| 王燕芳,杨丽云,赵炜祎,江 巍,刘志宏.血清sACE2、Lp-PLA2与老年ST段抬高型心肌梗死患者心功能、心室重构及预后的关系研究[J].,2023,(19):3724-3728 |
| 血清sACE2、Lp-PLA2与老年ST段抬高型心肌梗死患者心功能、心室重构及预后的关系研究 |
| Study on the Relationship between Serum sACE2, Lp-PLA2 and Cardiac Function, Ventricular Remodeling, and Prognosis in Elderly Patients with ST Segment Elevation Myocardial Infarction |
| 投稿时间：2023-03-25 修订日期：2023-04-21 |
| DOI：10.13241/j.cnki.pmb.2023.19.025 |
| 中文关键词: ST段抬高型心肌梗死 可溶性血管紧张素转化酶2 脂蛋白相关磷脂酶A2 心功能 心室重构 主要心血管不良事件 |
| 英文关键词: ST-elevation myocardial infarction Soluble angiotensin converting enzyme 2 Lipoprotein associated phospholipase A2 Cardiac function Ventricular remodeling Major adverse cardiovascular events |
| 基金项目:内蒙古自治区自然科学基金项目（2020MS03061） |
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| 中文摘要: |
| 摘要 目的：探讨血清可溶性血管紧张素转化酶2（sACE2）、脂蛋白相关磷脂酶A2（Lp-PLA2）与老年ST段抬高型心肌梗死（STEMI）患者心功能、心室重构及预后的关系。方法：回顾性分析2018年1月至2021年12月期间本院收治的92例老年STEMI患者的临床资料，根据术后是否发生主要不良心血管事件（MACE）分为预后良好亚组和预后不良亚组，并纳入同期50例非心肌梗死患者作为对照组。采用酶联免疫吸附法检测血清sACE2水平，采用化学发光法检测血清Lp-PLA2水平，根据中位值水平为为低水平亚组和高水平亚组，比较亚组间心功能和心室重构指标[左室射血分数（LVEF）、左室收缩期内径（LVIDS）、左室短轴缩短率（LVFS）]差异，并进行Pearson相关性分析。采用受试者工作特征（ROC）曲线分析老年STEMI患者血清sACE2、Lp-PLA2水平预测MACE发生的效能。结果：（1）STEMI组患者血清sACE2和Lp-PLA2水平均显著高于对照组（P＜0.05）。（2）高sACE2亚组和高Lp-PLA2水平亚组患者LVEF显著低于低sACE2水平亚组和低Lp-PLA2水平亚组，LVFS、LVEDd和LVEDs显著大于低sACE2水平亚组和低Lp-PLA2水平亚组（P<0.05）。（3）血清sACE2、Lp-PLA2水平与STEMI患者LVEF呈显著负相关关系，与LVFS、LVEDd和LVEDs呈显著正相关关系（P<0.05）。（4）预后不良亚组患者血清sACE2和Lp-PLA2水平均显著高于预后良好亚组（P<0.05）。（5）血清sACE2和Lp-PLA2水平预测STEMI患者发生不良预后的AUC分别为0.885（95%CI：0.802~0.969）、0.907（95%CI：0..847~0.967），最佳诊断Cut-off值分别为血清sACE2≥6355.48 pg/mL、血清Lp-PLA2≥292.73 ng/mL。结论：血清sACE2和Lp-PLA2水平与STEMI患者心功能和心室重构有密切关系，高水平表达对MACE发生具有良好的预测价值。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the relationship between serum soluble angiotensin converting enzyme 2 (sACE2), lipoprotein associated phospholipase A2 (Lp PLA2), and cardiac function, ventricular remodeling, and prognosis in elderly patients with ST elevation myocardial infarction (STEMI). Methods: A retrospective analysis was conducted on the clinical data of 92 elderly STEMI patients admitted to our hospital from January 2018 to December 2021. Based on the occurrence of major adverse cardiovascular events (MACE) after surgery, they were divided into a subgroup with good prognosis and a subgroup with poor prognosis, and 50 non myocardial infarction patients of the same period were included as the control group. Serum sACE2 levels were detected using enzyme-linked immunosorbent assay (ELISA), and serum Lp-PLA2 levels were measured using chemiluminescence assay. According to the median level, the subgroups were divided into low level subgroups and high level subgroups. The differences in cardiac function and ventricular remodeling indicators (left ventricular ejection fraction (LVEF), left ventricular systolic diameter (LVIDS), and left ventricular short axis shortening rate (LVFS)) between the subgroups were compared, and Pearson correlation analysis was performed. The efficacy of using receiver operating characteristic (ROC) curves to analyze the serum levels of sACE2 and Lp-PLA2 in elderly STEMI patients in predicting the occurrence of MACE. Results: (1) The serum levels of sACE2 and Lp-PLA2 in the STEMI group were significantly higher than those in the control group (P<0.05). (2) The LVEF of patients in the high sACE2 and high Lp PLA2 subgroups was significantly lower than that in the low sACE2 and low Lp PLA2 subgroups, while LVFS, LVEDd, and LVEDs were significantly higher than those in the low sACE2 and low Lp PLA2 subgroups(P<0.05). (3) The serum levels of sACE2 and Lp-PLA2 were significantly negatively correlated with LVEF in STEMI patients, and positively correlated with LVFS, LVEDd, and LVEDs (P<0.05). (4) The serum levels of sACE2 and Lp-PLA2 in patients with poor prognosis subgroup were significantly higher than those in patients with good prognosis subgroup (P<0.05). (5) The AUC of serum sACE2 and Lp-PLA2 levels predicting adverse prognosis in STEMI patients was 0.885 (95% CI: 0.802-0.969) and 0.907 (95% CI: 0.847-0.967), respectively. The optimal diagnostic Cut-off values were serum sACE2≥6355.48 pg/mL and serum Lp-PLA2≥292.73 ng/mL, respectively. Conclusion: The levels of serum sACE2 and Lp-PLA2 are closely related to cardiac function and ventricular remodeling in STEMI patients, and high levels of expression have good predictive value for the occurrence of MACE. |
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