转化生长因子-β1与ST段抬高心肌梗死患者梗死范围冠状动脉内血栓负荷的相关性分析Correlation analysis between transforming growth factor β1 and coronary thrombus load in patients with acute myocardial infarction
马梦晴;张定欣;杨宇;
摘要(Abstract):
目的探讨转化生长因子-β1(transforming growth factor-β1,TGF-β1)与ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者梗死范围冠状动脉内血栓负荷的关系。方法选取2019年1月至2020年8月于安徽医科大学第一附属医院行急诊经皮冠状动脉介入治疗的147例STEMI患者纳入研究组,依据心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血栓分级将其分为低血栓负荷组(0~3级,80例)和高血栓负荷组(4~5级,67例),另选取同期该院100例有胸痛症状,但经影像学检查证实完全正常者纳入对照组。收集所有受试者一般资料和实验室数据,采用二元Logistic回归分析评估影响STEMI患者冠状动脉内高血栓负荷的危险因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价心肌肌钙蛋白I(cardiac troponin I,cTnI)、C反应蛋白(C-reactive protein,CRP)、TGF-β1对STEMI患者冠状动脉内高血栓负荷的预测效能。结果研究组患者吸烟、合并高血压占比以及血红蛋白、肌酐、甘油三酯、低密度脂蛋白胆固醇、TGF-β1水平均显著高于对照组(均P<0.05),高密度脂蛋白胆固醇水平显著低于对照组(P<0.05);高血栓负荷组患者CRP、cTnI、TGF-β1水平均显著高于低血栓负荷组(均P<0.05);二元Logistic回归分析结果显示TGF-β1水平升高是STEMI患者发生冠状动脉内高血栓负荷的独立危险因素(P<0.05);ROC曲线显示,血清TGF-β1预测STEMI患者冠状动脉内高血栓负荷的曲线下面积为0.708(95%CI:1.254~7.642,P=0.003),灵敏度为80.34%,特异度为64.29%,界值为16.62 ng/ml。结论血清TGF-β1水平与STEMI患者冠状动脉内高血栓负荷关系密切,其能够协助临床进行风险预警,评估病情严重程度,进一步降低围手术期发生慢血流、无复流风险。
关键词(KeyWords): 转化生长因子β1;急性心肌梗死;冠状动脉血管;血栓负荷
基金项目(Foundation):
作者(Authors): 马梦晴;张定欣;杨宇;
参考文献(References):
- [1]陈玲,张馥,曾伯石,等.急性ST段抬高型心肌梗死患者救治中胸痛中心模式的应用价值分析[J].中国医学前沿杂志(电子版),2019,11(3):68-71.
- [2]裘存新,章锡林,汪靖,等.高血栓负荷的急性ST段抬高型心肌梗死患者急诊冠脉介入治疗39例临床分析[J].安徽医药,2017,21(11):2038-2041.
- [3]MITSUSE T,KAIKITA K,ISHII M,et al.Total Thrombus-Formation Analysis System can Predict 1-Year Bleeding Events in Patients with Coronary Artery Disease[J].J Atheroscler Thromb,2020,27(3):215-225.
- [4]ZHAO Q,ZHANG R,HOU J,et al.Relationship between Fragmented QRS and NT-proBNP in Patients with ST Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention[J].Acta Cardiol Sin,2018,34(1):13-22.
- [5]周桑,王洪如,薛苗,等.急性心肌梗死患者抗心肌肌钙蛋白Ⅰ自身抗体与左心室重构关系的分析[J].中国循环杂志,2018,33(4):322-326.
- [6]石斌豪,徐宗佩,樊官伟.基于TGF-β1/Smads信号通路治疗心肌梗死后心肌纤维化的研究进展[J].中国药理学通报,2018,34(1):5-8.
- [7]李玉.TGF-β1和CTGF与急性冠状动脉综合征危险度分层的关系[J].中西医结合心血管病电子杂志,2014,2(6):49.
- [8]王正辉.转化生长因子β1与心血管疾病的研究进展[J].国际病理科学与临床杂志,2019,39(2):405-409.
- [9]HILBERS F S,BOEKEL N B,VAN DEN BROEK A J,et al.Genetic variants in TGFβ-1 and PAI-1 as possible risk factors for cardiovascular disease after radiotherapy for breast cancer[J].Radiother Oncol,2012,102(1):115-121.
- [10]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J].中华心血管病杂志,2019,47(10):766-783.
- [11]中国医师协会心血管内科医师分会冠状动脉血栓抽吸共识专家组.冠状动脉血栓抽吸临床应用专家共识[J].中华医学杂志,2017,48(21):102-105.
- [12]GüNTEKIN ü,TOSUN V,KILIN? A Y,et al.ST segment elevation myocardial infarction (STEMI) patients are more likely to achieve lipid-lowering treatment goals:A retrospective analysis of patients presenting with first acute coronary syndromes[J].Medicine (Baltimore),2018,97(39):e12225.
- [13]KHAN M H,ISLAM M N,AHMED M U,et al.Comparison between Angiographic Findings of Coronary Artery Disease in STEMI and NSTEMI Patients of Bangladesh[J].Mymensingh Med J,2016,25(2):221-225.
- [14]任洁,余航,李晶瑾,等.经桡动脉与经股动脉PCI对老年急性ST段抬高型心肌梗死的临床效果比较[J].中国医学前沿杂志(电子版),2018,10(10):49-52.
- [15]PANT S,DESHMUKH A,GURUMURTHY G S,et al.Inflammation and atherosclerosis-revisited[J].J Cardiovasc Pharmacol Ther,2014,19(2):170-178.
- [16]ENAS E A,VARKEY B,DHARMARAJAN T S,et al.Lipoprotein(a):An independent,genetic,and causal factor for cardiovascular disease and acute myocardial infarction[J].Indian Heart J,2019,71(2):99-112.
- [17]MA C Y,XU Z Y,WANG S P,et al.Change of Inflammatory Factors in Patients with Acute Coronary Syndrome[J].Chin Med J (Engl),2018,131(12):1444-1449.
- [18]HALDER L D,JO E A H,HASAN M Z,et al.Immune modulation by complement receptor 3-dependent human monocyte TGF-β1-transporting vesicles[J].Nat Commun,2020,11(1):2331.
- [19]叶钜亨,谢颖,李军,等.先天性心脏病伴肺动脉高压患者血清BNP、VEGF及TGF-β1水平的表达及临床意义[J].海南医学,2018,29(9):1203-1205.
- [20]PADILLA-GUTIéRREZ J R,VALDéS-ALVARADO E,RODRíGUEZ-REYES S C,et al.Transforming Growth Factor Beta (TFG-β) Concentration Isoforms are Diminished in Acute Coronary Syndrome[J].Cell Biochem Biophys,2018,76(3):433-439.
- [21]SOVARI A A,MORITA N,WEISS J N,et al.Serum transforming growth factor-beta1 as a risk stratifier of sudden cardiac death[J].Med Hypotheses,2008,71(2):262-265.
- [22]寇民生,耿丽群,耿爱群.转化生长因子β1在不同程度冠状动脉粥样硬化中表达变化的意义[J].中西医结合心脑血管病杂志,2018,16(5):660-661.
- [23]白洁,彭飞,骆始华,等.转化生长因子β1基因多态性与老年患者冠状动脉支架内再狭窄的相关性分析[J].中华老年心脑血管病杂志,2019,21(12):1285-1288.
- [24]LIU D,SONG J,JI X,et al.PRDM16 Upregulation Induced by MicroRNA-448 Inhibition Alleviates Atherosclerosis via the TGF-β Signaling Pathway Inactivation[J].Front Physiol,2020,11:846.
- [25]刘彦辉.血清生化指标水平与冠状动脉粥样硬化严重程度的关系[J].心血管康复医学杂志,2019,28(3):310-315.