摘要
目的观察急性冠状动脉综合征(acute coronary syndrome, ACS)患者冠状动脉旁路移植术(coronary artery bypass grafting, CABG)术前血清可溶性肿瘤发生抑制蛋白2(suppression of tumorigenicity-2, sST2)水平和SYNTAXⅡ积分,探讨其对ACS患者术后近期预后的预测价值。方法行CABG治疗的ACS患者183例(CABG组)和体检健康者180例(对照组),采用ELISA法检测血清sST2、C反应蛋白(C-reactive protein, CRP)、B型利钠肽(B-type natriuretic peptide, BNP)水平,比较CABG组和对照组血清sST2水平和SYNTAXⅡ积分。术后随访6个月,根据随访期间的预后情况,将患者分为预后不良组48例和预后良好组135例,比较2组患者临床资料及血清sST2、CRP、BNP水平和SYNTAXⅡ积分,采用多因素logistic回归分析ACS患者CABG术后预后不良的危险因素;绘制ROC曲线,评估术前血清sST2水平、SYNTAXⅡ积分对ACS患者CABG术后预后不良的预测效能。结果 CABG组患者血清sST2水平[(35.24±6.42)μg/L]、SYNTAXⅡ积分[(30.24±6.29)分]均高于对照组[(11.24±2.35)μg/L、0](P<0.05)。预后不良组患者年龄、合并糖尿病比率、NYHA心功能分级Ⅳ级比率及左心房内径均大于预后良好组(P<0.05),血清CRP、BNP、肌酐、糖化血红蛋白、血乳酸、sST2水平及SYNTAXⅡ积分均高于预后良好组(P<0.05),白蛋白水平及左室射血分数低于预后良好组(P<0.05)。sST2≥35.24μg/L(OR=2.020,95%CI:1.952~2.253,P<0.001)、SYNTAXⅡ积分≥30.24分(OR=2.061,95%CI:1.967~2.345,P<0.001)是CABG术后预后不良的危险因素;sST2、SYNTAXⅡ积分的最佳截断值分别为36.49μg/L、30.15分时,单独及联合预测ACS患者CABG术后预后不良的AUC分别为0.755(95%CI:0.673~0.837,P<0.001)、0.781(95%CI:0.703~0.858,P<0.001)、0.931(95%CI:0.885~0.976,P<0.001),灵敏度分别为77.08%、79.17%、91.67%,特异度分别为77.78%、80.74%、94.07%;sST2联合SYNTAXⅡ积分预测ACS患者CABG术后预后不良的AUC高于单独sST2、SYNTAXⅡ积分(P<0.05)。结论高水平sST2、SYNTAXⅡ积分与CABG术后预后不良密切相关,sST2与SYNTAXⅡ积分联合可为患者近期预后评估提供准确信息。
Objective To observe the level of serum soluble suppression of tumorigenicity-2(sST2) and SYNTAXⅡ score in patients with acute coronary syndrome(ACS) before coronary artery bypass grafting(CABG), and to explore their predictive values to the short-term prognosis of patients with ACS. Methods The serum levels of sST2, C-reactive protein(CRP) and B-type natriuretic peptide(BNP) were detected by ELISA in 183 ACS patients undergoing CABG(CABG group) and 180 healthy volunteers(control group). The level of sST2 and SYNTAXⅡ score were compared between two groups. The patients were followed up for 6 months, and were divided into poor prognosis group(n=48) and good prognosis group(n=135) according to the follow-up result. The clinical data, serum levels of sST2, CRP and BNP and SYNTAXⅡ score were compared between two groups. Multivariate logistic regression was used to analyze the risk factors of poor prognosis of ACS patients after CABG. ROC was drawn to evaluate the predictive efficiacies of preoperative serum sST2 level and SYNTAXⅡ score on poor prognosis of ACS patients after CABG. Results The serum sST2 level and SYNTAXⅡ score were higher in CABG group((35.24±6.42) μg/L, 30.24±6.29) than those in control group((11.24±2.35) μg/L, 0)(P<0.05). The patients were older, the percentages of diabetes mellitus and NYHA heart function grade Ⅳ were higher, and left atrial diameter was longer in poor prognosis group than those in good prognosis group(P<0.05);the levels of serum CRP, BNP, creatinine, hemoglobin A1c, blood lactic acid and sST2, as well as SYNTAXⅡ score in poor prognosis group were higher than those in good prognosis group(P<0.05),and the albumin level and left ventricular ejection fraction were lower in poor prognosis group than those in good prognosis group(P<0.05).sST2 ≥35.24μg/L(OR=2.020,95%CI:1.952-2.253,P<0.001)and SYNTAXⅡ score ≥30.24(OR=2.061,95%CI:1.967-2.345,P<0.001)were the risk factors of poor prognosis of ACS patients after CABG.When the optimal cut-off values of sST2 and SYNTAXⅡ score were 36.49μg/L and 30.15,the AUCs of sST2,SYNTAXⅡ score and sST2+SYNTAXⅡ score for predicting poor prognosis of ACS patients after CABG were 0.755(95%CI:0.673-0.837,P<0.001),0.781(95%CI:0.703-0.858,P<0.001),and 0.931(95%CI:0.885-0.976,P<0.001),the sensitivities were 77.08%,79.17% and 91.67%,and the specificities were 77.78%,80.74% and94.07%,respectively.The AUCof sST2 combined with SYNTAXⅡscore for predicting poor prognosis of ACS patients after CABG was higher than that of either sST2 or SYNTAXⅡ score(P<0.05).Conclusion High sST2 level and SYNTAXⅡ score are closely correlated with poor prognosis in ACS patients after CABG.sST2 combined with SYNTAXⅡ score can provide accurate information for short-term prognosis evaluation.
作者
邢帅帅
贾梦奇
赵根尚
XING Shuai-shuai;JIA Meng-qi;ZHAO Gen-shang(Department of Cardiovascular Surgery,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450014,China;Department of Cardiology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450014,China)
出处
《中华实用诊断与治疗杂志》
2021年第4期372-375,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技发展计划项目(162102310200)。
