2023 年第 7 期 第 18 卷

急性心肌梗死患者血清可溶性致癌抑制因子2和分泌型卷曲相关蛋白5表达及对主要不良心血管事件的预测价值

Expression of serum soluble suppression of tumorigenicity 2 and secreted frizzled related protein 5 in patients with acute myocardial infarction and their predictive value for major adverse cardiovascular events 

作者：陈霞1李敏1何偲1李华华2

英文作者：Chen Xia1 Li Min1 He Si1 Li Huahua2

单位：1武汉亚洲心脏病医院心内科，武汉430000；2广西壮族自治区贺州市人民医院心内科，贺州542899

英文单位：1Department of Cardiology Wuhan Asian Heart Hospital Wuhan 430000 China; 2Department of Cardiology Hezhou People′s Hospital Guangxi Zhuang Autonomous Region Hezhou 542899 China

关键词：急性心肌梗死；可溶性致癌抑制因子2；分泌型卷曲相关蛋白5；主要不良心血管事件

英文关键词：Acutemyocardialinfarction;Solublesuppressionoftumorigenicity2;Secretedfrizzledrelatedprotein5;Majoradversecardiovascularevents

• 摘要：

• 目的  分析急性心肌梗死（AMI）患者血清可溶性致癌抑制因子2（sST2）、分泌型卷曲相关蛋白5（SFRP5）表达情况及其对主要不良心血管事件（MACE）的预测价值。方法  选择2019年8月至2021年7月于武汉亚洲心脏病医院和广西壮族自治区贺州市人民医院接受经皮冠状动脉介入（PCI）治疗的120例AMI患者，根据PCI术后住院期间是否发生MACE分为MACE组和非MACE组。比较2组基础资料与实验室指标，采用Logistic回归方法分析住院期间发生MACE的危险因素，Pearson方法分析血清sST2、SFRP5与实验室指标的相关性，绘制受试者工作特征（ROC）曲线分析血清sST2、SFRP5单独与联合预测发生MACE的价值。结果  120例AMI患者PCI术后住院期间共发生35例MACE，发生率为29.2%。MACE组心功能Killip分级Ⅲ～Ⅳ级比例与高敏C反应蛋白（hs-CRP）、白细胞计数（WBC）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、sST2水平［（40±8）μg/L比（30±7）μg/L］均高于非MACE组，左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）、心输出量、SFRP5水平［（30±7）μg/L比（47±7）μg/L］均低于非MACE组（均P＜0.05）。Logistic回归分析结果显示，心功能Killip分级、hs-CRP、WBC、cTnI、CK-MB、sST2是AMI患者PCI术后住院期间发生MACE的危险因素，而LVEF、LVFS、心输出量、SFRP5是保护因素（均P＜0.05）。Pearson相关性分析结果显示，hs-CRP、WBC、cTnI、CK-MB与血清sST2呈正相关，与SFRP5呈负相关（均P＜0.05）；LVEF、LVFS与血清sST2呈负相关，与SFRP5呈正相关（均P＜0.05）。血清sST2、SFRP5单独与联合预测AMI患者PCI术后住院期间发生MACE的曲线下面积分别为0.820、0.818、0.847。结论  AMI患者血清sST2表达上调、SFRP5表达下调，二者表达与患者PCI术后住院期间MACE发生风险、心功能等密切相关，可能成为短期不良预后的独立预测因子。

• Objective  To analyze the expression of serum soluble suppression of tumorigenicity 2 (sST2) and secreted frizzled related protein 5 (SFRP5) in patients with acute myocardial infarction (AMI) and their predictive value for major adverse cardiovascular events (MACE). Methods   From August 2019 to July 2021, a total of 120 patients with AMI who underwent percutaneous coronary intervention (PCI) in Wuhan Asian Heart Hospital and Hezhou People′s Hospital, Guangxi Zhuang Autonomous Region were selected, and they were divided into MACE group and non-MACE group according to whether MACE occurred during the hospitalization after PCI. The basic data and laboratory indicators in the two groups were compared. Logistic regression method was used to analyze the risk factors for MACE during hospitalization, Pearson method was used to analyze the correlation between serum sST2, SFRP5 and laboratory indicators, and receiver operating characteristic (ROC) curve was used to analyze the predictive values of serum sST2, SFRP5 alone and their combination for MACE. Results  A total of 35 cases of MACE occurred in 120 AMI patients during hospitalization after PCI, with an incidence rate of 29.2%. The proportion of Killip grade of cardiac function Ⅲ-Ⅳ and the levels of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), cardiac troponin I(cTnI), creatine kinase-muscle brain (CK-MB), and sST2［（40±8）μg/L vs （30±7）μg/L］in the MACE group were higher than those in the non-MACE group, and the levels of left ventricular ejection fraction(LVEF), left ventricular short-axis fractional shortening(LVFS), cardiac output, and SFRP5［（30±7）μg/L vs （47±7）μg/L］ were lower than those in the non-MACE group (all P＜0.05). Binary Logistic regression analysis showed that Killip grade of cardiac function, hs-CRP, WBC, cTnI, CK-MB and sST2 were risk factors for whether MACE occurred during hospitalization after PCI in AMI patients, and LVEF, LVFS, cardiac output and SFRP5 were protective factors (all P＜0.05). Pearson correlation analysis showed that hs-CRP, WBC, cTnI, and CK-MB positively correlated with serum sST2 and negatively correlated with SFRP5 (all P＜0.05). LVEF and LVFS negatively correlated with serum sST2 and positively correlated with SFRP5 (all P＜0.05). The areas under the curve of serum sST2 and SFRP5 alone and in combination to predict MACE in AMI patients during hospitalization after PCI were 0.820, 0.818 and 0.847, respectively. Conclusion  The expression of serum sST2 is up-regulated and that of SFRP5 is down-regulated in AMI patients, and the expression of the two are closely related to the risk and cardiac function of MACE during hospitalization after PCI. They may become independent predictors of short-term poor prognosis.