2021 年第 5 期 第 16 卷

急性心肌梗死患者血清可溶性信号素4D和趋化素水平与左心室重构的关系

The relationship between serum soluble semaphorin 4D, chemokine levels and left ventricular remodeling in patients with acute myocardial infarction

作者：李朵1唐琦2华蕾1

英文作者：Li Duo1 Tang Qi2 Hua Lei1

单位：1中国人民解放军陆军第九五八医院心血管内科，重庆400000；2重庆市两江新区第一人民医院急诊部401121

英文单位：1Department of Cardiovascular Medicine 958th Hospital of the Chinese People′s Liberation Army Ground Force Chongqing 400000 China; 2Department of Emergency the First People′s Hospital of Chongqing Liang Jiang New Area Chongqing 401121 China

关键词：急性心肌梗死；左心室重构；可溶性信号素4D；趋化素

英文关键词：Acutemyocardialinfarction;Leftventricularremodeling;Solublesemaphorin4D;Chemokine

• 摘要：

• 目的 探讨急性心肌梗死(AMI)患者血清可溶性信号素4D(sSema4D)、趋化素水平与左心室重构(LVRM)的关系。方法 选取中国人民解放军陆军第九五八医院2013年1月至2019年12月收治的197例AMI患者，根据是否出现LVRM分为LVRM组（82例）和非LVRM组（115例），另选取63例体检健康者为对照组。比较3组一般资料和血清sSema4D、趋化素水平及超声心动图指标，分析血清sSema4D、趋化素水平与超声心动图指标和LVRM的关系，采用受试者工作特征（ROC）曲线判断血清sSema4D、趋化素水平预测AMI患者LVRM的价值。结果 LVRM组血清N末端B型脑钠肽前体、高敏C反应蛋白（hs-CRP）、sSema4D、趋化素水平明显高于非LVRM组和对照组，非LVRM组明显高于对照组(均P＜0.05)。LVRM组左心室质量指数（LVMI）、左心室舒张末期内径（LVEDD）明显高于非LVRM组和对照组，非LVRM组LVMI、LVEDD明显高于对照组(均P＜0.05)。Pearson相关性分析显示，LVRM组血清sSema4D、趋化素水平与LVMI（r=0.491、0.521,均P＜0.001）、LVEDD(r=0.531、0.589，均P＜0.001)均呈正相关。多因素Logistic回归分析结果显示，hs-CRP、sSema4D、趋化素为AMI患者发生LVRM的独立影响因素(均P＜0.05)。ROC曲线分析结果显示，血清sSema4D联合趋化素预测AMI患者LVRM的曲线下面积明显大于血清sSema4D、趋化素单独预测(0.905比0.844、0.840)(Z=4.140、3.256，均P＜0.05)，敏感度和特异度也高于各指标单独预测。结论 AMI患者血清sSema4D、趋化素水平明显升高，LVRM后进一步提高，二者均为LVRM的独立影响因素，二者联合检测可提高对LVRM的预测价值。

• Objective To investigate the relationship between the levels of serum soluble semaphorin 4D (sSema4D), chemokine and left ventricular remodeling (LVRM) in patients with acute myocardial infarction (AMI). Methods From January 2013 to December 2019， 197 AMI patients admitted to 958th Hospital of the Chinese People′s Liberation Army Ground Force were selected. The patients were divided into LVRM group (82 cases) and non-LVRM group (115 cases) according to whether there was LVRM. Another 63 healthy people who underwent physical examination were selected as the control group. The general data, serum sSema4D and chemokine levels and echocardiography indexes were compared among the three groups, and the relationships between serum sSema4D, chemokine levels and echocardiography indexes and LVRM were analyzed. Receiver operating characteristic (ROC) curve was used to determine the value of serum sSema4D and chemokine levels in predicting LVRM of AMI patients. Results Serum levels of N-terminal pro-brain natriuretic peptide, high-sensitivity C-reactive protein (hs-CRP), sSema4D, chemokine in LVRM group were significantly higher than those in non-LVRM group and control group, and those in the non-LVRM group were significantly higher than those in the control group (all P＜0.05). The left ventricular mass index (LVMI) and left ventricular end diastolic diameter (LVEDD) in LVRM group were significantly higher than those in non-LVRM group and control group, LVMI and LVEDD in non-LVRM group were significantly higher than those in control group (all P<0.05). Pearson correlation analysis showed that serum sSema4D and chemokine levels in the LVRM group were positively correlated with LVMI（r=0.491, 0.521, both P＜0.001） and LVEDD(r=0.531, 0.589， both P＜0.001). Multivariate Logistic regression analysis showed that hs-CRP, sSema4D, chemokine were independent influencing factors of LVRM in AMI patients (all P＜0.05). ROC curve showed that the area under the curve of serum sSema4D+chemokine in predicting LVRM in patients with AMI was larger than that of sSema4D and chemokine alone(0.905 vs 0.844, 0.840)(Z=4.140, 3.256, both P＜0.05),and the sensitivity and specificity of serum sSema4D+chemokine were also higher than those predicted by each index alone. Conclusions The serum levels of sSema4D and chemokine in AMI patients increase significantly, and further increase after LVRM. Those are independent influencing factors of LVRM. Combined detection of both can improve the predictive value of LVRM.