologiia,2002,42(9):30-34.
[4]Van Diepen S,Roe MT,Lopes RD,et al.Baseline NT-proBNP and biomarkers of inflammation and necrosis in patients with ST-segment elevation myocardial infarction:insights from the APEX-AMI trial[J].J Thromb Thrombolysis,2012,34(1):106-113.
[5]Horne BD,Anderson JL,John JM,et al.Which white blood cell subtypes predict increased cardiovascular risk?[J].Am Coll Cardiol,2005,45(10):1638-1643.
[6]中华医学会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-392.
[7]中华医学会.非ST段抬高急性冠脉综合征诊断和治疗指南[J].中华心血管病杂志,2012,40(5):353-367.
[8]Ola RK,Meena CB,Ramakrishnan S,et al.Detection of left ventricular remodeling in acute ST elevation myocardial infarction after primary percutaneous coronary intervention by two dimensional and three dimensional echocardiography[J].J Cardiovasc Echogr,2018,28(1):39-44.
[9]Barberato SH,Souza AM,Costantini CO,et al.Non invasive assessment of left ventricular filling pressure and remodeling after acute myocardial infarction[J].Arq Bras Cardiol,2013,100(6):531-537.
[10]Lv P,Zhou M,He J,et al.Circulating miR-208b and miR-34a are associated with left ventricular remodeling after acute myocardial infarction[J].Int J Mol Sci,2014,15(4):5774-5788.
[11]Zaliaduonyte-Peksiene D,Simonyte S,Lesauskaite V,et al.Left ventricular remodelling after acute myocardial infarction:impact of clinical,echocardiographic parameters and polymorphism of angiotensinogen gene[J].J Renin Angiotensin Aldosterone Syst,2014,15(3):286-293.
[12]Bolognese L,Cerisano G,Buonamici P,et al.Influence of infarct-zone viability on left ventricular remodeling after acute myocardial infarction[J].Circulation,1997,96(10):3353-3359.
[13]Cerisano G,Bolognese L,Carrabba N,et al.Doppler-derived mitral deceleration time:an early strong predictor of left ventricular remodeling after reperfused anterior acute myocardial infarction[J].Circulation,1999,99(2):230-236.
[14]代佩灵,张翠丽,富路.急性心肌梗死早期生化标志物的研究进展[J].医学综述,2013,7(19):1228-1231.
[15]Türko?lu C,Gür M,?eker T,et al.The predictive value of M30 and oxidative stress for left ventricular remodeling in patients with anterior ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention[J].Coron Artery Dis,2016,27(8):690-695.
[16]Liu X,Yuan L,Chen F,et al.Circulating miR-208b:a potentially sensitive and reliable biomarker for the diagnosis and prognosis of acute myocardial infarction[J].Clin Lab,2017,63(1):101-109.
[17]Grufman H,Yndigegn T,Gon?alves I,et al.Elevated IL-27 in patients with acute coronary syndrome is associated with adverse ventricular remodeling and increased risk of recurrent myocardial infarction and cardiovascular death[J].Cytokine,2018.DOI:10.1016/j.cyto.2017.11.002.
[18]刘恩华,陈怀敏,孔丽清,等.急性心肌梗死患者心肌损伤标志物动态监测价值的比较[J].标记免疫分析与临床,2010,17(2):65.
[19]马依彤,霍勇,杨毅宁,等.心脏标志物临床应用进展[M].北京:人民卫生出版社,2009:1-14.
[20]Hallén J,Jensen JK,Fagerland MW,et al.Cardiac troponin I for the prediction of functional recovery and left ventricular remodelling following primary percutaneous coronary intervention for ST-elevation myocardial infarction[J].Heart,2010,96(23):1892-1897.
[21]Bassan R,Potsch A,Maisel A,et al.B-type nartiuretic peptide:a novel early blood marker of acute myocardial infarction in patients with chest pain and non ST-segment elevation[J].Eur Heart J,2005,26(3):234-240.
[22]Inoue T,Sakuma M,Yaguchi I,et al.Early recanalization and plasma brain natriuretic peptide as an indicator of left ventricular function after acute myocardial infarction[J].Am Heart J,2002,143(5):790-796.
[23]Duffy BK,Gurm HS,Rajagopal V,et al.Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous conranry intervention[J].Am J Cardiol,2006,97(7):933-996.
[24]Arbel Y,Finkelstein A,Halkin A,et al.Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography[J].Atherosclerosis,2012,225(2):456-460.
[25]Tanlndl A,Erkan AF,Ekici B,et al.Neutrophil to lymphocyte ratio is associated with more extensive,severe and complex coronary artery disease and impaired myocardial perfusion[J].Turk Kardiyol Dern Ars,2014,42(2):125-130.
[26]B?rek?i A,Gür M,Türko?lu C,et al.Neutrophil to lymphocyte ratio predicts left ventricular remodeling in patients with ST elevation myocardial infarction after primary percutaneous coronary intervention[J].Korean Circ J,2016,46(1):15-22.