儿茶酚抑素对ST段抬高型心肌梗死患者住院期间发生心力衰竭的预测价值
인다분억소대ST단태고형심기경사환자주원기간발생심력쇠갈적예측개치
Prognostic value of circulating catestatin levels for in-hospital heart failure in patients with acute myocardial infarction
  • 万方数据
    中华心血管病杂志 중화심혈관병잡지
    Chinese Journal of Cardiology
    2012年 11期 914-919 ,共6页

    冀磊%裴志强%马登峰%张静%苏晋生%高向东%薛伟珍%陈小平%王卫淑

    기뢰%배지강%마등봉%장정%소진생%고향동%설위진%진소평%왕위숙

    心肌梗死%心力衰竭%儿茶酚胺类%抑素类 心肌梗死%心力衰竭%兒茶酚胺類%抑素類
    심기경사%심력쇠갈%인다분알류%억소류
    Myocardial infarction%Heart failure%Catecholamines%Chalones
    目的 评价儿茶酚抑素(catestatin,CST)对ST段抬高型心肌梗死(STEMI)患者住院期间发生心力衰竭的预测价值.方法 前瞻性连续收集2010年11月至2011年9月住院的STEMI患者120例.入院后测定血浆CST浓度,收集临床资料.依据CST浓度四分位数间距分为≤74.72、74.73 ～79.67、79.68 ～84.21、≥84.22 ng/L4个组,每组30例,比较临床特征、治疗过程.依据患者临床特征,判断有无心力衰竭,并进行Killip分级,Killip Ⅰ级(n=68),Killip Ⅱ级(n=23),KillipⅢ级(n=18),Killip Ⅳ级(n=11),比较各组CST、去甲肾上腺素(NE)、氨基末端B型利钠肽前体(NT-proBNP)浓度.通过Spearman秩相关分析CST与左心室射血分数(LVEF),CST与NT-proBNP的关系;用多因素logistic回归筛选影响住院期间STEMI患者发生心力衰竭的相关因素;用受试者工作特征(ROC)曲线评价CST和NT-proBNP对住院期间STEMI患者发生心力衰竭的预测价值.结果 4组在性别、住院天数、既往吸烟史、高血压病史、心肌梗死史,入院时血压、心率、血糖、血脂水平以及早期再灌注等指标差异均无统计学意义(P＞0.05).在年龄,既往患糖尿病史、心绞痛病史,体质指数,白细胞计数,胱抑素-C,高敏C反应蛋白及利尿剂应用随着CST浓度升高而明显增加(P＜0.05).LVEF随着CST浓度升高而明显降低(P=0.005),NE、NT-proBNP浓度随着CST浓度升高明显升高(P＜0.01).STEMI患者伴心力衰竭时,CST、NT-proBNP浓度显著高于STEMI不伴心力衰竭的患者(P＜0.01).NE浓度水平在两组间差异无统计学意义(P＞0.05).随着心功能的恶化,CST、NE、NT-proBNP浓度逐渐升高(P＜0.05).Spearman秩相关分析显示CST与LVEF呈显著负相关(rs=-0.923,P＜0.001);CST与NT-proBNP呈显著正相关(rs=0.884,P＜0.001).多因素logistic回归分析显示CST是住院期间STEMI患者发生心力衰竭的独立危险因素(OR=1.125,95％ CI:1.056～1.198,P＜0.001),其预测住院期间心力衰竭发生的ROC曲线下面积为0.777 (P ＜0.01),当血浆CST=77.29 ng/L时预测价值最高,敏感度和特异度分别为92.8％和70.6％.NT-proBNP预测住院期间STEMI患者发生心力衰竭的ROC曲线下面积为0.874.结论 CST是STEMI患者住院期间心力衰竭发生的独立危险因素,能有效预测STEMI患者住院期间心力衰竭的发生.
    목적 평개인다분억소(catestatin,CST)대ST단태고형심기경사(STEMI)환자주원기간발생심력쇠갈적예측개치.방법 전첨성련속수집2010년11월지2011년9월주원적STEMI환자120례.입원후측정혈장CST농도,수집림상자료.의거CST농도사분위수간거분위≤74.72、74.73 ～79.67、79.68 ～84.21、≥84.22 ng/L4개조,매조30례,비교림상특정、치료과정.의거환자림상특정,판단유무심력쇠갈,병진행Killip분급,Killip Ⅰ급(n=68),Killip Ⅱ급(n=23),KillipⅢ급(n=18),Killip Ⅳ급(n=11),비교각조CST、거갑신상선소(NE)、안기말단B형리납태전체(NT-proBNP)농도.통과Spearman질상관분석CST여좌심실사혈분수(LVEF),CST여NT-proBNP적관계;용다인소logistic회귀사선영향주원기간STEMI환자발생심력쇠갈적상관인소;용수시자공작특정(ROC)곡선평개CST화NT-proBNP대주원기간STEMI환자발생심력쇠갈적예측개치.결과 4조재성별、주원천수、기왕흡연사、고혈압병사、심기경사사,입원시혈압、심솔、혈당、혈지수평이급조기재관주등지표차이균무통계학의의(P＞0.05).재년령,기왕환당뇨병사、심교통병사,체질지수,백세포계수,광억소-C,고민C반응단백급이뇨제응용수착CST농도승고이명현증가(P＜0.05).LVEF수착CST농도승고이명현강저(P=0.005),NE、NT-proBNP농도수착CST농도승고명현승고(P＜0.01).STEMI환자반심력쇠갈시,CST、NT-proBNP농도현저고우STEMI불반심력쇠갈적환자(P＜0.01).NE농도수평재량조간차이무통계학의의(P＞0.05).수착심공능적악화,CST、NE、NT-proBNP농도축점승고(P＜0.05).Spearman질상관분석현시CST여LVEF정현저부상관(rs=-0.923,P＜0.001);CST여NT-proBNP정현저정상관(rs=0.884,P＜0.001).다인소logistic회귀분석현시CST시주원기간STEMI환자발생심력쇠갈적독립위험인소(OR=1.125,95％ CI:1.056～1.198,P＜0.001),기예측주원기간심력쇠갈발생적ROC곡선하면적위0.777 (P ＜0.01),당혈장CST=77.29 ng/L시예측개치최고,민감도화특이도분별위92.8％화70.6％.NT-proBNP예측주원기간STEMI환자발생심력쇠갈적ROC곡선하면적위0.874.결론 CST시STEMI환자주원기간심력쇠갈발생적독립위험인소,능유효예측STEMI환자주원기간심력쇠갈적발생.
    Objective To determine whether circulating level of catestatin (CST) could provide prognostic information independently of conventional risk markers for the development of in-hospital heart failure in patients with ST-segment elevation myocardial infarction (STEMI).Methods The data of 120 STEMI patients (mean age:61 years,73％ male) were collected from the Second Hospital of Shanxi Medical University and Taiyuan Central Hospital between November 2010 and September 2011.The patients were categorized into 4 groups according to CST (ng/L) quartile:≤74.72,74.73-79.67,79.68-84.21and ≥84.22 ng/L.Clinical features,therapeutic approaches were compared among groups.The patients were also grouped according to Killip class:Killip level Ⅰ (n =68),Killip level Ⅱ (n =23),Killip level Ⅲ (n =18),Killip level Ⅳ (n =11).CST,NE and NT-proBNP were compared among groups.The Spearma rank correlation and multivariate logistic regression analysis were applied to determine the association between risk factors and in-hospital heart failure.Receiver-operator characteristic (ROC) curve was performed to evaluate the power of CST and NT-proBNP on predicting in-hospital heart failure.Results Gender,hospital days,past history of smoking,hypertension,myocardial infarction,CK-MB peak level,TnI peak level,heart rate,blood pressure,blood glucose,blood lipid levels on admission and early reperfusion therapy were similar among groups.Patients with higher CST values were more likely to be older,to have lower body mass index,to have higher white blood cell count,CysC,hs-CRP,NE,NT-proBNP,past history of angina,diabetes mellitus,being diuretic users,and to have a lower ejection fraction (all P ＜0.05).Higher CST levels were also associated with increased risk of heart failure (P ＜ 0.05).In proportion with the deterioration of the cardiac function,CST,NE,NT-proBNP concentration gradually increased (all P ＜0.05).Spearman rank correlation analysis showed that the CST was negatively correlated with LVEF (rs =-0.923,P ＜ 0.001) and positivey correlated with NT-proBNP (rs =0.884,P ＜ 0.001).After multivariate adjustment,CST remained to be an independent risk factor for the development of in-hospital heart failure(OR =1.125,95％ CI:1.056-1.198 ; P ＜ 0.001).The area under the ROC curve of CST and NT-proBNP was 0.777 and 0.874.Using CST =77.29 ng/L as a cut-off value,the sensitivity was 92.8％ and specificity was 70.6％ for predicting the development of in-hospital heart failure.Conclusion The plasma CST level is an independent predictor for the development of in-hospital heart failure in patients with STEMI.
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