摘要
目的研究能够预测GRACE评分为高风险的急性冠脉综合征患者远期发生射血分数减低型心力衰竭风险的生物标记物。方法收集2015年至2018年我院收治的CRACE风险分层为高风险的患者231例。所有患者治疗出院后1个月再次检测血清sST2和Galectin-3水平。计算治疗出院后1月内sST2和Galectin-3的下降百分比。随访12个月,终点事件定义为12个月内发生的射血分数减低型心力衰竭(heart failure with reduced ejection fraction,HFrEF)。受试者工作曲线评估血清sST2和Galectin-3对于既往NSTE-ACS患者发生HFrEF的预测价值,同时根据约登指数和最佳截断值对进行患者分组。Chi-Square检验分析不同分组患者1年内发生HFrEF的发生风险,Logistic多因素回归分析明确1年内NSTE-ACS患者发生HFrEF的独立危险因素。结果所有GARCE评分高风险的NST-ACS患者出院后1年内HFrEF发生率为34.2%。sST2和Galectin-3下降百分比的受试者工作曲线下面积(Area under curve,AUC)分别为0.86和0.69。最佳截断值分别为43%和54%。Chi-Square分析显示相对于sST2下降百分比超过43%的患者其1年内HFrEF发生率相对于对照组显著降低(=22.50,P<0.001)。Galectin-3下降百分比超过54%的患者其1年内HFrEF发生率相对于对照组无统计学差异(=1.05,P=0.305)。Logistics多因素回归分析显示,sST2下降百分比,血管紧张素转换酶抑制剂(ACEI)或受体拮抗剂(ARB)治疗和1年内再次不稳定性心绞痛相关住院事件是1年内HFrEF发生风险的独立因素。结论GRACE高风险的NSTE-ACS患者出院后1个月的sST下降程度是其1年内发生HFrEF的独立危险因素,出院后1个月内下降比例超过54%的患者具有更低的发生HFrEF的风险。
Objective To study the biomarkers that could be able to predict acute coronary syndrome who rated high risk GRACE score have a long-term risk of heart failure with reduced ejection fraction.Methods From 2015 to 2018,231 patients with high-risk CRACE who were admitted to our hospital were collected.For all patients,serum sST2 and Galectin-3 levels 1 month after discharge were tested.The decreased percentage of sST2 and Galectin-3 within one month after discharge was calculated.At the 12-month follow-up,the endpoint event was defined as heart failure with reduced ejection fraction(HFrEF)that occurred within 12 months.The receiver operating curve was used to evaluate the predictive value of serum sST2 and Galectin-3 for the occurrence of HFrEF in patients with previous NSTE-ACS.At the same time,patients were grouped according to the Jordan index and the best cutoff value.The Chi-Square test was used to analyze the risk of HFREF in different groups of patients within 1 year.Logistic multivariate regression analyses were used to identifie independent risk factors for HFREF in NSTE-ACS patients within 1 year.Results The incidence of HFREF in all NST-ACS patients with high GARCE scores within 1 year after discharge was 34.2%.The area under curve(AUC)of subjects with sST2 and Galectin-3 reduction percentages were 0.86 and 0.69,respectively.And the best cutoffs are 43%and 54%,respectively.Chi-Square analysis showed that the incidence of HFrEF in patients with a reduction of more than 43%relative to sST2 within 1 year was significantly lower than that in the control group(=22.50,P<0.001).There was no significant difference in the incidence of hfreef in patients with more than 54%decrease of galectin-3 compared with the control group(=1.05,P=0.305).Logistics multivariate regression analysis showed that there were some independent factors for the risk of HFREF within 1 year,such as the percentage decrease in sST2,angiotensin-converting enzyme inhibitor(ACEI)or receptor antagonist(ARB)treatment,and re-stability of angina pectoris associated with hospitalization within 1 year.Conclusion The sST decline degree within 1 month after discharge of GRACE high-risk NSTE-ACS patients would be an independent risk factor for HFrEF within 1 year.The proportion of patients with a decline of more than 54%within 1 month after discharge may have a lower risk of HFREF.
作者
尹锐
陈巍
贾国渠
张成伟
Yin Rui;Chen Wei;Jia Guoqu(The Second Affiliated Hospital of Chengdu Medical College,China National Nuclear Corporation 416 Hospital,Chengdu,Sichuan 610051,China)
出处
《四川医学》
CAS
2020年第2期157-162,共6页
Sichuan Medical Journal
