赵晓静.生长停滞特异性基因6蛋白可预测老年急性ST段抬高型心肌梗死患者PCI术后发生心力衰竭[J].内科急危重症杂志,2022,28(6):500-503
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| DOI：10.11768/nkjwzzzz20220615 |
| 中文关键词: 生长停滞特异性基因6蛋白 老年人 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 心力衰竭 |
| 英文关键词: |
| 基金项目:河北省保定市科学技术研究与发展指导计划（No：18ZF289） |
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| 中文摘要: |
| 摘要 目的：探讨血清生长停滞特异性基因6（GAS6）蛋白对老年急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后住院期间发生心力衰竭的预测价值。方法：回顾性分析168例行急诊PCI治疗的老年STEMI患者的临床资料，根据患者PCI术后住院期间是否发生心力衰竭，分为无心力衰竭组（127例）和心力衰竭组（41例），比较2组患者一般资料。用酶联免疫吸附试验（ELISA）检测患者急诊入院时血清GAS6蛋白、血清B-型脑钠肽前体(BNP)、心肌肌钙蛋白 I（cTnI）、C反应蛋白（CRP）表达水平。用Pearson相关性分析、Logistic回归分析心力衰竭发生的影响因素；绘制受试者工作特征（ROC）曲线分析血清GAS6蛋白预测心力衰竭的价值，计算曲线下面积（AUC）。结果：心力衰竭组PCI术后TIMI血流3级患者比例和术前左室射血分数（LVEF）低于同时点无心力衰竭组（P均＜0.05）。心力衰竭组患者PCI术前BNP、cTnI和CRP水平高于无心力衰竭组（P均＜0.05）。心力衰竭组患者PCI术前血清GAS6蛋白水平与BNP、cTnI和CRP呈正相关，与LVEF呈负相关（P均＜0.05）。多因素分析显示，PCI术前血清GAS6蛋白、BNP、cTnI、CRP、LVEF和PCI术后TIMI血流3级是STEMI患者PCI术后发生心力衰竭的独立影响因素（P均＜0.05）。PCI术前血清GAS6蛋白水平预测STEMI患者PCI术后发生心力衰竭的AUC为0.832（P＜0.001）。当血清GAS6蛋白水平为26.09ng/mL时，约登指数最大（0.509），预测价值最高，此时灵敏度和特异性分别为70.65%和80.33%。结论：血清GAS6蛋白水平与患者心功能密切相关，血清GAS6蛋白表达水平的上升可能意味着心功能的下降，PCI术前血清GAS6蛋白水平对预测老年STEMI患者PCI术后发生心力衰竭有一定价值。. |
| 英文摘要: |
| Abstract Objective: To investigate the predictive value of serum growth arrest specific gene 6 (GAS6) protein in elderly patients with acute ST segment elevation myocardial infarction (STEMI) during hospitalization after percutaneous coronary intervention (PCI). Methods: The clinical data of 168 elderly patients with STEMI treated by emergency PCI were analyzed retrospectively. According to whether the patients had heart failure during hospitalization after PCI, they were divided into non heart failure group (n=127) and heart failure group (n=41). The general data of the two groups were compared. Enzyme linked immunosorbent assay (ELISA) was used to detect the expression levels of serum GAS6 protein, serum B-type brain natriuretic peptide precursor (BNP), cardiac troponin (cTnI) and C-reactive protein (CRP) in patients at emergency admission. The influencing factors of heart failure were analyzed by Pearson correlation analysis and Logistic regression. The receiver operator characteristic curve was drawn to analyze the value of serum GAS6 protein in predicting heart failure, and the area under the curve (AUC) was calculated. Results: The proportion of patients with TIMI blood flow grade 3 and left ventricular ejection fraction (LVEF) in the heart failure group after PCI were lower than those in the non-heart failure group at the same time point (P<0.05). The levels of BNP, cTnI and CRP in patients with heart failure before PCI were higher than those in patients without heart failure (all P< 0.05). The level of serum GAS6 protein was positively correlated with BNP, cTnI and CRP, and negatively correlated with LVEF in patients with heart failure before operation (all P<0.05). Multivariate analysis showed that GAS6 protein, BNP, cTnI, CRP, LVEF before PCI and TIMI blood flow grade 3 after PCI were independent influencing factors of heart failure in STEMI patients after PCI (all P<0.05). The AUC predicted by the level of GAS6 protein before PCI was 0.832 (P<0.001). When the serum level of GAS6 protein was 26.09 ng/mL, the Yodon index was the largest (0.509), with the highest predictive value. At this time, the sensitivity and specificity were 70.65% and 80.33%, respectively. Conclusion: The level of serum GAS6 protein is closely related to the cardiac function of patients. The increase of the expression level of GAS6 protein may mean the decline of cardiac function. The level of serum GAS6 protein before PCI has certain value in predicting the occurrence of heart failure in elderly patients with STEMI after PCI. |
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