摘要
目的评价儿茶酚抑素（catestatin，CST）对ST段抬高型心肌梗死（STEMI）患者住院期间发生心力衰竭的预测价值。方法前瞻性连续收集2010年11月至2011年9月住院的STEMI患者120例。入院后测定血浆CST浓度，收集临床资料。依据CST浓度四分位数间距分为≤74．72、74．73～79．67、79．68—84．21、≥84．22ng／L4个组，每组30例，比较临床特征、治疗过程。依据患者临床特征，判断有无心力衰竭，并进行Killip分级，KillipⅠ级（n=68），KillipⅡ级（n=23），KillipⅢ级（n=18），KillipⅣ级（n=11），比较各组CST、去甲肾上腺素（NE）、氨基末端B型利钠肽前体（NT—proBNP）浓度。通过Spearman秩相关分析CST与左心室射血分数（LVEF），CST与NT—proBNP的关系；用多因素logistic回归筛选影响住院期间STEMI患者发生心力衰竭的相关因素；用受试者工作特征（ROC）曲线评价CST和NT－proBNP对住院期间STEMI患者发生心力衰竭的预测价值。结果4组在性别、住院天数、既往吸烟史、高血压病史、心肌梗死史，入院时血压、心率、血糖、血脂水平以及早期再灌注等指标差异均无统计学意义（P〉0．05）。在年龄，既往患糖尿病史、心绞痛病史，体质指数，白细胞计数，胱抑素-C，高敏C反应蛋白及利尿剂应用随着CST浓度升高而明显增加（P〈0．05）。LVEF随着CST浓度升高而明显降低（P=0．005），NE、NT—proBNP浓度随着CST浓度升高明显升高（P〈0．01）。STEMI患者伴心力衰竭时，CST、NT－proBNP浓度显著高于STEMI不伴心力衰竭的患者（P〈0．01）。NE浓度水平在两组问差异无统计学意义（P〉0．05）。随着心功能的恶化，CST、NE、NT—proBNP浓度逐渐升高（P〈0．05）。Spearman秩相关分析显示CST与LVEF呈显著负相关（t=－0．923，P〈0．001）；CST与NT—proBNP呈显著正相关（rs=0．884，P〈0．001）。多因素logistic回归分析显示CST是住院期间STEMI患者发生心力衰竭的独立危险因素（OR=1．125，95％CI：1．056～1．198，P〈0．001），其预测住院期间心力衰竭发生的ROC曲线下面积为0．777（P〈0．01），当血浆CST=77．29ng／L时预测价值最高，敏感度和特异度分别为92．8％和70．6％。NT—proBNP预测住院期间STEMI患者发生心力衰竭的ROC曲线下面积为0．874。结论CST是STEMI患者住院期间心力衰竭发生的独立危险因素，能有效预测STEMI患者住院期间心力衰竭的发生。
Objective To determine whether circulating level of catestatin （CST） could provide prognostic information independently of conventional risk markers for the development of in-hospital heart failure in patients with ST-segment elevation myocardial infarction （STEMI）. Methods The data of 120 STEMI patients （mean age： 61 years, 73% male） were collected fi＇om the Second Hospital of Shanxi Medical University and Taiyuan Central Hospital between November 2010 and September 2011. The patients were categorized into 4 groups according to CST （ng/L） quartile： ≤74.72, 74. 73 -79. 67, 79. 68 -84. 21 and ≥84. 22 ng/L. Clinical features, therapeutic approaches were compared among groups. The patients were also grouped according to Killip class ： Killip level Ⅰ （ n = 68） , Killip level Ⅱ （ n = 23 ） , Killip level Ⅲ（n = 18）, Killip level Ⅳ （n = 11 ）. CST, NE and NT-proBNP were compared among groups. The Spearma rank correlation and multivariate logistic regression analysis were applied to determine the association between risk factors and in-hospital heart failure. Receiver-operator characteristic （ROC） curve was performed to evaluate the power of CST and NT-proBNP on predicting in-hospital heart failure. Results Gender, hospital days, past history of smoking, hypertension, myocardial infarction, CK-MB peak level, TnI peak level, heart rate, blood pressure, blood glucose, blood lipid levels on admission and early reperfusion therapy were similar among groups. Patients with higher CST values were more likely to be older, to have lower body mass index, to have higher white blood cell count, CysC, hs-CRP, NE, NT-proBNP, past history of angina, diabetes mellitus, being diuretic users, and to have a lower ejection fraction （ all P 〈 0.05 ）. Higher CST levels were also associated with increased risk of heart failure （ P 〈 0. 05 ）. In proportion with the deterioration of the cardiac function, CST, NE, NT-proBNP concentration gradually increased （ all P 〈 0. 05 ）. Spearman rank correlation analysis showed that the CST was negatively correlated with LVEF （rs = -0. 923, P 〈 0. 001 ） and positivey correlated with NT-proBNP （ rs = 0. 884, P 〈 0. 001 ）, After multivariate adjustment, CST remained to be an independent risk factor for the development of in-hospital heart failure（ OR = 1. 125,95% CI： 1. 056 - 1. 198 ;P 〈 0. 001 ）. The area under the ROC curve of CST and NT-proBNP was 0. 777 and 0. 874. Using CST = 77.29 ng/L as a cut-off value, the sensitivity was 92. 8% and specificity was 70. 6% for predicting the development of in-hospital heart failure. Conclusion The plasma CST level is an independent predictor for the development of in-hospital heart failure in patients with STEMI.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第11期914-919,共6页
Chinese Journal of Cardiology
基金
太原市中心医院科研项目（1120102）
关键词
心肌梗死
心力衰竭
儿茶酚胺类
抑素类
Myocardial infarction
Heart failure
Catecholamines
Chalones
