本文選題：可溶性ST2　切入點(diǎn)：急性心肌梗死　出處：《蘭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探索接受經(jīng)皮冠狀動(dòng)脈介入治療(PCI)的急性心肌梗死(AMI)患者,其血清可溶性ST2(sST2)水平與心肌纖維化的關(guān)系以及對(duì)PCI術(shù)后主要不良心血管事件(MACE)的預(yù)測(cè)價(jià)值。方法:入選2015年1月1日至2016年1月31日就診于蘭州大學(xué)第一醫(yī)院心臟中心的249例患者,AMI組為首次診斷急性心肌梗死的166例患者,對(duì)照組為冠狀動(dòng)脈造影陰性的83例患者。收集患者的臨床基線資料、血常規(guī)、血生化及超聲心動(dòng)圖中相關(guān)指標(biāo),測(cè)定患者血清可溶性ST2、III型前膠原氨端肽(PIIINP)及氨基末端腦鈉肽前體(NT-pro BNP)水平,并對(duì)AMI組患者在PCI術(shù)后電話隨訪1年,依據(jù)隨訪的情況,將AMI組分為發(fā)生MACE事件組(含23人)與未發(fā)生MACE事件組(含143人)兩個(gè)亞組,其后對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.在AMI組,循環(huán)中可溶性ST2、PIIINP及NT-proBNP水平均高于對(duì)照組,而左室射血分?jǐn)?shù)(LVEF)的值低于對(duì)照組,上述值在AMI組及對(duì)照組間均存在統(tǒng)計(jì)學(xué)差異(P值均0.05)。2.在AMI組中,血清可溶性ST2受到臨床資料中的體質(zhì)指數(shù)、高血壓、甘油三酯、谷草轉(zhuǎn)氨酶、左室收縮末容積(left ventricular end-systolic diameter,LVESV)及左室射血分?jǐn)?shù)(left ventricular ejection fraction,LVEF)的影響,且血清可溶性ST2與MACE事件、PIIINP(type III procollagen amino terminal peptide,PIIINP))呈正相關(guān),與NT-ProBNP無(wú)相關(guān)性。3.在AMI組中,循環(huán)中可溶性ST2、NT-proBNPP診斷AMI后出現(xiàn)心力衰竭的ROC曲線下面積分別為:0.608、0.683。4.發(fā)生MACE事件組血清可溶性ST2水平明顯高于未發(fā)生MACE事件組[(44.50±5.32)ng/m L與(23.59±1.15)ng/m L,P=0.001];經(jīng)logistic多因素分析顯示:在行PCI術(shù)的AMI患者中,血清可溶性ST2水平(OR值:1.051,95%CI:1.016~1.087)是其發(fā)生MACE事件的預(yù)測(cè)因子。5.在行PCI術(shù)的AMI患者中,血清可溶性ST2水平預(yù)測(cè)MACE事件的ROC曲線下面積為0.787,大于NT-pro BNP,與NT-proBNP結(jié)合后曲線下面積可達(dá)到0.82。6.根據(jù)ROC曲線獲得的可溶性ST2的最大切點(diǎn)(30ng/mL),做生存曲線可知:血清可溶性ST2水平≤30ng/mL組患者PCI術(shù)后1年的死亡率較可溶性ST2水平30ng/mL組患者低(0.81%vs 7.1%,P=0.04),且具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.血清可溶性ST2可能參與急性心肌梗死后心肌纖維化的過程,此外,與左心室的收縮功能有關(guān),并對(duì)AMI患者出現(xiàn)心力衰竭具有診斷價(jià)值。2.對(duì)于PCI術(shù)后的AMI患者,血清可溶性ST2可作為其發(fā)生MACE事件的獨(dú)立預(yù)測(cè)因子,與此同時(shí)和NT-proBNP聯(lián)合后可提高對(duì)其MACE事件的預(yù)測(cè)價(jià)值。3.可溶性ST2水平越高其PCI術(shù)后1年的生存率越低。
[Abstract]:Objective: to explore patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). The relationship between serum soluble ST2s ST2 and myocardial fibrosis and its predictive value for major adverse cardiovascular events after PCI were selected from January 1st 2015 to January 31st 2016 at the first Hospital of Lanzhou University. There were 249 patients with AMI in the center of the viscera. 166 patients with acute myocardial infarction were diagnosed for the first time. The control group consisted of 83 patients with negative coronary arteriography. The clinical baseline data, blood routine, blood biochemical and echocardiographic parameters were collected. The serum levels of soluble ST2 + type III procollagen terminal peptide (PIIINP) and amino-terminal brain natriuretic peptide precursor (NT-pro BNPP) were measured. The patients in AMI group were followed up by telephone for one year after PCI. The AMI group was divided into two subgroups: the MACE event group (including 23 persons) and the non-occurrence MACE event group (including 143 people). The data were analyzed statistically. Results: 1. In the AMI group, the levels of soluble ST2PIIINP and NT-proBNP in the circulation were higher than those in the control group. The value of left ventricular ejection fraction (LVEF) was lower than that of control group (P < 0.05). In AMI group, serum soluble ST2 was affected by body mass index (BMI), hypertension and triglyceride. The effects of alanine aminotransferase, left ventricular end-systolic volume, left ventricular ejection fractionation (LVEF) and left ventricular ejection fraction (LVEF), and serum soluble ST2 were positively correlated with MACE event (PIIINP type III procollagen amino terminal peptide PIIINP), but not with NT-ProBNP. The area under the ROC curve of circulating soluble ST2nT-proBNPP in diagnosing AMI was: 0.608 鹵0.683.4. The serum soluble ST2 level in the MACE event group was significantly higher than that in the non-#en4# event group [44.50 鹵5.32 ng / mL and 23.59 鹵1.15ngP / m LP0.001]. The results of logistic multivariate analysis showed that:. In AMI patients undergoing PCI, The OR value of serum soluble ST2 was 1.051 ~ 95% CI: 1.016 ~ 1.087) was the predictor of MACE events. 5. In AMI patients undergoing PCI surgery, The area under the ROC curve of serum soluble ST2 for predicting MACE events was 0.787, larger than that of NT-proBNP, and the area under the curve after combining with NT-proBNP could reach 0.82.6. The maximum tangent point of soluble ST2 obtained from ROC curve was 30 ng / mL, and the survival curve showed that the soluble serum was soluble. The mortality of patients with ST2 鈮，

本文編號(hào)：1565455