摘要
目的:探讨无肾脏疾病的急性ST段抬高型心肌梗死(STEMI)患者血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与基质金属蛋白酶-9(MMP-9)、高敏C反应蛋白(hs-CRP)、白细胞介素(IL)-1β和冠状动脉(冠脉)狭窄程度的关系,及其识别冠脉病变严重程度的能力。方法:收集2014-01至2017-03在我院住院的STEMI患者124例(STEMI组),同期纳入没有明显冠脉狭窄的对照患者124例(对照组)。再根据SYNTAX积分将STEMI患者分为高积分亚组(≥33分,n=26)和低积分亚组(<33分n=98)。采用Spearman相关系数分析STEMI患者血浆NGAL水平与MMP-9水平、IL-1β水平和冠脉狭窄程度的关系。采用受试者工作特征(ROC)曲线评价血浆NGAL水平识别严重冠脉狭窄的能力。用Logistic回归分析影响SYNTAX积分的相关因素。结果:STEMI组患者血浆NGAL、MMP-9和hs-CRP水平显著高于对照组(P均<0.01),IL-1β水平在两组间差异无统计学意义(P=0.272)。血浆NGAL水平与MMP-9水平(r=0.757,P<0.01)、SYNTAX积分(r=0.616,P<0.01)和IL-1β水平(r=0.185,P<0.05)均呈正相关。高积分亚组患者血浆NGAL和MMP-9水平显著高于低积分亚组(P均<0.01),而左心室射血分数明显低于低积分亚组(P<0.01)。ROC曲线分析显示,在识别严重冠状动脉狭窄的STEMI患者能力方面,血浆NGAL(曲线下面积=0.881,95%Cl:0.813~0.949,P<0.01)大于血浆MMP-9(曲线下面积=0.799,95%Cl:0.709~0.890,P<0.01)和hs-CRP(曲线下面积=0.446,95%Cl:0.306~0.587,P=0.400)。多因素回归分析显示,STEMI患者血浆NGAL水平与高SYNTAX积分存在独立相关性(OR=1.115,95%Cl:1.107~1.123,P<0.01)。结论:STEMI组患者血浆NGAL、MMP-9和hs-CRP水平较对照组显著增高,血浆NGAL水平与MMP-9水平、IL-1β水平和冠脉病变严重程度均呈正相关,在识别严重冠脉狭窄的STEMI患者能力方面NGAL优于MMP-9和hsCRP。NGAL作为新的心脏领域的标志物有助于STEMI患者的危险分层。
Objective：To study the relationship between plasma levels of Neutrophil gelatinase-associated lipocalin（NGAL）,matrix metalloproteinase（MMP-9）,hs-CRP,IL-1β and the severity of coronary stenosis in acute ST-elevation myocardial infarction（STEMI） patients without kidney disease;to explore the ability for NGAL discriminating severe coronary stenosis.Methods：Our research included in 2 groups：STEMI group,n=124 patients admitted in our hospital from 2014-01 to 2017-03 and Control group,n=124 subjects without obvious coronary stenosis.According to SYNTAX score,the patients were divided into another set of 2 groups：High score group,patients with SYNTAX score ≥ 33,n=26 and Low score group,patients with SYNTAX score 〈33,n = 98.Relationship between plasma levels of NGAL,MMP-9,hs-CRP,IL-1β and the severity of coronary stenosis were studied by Spearman correlation analysis;the ability for NGAL discriminating severe coronary stenosis was examined by ORC curve;the influencing factors for SYNTAX score were determined by Logistic regression analysis.Results：Compared with Control group,STEMI group had increased plasma levels of NGAL,MMP-9,hs-CRP,all P 0.01,while IL-1β was similar between 2 groups,P=0.272.NGAL was positively related to MMP-9（r=0.757,P〈0.01）,SYNTAX score（r=0.616,P〈0.01） and IL-1β（r=0.185,P〈0.05）.Compared with Low score group,High score group showed the higher plasma levels of NGAL,MMP-9,both P〈0.01,while the lower LVEF,P〈0.01.The area under ROC curve for NGAL discriminating severe coronary stenosis was 0.881（95% Cl 0.813-0.949,P〈0.01） which was greater than MMP-9 [0.799（95% Cl 0.709-0.890,P〈0.01）] and hs-CRP [0.446（95% Cl 0.306-0.587,P=0.400）].Multivariate regression analysis presented that plasma NGAL level was independently related to high SYNTAX score [OR=1.115,95% Cl（1.107-1.123）,P〈0.01].Conclusion：STEMI patients had increased plasma levels of NGAL,MMP-9 and hs-CRP;NGAL had better ability for discriminating severe coronary stenosis than MMP-9 and hs-CRP.NGAL as a new biomarker should be helpful for risk stratification in STEMI patients.
作者
李超
彭瑜
高涵翔
王永祥
赵晶
蒋英志
潘晨亮
张钲
LI Chao, PENG Yu, GAO Han-xiang, WANG Yong-xiang, ZHAO Jing, JIANG Ying-zhi, PAN Chen-liang, ZHANG Zheng.(Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou （730000）, Gansu, China)
出处
《中国循环杂志》
CSCD
北大核心
2018年第3期222-226,共5页
Chinese Circulation Journal
基金
甘肃省心血管疾病重点实验室建设项目(1206RTSA025)
