摘要
目的探讨急性心肌梗死(AMI)患者血清中帕金森病蛋白7(Park7)、P2X7嘌呤能受体(P2X7R)的表达水平变化及其临床意义。方法招募2021年2月-2023年5月在承德市荣军优抚医院收治的AMI患者145例作为AMI组,根据Gensini评分评估冠脉病变严重程度,分为轻度组(≤30分,n=68)、中度组(30~59分,n=42)、重度组(≥60分,n=35);同期招募在该院体检的健康志愿者120例作为对照组。ELISA法测定血清中Park7、P2X7R表达水平;Spearman法分析AMI患者血清Park7、P2X7R水平与Gensini评分的相关性;ROC曲线评价血清Park7、P2X7R对MACE发生的预测价值;绘制Kaplan-Meier曲线分析不同Park7和P2X7R表达患者的累积MACE发生率;Cox回归分析AMI患者发生MACE的影响因素。结果与对照组相比,AMI组TC、TG、LDL-C、IL-6、CTnI、CK-MB、BNP及血清P2X7R水平显著升高(P<0.05),血清HDL-C、Park7水平显著降低(P<0.05),且不同严重程度患者血清P2X7R、Park7水平之间差异有统计学意义(P<0.05)。AMI患者血清Park7与Gensini评分呈负相关(r=-0.497,P<0.05),P2X7R水平与Gensini评分呈正相关(r=0.441,P<0.05)。MACE组患者血清Park7水平显著低于非MACE组(P<0.05),P2X7R水平显著高于非MACE组(P<0.05)。血清Park7、P2X7R以及联合预测AMI患者发生MACE的AUC分别为0.851、0.820、0.905,联合预测效果更佳(Z_(二者联合-Park7)=2.324、Z_(二者联合-P2X7R)=2.538,P<0.05)。Park7低表达患者6个月累积MACE发生率(51.22%)低于Park7高表达患者(80.95%)(Log Rankχ^(2)=12.178,P<0.001);P2X7R低表达患者6个月累积MACE发生率(82.09%)高于P2X7R高表达患者(48.72%)(Log Rankχ^(2)=20.233,P<0.001)。CTnI、CK-MB、BNP、Park7、P2X7R是AMI患者发生MACE的影响因素(P<0.05)。结论AMI患者血清Park7水平下调,P2X7R水平上调,与病情严重程度密切相关,二者联合对AMI患者发生MACE具有较高的预测价值。
Objective To investigate the changes in expression levels of Parkinson's disease protein 7(Park7)and P2X7R purinergic receptor(P2X7R)in the serum of patients with acute myocardial infarction(AMI)and their clinical significance.Methods A total of 145 AMI patients admitted to Chengde Veterans Hospital between February 2021 and May 2023 were recruited as the AMI group.According to the Gensini score for assessing the severity of coronary lesions,they were subdivided into a mild group(≤30 points,n=68),a moderate group(30-59 points,n=42),and a severe group(≥60 points,n=35).Additionally,120 healthy volunteers undergoing physical examinations at the same hospital were recruited as the control group.ELISA method was used to measure serum levels of Park7 and P2X7R.Correlation between serum Park7 and P2X7R levels and Gensini score in AMI patients was analysed by Spearman's method.ROC curves were used to evaluate the predictive value of serum Park7 and P2X7R for the occurrence of MACE.Plot Kaplan-Meier curves were plotted to analyze the cumulative MACE incidence rates in patients with different Park7 and P2X7R expression levels.Cox regression analysis was used to identify risk factors for MACE occurrence in AMI patients.Results Compared with the control group,the AMI group showed significantly increased levels of TC,TG,LDL-C,IL-6,CTnI,CK-MB,BNP,and serum P2X7R(P<0.05),and significantly decreased levels of serum HDL-C and Park7(P<0.05).Furthermore,statistically significant differences were observed in serum P2X7R and Park7 levels among patients with different severity levels(P<0.05).There was a negative correlation between serum Park7 and Gensini score in AMI patients(r=-0.497,P<0.05),while a positive correlation between P2X7R level and Gensini score(r=0.441,P<0.05).Serum Park7 level in the MACE group was significantly lower than that in the non MACE group(P<0.05),while the P2X7R level was significantly higher(P<0.05).The AUCs for serum Park7,P2X7R,and their combination in predicting MACE in AMI patients was 0.851,0.820,and 0.905,respectively,with the combined prediction demonstrating superior performance(Z_(combination-Park7)=2.324,Z_(combination-P2X7R)=2.538,P<0.05).The 6-month cumulative MACE incidence was lower in patients with low Park7 expression(51.22%)than in those with high Park7 expression(80.95%)(Log Rankχ^(2)=12.178,P<0.001);conversely,the 6-month cumulative MACE incidence was higher in patients with low P2X7R expression(82.09%)than in those with high P2X7R expression(48.72%)(Log Rankχ^(2)=20.233,P<0.001).CTnI,CK-MB,BNP,Park7,and P2X7R were identified as influencing factors for MACE in AMI patients(P<0.05).Conclusion Serum Park7 level is downregulated while P2X7Rlevel is upregulated in AMI patients,both closely related to the severity of the disease.The combination of the two has high predictive value for the occurrence of MACE in AMI patients.
作者
王雪梅
陈海青
陈立娜
WANG Xuemei;CHEN Haiqing;CHEN Lina(Diagnosis and Treatment Center,Chengde Veterans Hospital,Chengde Hebei 067000;Department of Critical Care Medicine,Ninth Eighty-First Hospital of the Joint Logistics Support Force,People’s Liberation Army,Chengde Hebei 067400;Department of Rehabilitation Medicine,Affiliated Hospital of Chengde Medical College,Chengde Hebei 067020,China)
出处
《昆明医科大学学报》
2025年第11期130-137,共8页
Journal of Kunming Medical University
基金
河北省中医药管理局科研计划项目(2023333)。
关键词
急性心肌梗死
帕金森病蛋白7
P2X7嘌呤能受体
临床意义
Acute myocardial infarction
Parkinson's disease protein 7
P2X7 purinergic receptor
Clinical significance
