摘要
目的探讨老年急性非ST段抬高型心肌梗死(NSTEMI)患者PCI术前后血清半乳糖凝集素-3(Galectin-3)、基质金属蛋白酶-9(MMP-9)、类胰蛋白酶(Tryptase)水平的表达及其临床意义。方法回顾性分析2017年3月至2019年2月空军军医大学第二附属医院收治的188例老年NSTEMI患者(观察组)的临床资料,根据患者的住院及6个月随访期间的急性心血管事件发生情况,将患者分为急性心血管事件组26例和无急性心血管事件组162例,比较两组患者PCI术前后的血清Galectin-3、MMP-9、Tryptase水平。另收集同期体检健康者100例作为对照组。应用ROC曲线分析Galectin-3、MMP-9、Tryptase水平对老年急性NSTEMI患者预后的预测价值,并以多因素Logistic回归分析影响患者预后的因素。结果观察组患者术前、术后3 d、术后7 d的血清Galectin-3、MMP-9、Tryptase水平明显高于对照组,且观察组患者术后3 d、术后7 d的血清水平明显低于术前,差异均有统计学意义(P<0.05);急性心血管事件组患者的性别、年龄、术前Killip分级≥2级、心肌梗死病史、高血压史与无急性心血管事件组比较差异均无统计学意义(P>0.05);急性心血管事件组患者术后3 d、7 d的血清Galectin-3、MMP-9、Tryptase水平明显高于无急性心血管事件组,差异均有统计学意义(P<0.05);ROC曲线分析结果显示,术后3 d,Galectin-3AUC为0.848,大于MMP-9的0.748和Tryptase的0.813,当截断值>36.93时,敏感度为75.00%,特异度为82.72%;术后7 d,MMP-9 AUC为0.958,大于Galectin-3的0.881和Tryptase的0.782,当截断值为>216.24时,敏感度为88.46%,特异度为95.68%;多因素Logistic回归分析结果显示,血清Galectin-3、MMP-9、Tryptase水平为影响老年急性NSTEMI患者预后的重要危险因素(P<0.05)。结论血清Galectin-3、MMP-9、Tryptase水平在老年急性NSTEMI患者中呈异常升高表达,PCI术后呈降低趋势,均为影响预后的重要危险因素,在预测预后方面具有较高应用价值。
Objective To investigate the expression of serum Galectin-3,matrix metalloproteinase-9(MMP-9),and Tryptase level in elderly patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)before and after percutaneous coronary intervention(PCI)and their clinical significance.Methods The clinical data of 188 elderly NSTEMI patients(observation group)admitted to the Second Affiliated Hospital of Air Force Military Medical University from March 2017 to February 2019 were retrospectively analyzed.According to the patient’s hospitalization and the occurrence of acute cardiovascular events during the 6-month follow-up,the patients were divided into 26 patients with acute cardiovascular events group and 162 patients without acute cardiovascular events group.Serum Galectin-3,MMP-9,and Tryptase levels were compared between the two groups before and after PCI.Another 100 healthy people who were examined during the same period were collected as the control group.ROC curve was used to analyze the predictive value of Galectin-3,MMP-9,and Tryptase levels on the prognosis of elderly patients with acute NSTEMI,and the factors affecting the prognosis of patients were analyzed by multivariate logistic regression.Results The levels of serum Galectin-3,MMP-9,and Tryptase in the observation group were significantly higher than those in the control group before operation,3 days after operation,and 7 days after operation,and the serum levels of the observation group 3 days and 7 days after operation were significantly lower than those before operation,with statistically significant differences(P<0.05).Compared with the group without acute cardiovascular event,the gender,age,preoperative Killip grade≥2,history of myocardial infarction,history of hypertension in the acute cardiovascular event group were not statistically significant(P>0.05).The levels of serum Galectin-3,MMP-9,and Tryptase in the patients with acute cardiovascular events 3 days and 7 days after operation were significantly higher than those in the patients without acute cardiovascular events(P<0.05).ROC curve analysis results showed that 3 days after surgery,Galectin-3 AUC was 0.848,which was greater than 0.748 of MMP-9 and 0.813 of Tryptase,and when the cutoff value was greater than 36.93,the sensitivity was 75.00%and the specificity was 82.72%;at 7 days after surgery,the AUC of MMP-9 was 0.958,which was greater than 0.881 of Galectin-3 and 0.782 of Tryptase,and when the cutoff value was greater than 216.24,the sensitivity was88.46%and the specificity was 95.68%.Multivariate logistic regression analysis showed that serum galectin-3,MMP-9,and tryptase levels were important risk factors affecting the prognosis of elderly patients with acute NSTEMI(P<0.05).Conclusion The levels of serum galectin-3,MMP-9,and tryptase are abnormally elevated in elderly patients with acute NSTEMI,and have decreased after PCI,which are all important risk factors affecting prognosis and have high application value in predicting prognosis.
作者
高砚丽
张莹
康黎
GAO Yan-li;ZHANG Ying;KANG Li(Department of Geriatrics,the Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,Shaanxi,CHINA)
出处
《海南医学》
CAS
2020年第14期1782-1786,共5页
Hainan Medical Journal
