摘要
目的通过对经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者的血液进行靶向代谢组学研究,探究与STEMI预后可能相关的标志物,为及早开通闭塞冠状动脉带来的获益提供代谢组学方面的依据。方法选取2019年3月-2019年9月锦州医科大学附属第一医院STEMI患者43例,按照血管开通时间结合住院及出院随访期间(1个月)心脏事件发生情况将其分为A、B两组。用干血点法结合直接进样质谱代谢组学检测患者入院时、PCI术后第2天及术后1个月时的血液代谢物;构建主成分分析(PCA)及正交偏最小二乘判别分析(OPLS-DA)模型,筛选差异代谢物;记录两组患者术后住院期间及术后1个月随访时心脏彩超左室射血分数(LVEF),并将其与差异代谢物进行相关性分析。结果A组患者平均住院时间短于B组,心衰及心律失常率低于B组(P<0.05);PCA模型显示代谢物在术后1个月区分聚类趋势明显,将其进一步行OPLS-DA分析后,最终筛选出14个差异代谢物(包括4个氨基酸和10个肉碱);代谢物与LVEF呈负相关(P<0.05)。结论越早开通STEMI患者闭塞冠状动脉,心血管不良事件发生越少;心肌缺血、缺氧时间越长,血液中亮氨酸、缬氨酸(支链氨基酸)及长链酰基肉碱类物质含量越高,高代谢物可能与心肌梗死后心功能不全有关。
Objective To explore possible markers associated with the prognosis of STEMI to provide metabolomic evidence for the benefits of early access to occlusive coronary arteries. Method Forty-three STEMI patients were included and divided into groups A and B, according to the time of vascular opening and the occurrence of cardiac events during the hospitalization and discharge follow-up period(1 month). A dried blood spot method integrated with direct infusion mass spectrometry(MS) metabolomic analysis was applied for the detection of metabolite toward patients with STEMI at admission, first days after PCI,and 1 month after PCI;PCA and OPLSDA were used to construct a differential model to screen related differential metabolites. The LVEF of the two groups was recorded during postoperative hospital stay and followed up 1 month after PCI, and its correlation with differential metabolites was analyzed. Result The average length of hospital stay in group A was shorter than that in group B, and the rate of heart failure and arrhythmia was lower than that in group B(P < 0.05);PCA model showed that the clustering trend of metabolites was obvious 1 month after PCI, after further OPLS-DA analysis, 14 differential metabolites were screened, including 4 amino acids and 10 carnitine;The metabolites were negatively correlated with LVEF. Conclusions The earlier you open STEMI patients with occluded coronary arteries, the less likely you are to have AEs with cardiac dysfunction;myocardial ischemia and hypoxia lasted a long time, and the content of valine(branched amino acid) and acylcarnitine in blood was relatively high. High metabolites may be related to cardiac dysfunction after myocardial infarction.
作者
尹倩倩
李今朝
Qian-qian Yin;Jin-zhao Li(Department of Cardiology,The First Affiliated Hospital of Jinzhou Medical University,Jinzhou,Liaoning 121011,China)
出处
《中国现代医学杂志》
CAS
北大核心
2022年第3期81-86,共6页
China Journal of Modern Medicine
