摘要
目的探讨血清胰高血糖素样肽-1(GLP-1)、Dickkopf相关蛋白1(DKK1)、酰基辅酶A合成酶长链家族成员4(ACSL4)水平与2型糖尿病(T2DM)合并急性ST段抬高型心肌梗死(ASTEMI)患者经皮冠状动脉介入治疗(PCI)术后预后不良的关系。方法选取2022年8月至2024年8月该院收治的119例T2DM合并ASTEMI患者为ASTEMI组,根据Gensini评分分为轻度冠状动脉病变组(56例)、中度冠状动脉病变组(41例)和重度冠状动脉病变组(22例)。另选同期该院收治的119例单纯T2DM患者为T2DM组,以及同期在该院进行体检的119例健康体检者为对照组。根据T2DM合并ASTEMI患者PCI术后半年内是否发生主要不良心血管事件将ASTEMI组分为预后不良组和预后良好组。采用酶联免疫吸附试验检测血清GLP-1、DKK1、ACSL4水平。采用多因素Logistic回归分析T2DM合并ASTEMI患者PCI术后预后不良的影响因素。绘制受试者工作特征(ROC)曲线分析血清GLP-1、DKK1、ACSL4单独及联合对T2DM合并ASTEMI患者PCI术后预后不良的预测价值。结果ASTEMI组血清GLP-1、DKK1、ACSL4水平高于对照组和T2DM组,且T2DM组高于对照组,差异均有统计学意义(P<0.05)。重度冠状动脉病变组血清GLP-1、DKK1、ACSL4水平高于轻度冠状动脉病变组、中度冠状动脉病变组,且中度冠状动脉病变组高于轻度冠状动脉病变组,差异均有统计学意义(P<0.05)。预后不良组糖化血红蛋白(HbA1c)及血清GLP-1、DKK1、ACSL4水平高于预后良好组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,HbA1c及血清GLP-1、DKK1、ACSL4水平升高是T2DM合并ASTEMI患者PCI术后预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,GLP-1、DKK1、ACSL4联合预测T2DM合并ASTEMI患者PCI术后预后不良的曲线下面积(AUC)为0.947,大于GLP-1、DKK1、ACSL4单独预测的AUC(Z=4.316、3.788、3.487,均P<0.05)。结论T2DM合并ASTEMI患者血清GLP-1、DKK1、ACSL4水平升高,可反映患者冠状动脉病变严重程度,还可作为预测T2DM合并ASTEMI患者PCI术后预后不良的生物标志物,并且3项指标联合检测的预测效能更高。
Objective To investigate the relationship between serum levels of glucagon-like peptide-1(GLP-1),Dickkopf-related protein 1(DKK1),and acyl-coA synthetase long-chain family member 4(ACSL4)and the poor prognosis of patients with type 2 diabetes mellitus(T2DM)and acute ST-segment elevation myocardial infarction(ASTEMI)after percutaneous coronary intervention(PCI).Methods A total of 119 patients with T2DM and ASTEMI admitted to the hospital from August 2022 to August 2024 were selected as the ASTEMI group.They were divided into mild coronary artery lesion group(56 cases),moderate coronary artery lesion group(41 cases),and severe coronary artery lesion group(22 cases)according to the Gensini score.Another 119 patients with simple T2DM admitted to the hospital during the same period were selected as the T2DM group,and 119 healthy individuals undergoing physical examination at the same period were selected as the control group.The ASTEMI group was divided into poor prognosis group and good prognosis group based on whether major adverse cardiovascular events occurred within half a year after PCI.Serum levels of GLP-1,DKK1 and ACSL4 were detected by enzyme-linked immunosorbent assay.Multivariable Logistic regression analysis was used to analyze the influencing factors of poor prognosis in T2DM complicated with ASTEMI after PCI.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum GLP-1,DKK1 and ACSL4 alone and in combination for poor prognosis of T2DM complicated with ASTEMI after PCI.Results The serum levels of GLP-1,DKK1 and ACSL4 in the ASTEMI group were higher than those in the control group and the T2DM group,and those in the T2DM group was higher than those in the control group,and the differences were statistically significant(P<0.05).The serum levels of GLP-1,DKK1 and ACSL4 in the severe coronary artery lesion group were higher than those in the mild coronary artery lesion group and the moderate coronary artery lesion group,and those in the moderate coronary artery lesion group were higher thanthose in the mild coronary artery lesion group,and the differences were statistically significant(P<0.05).The glycosylated hemoglobin(HbA1c)and serum levels of GLP-1,DKK1 and ACSL4 in the poor prognosis group were higher than those in the good prognosis group,and the differences were statistically significant(P<0.05).The results of Multivariable Logistic regression analysis showed that elevated HbA1c and serum levels of GLP-1,DKK1 and ACSL4 were risk factors for poor prognosis in patients with T2DM and ASTEMI after PCI(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of the combined prediction of the GLP-1,DKK1 and ACSL4 for poor prognosis of patients with T2DM and ASTEMI after PCI was 0.947,which was larger than the AUC of GLP-1,DKK1 and ACSL4 alone(Z=4.316,3.788,3.487,all P<0.05).Conclusion The serum levels of GLP-1,DKK1 and ACSL4 in patients with T2DM and ASTEMI are elevated,which can reflect the severity of coronary artery lesions and can be used as biomarkers for predicting poor prognosis of patients with T2DM and ASTEMI after PCI.Moreover,the combined detection of the three indicators has a higher predictive efficacy.
作者
翟双久美
程光慧
李迎婕
王慧
李新军
ZHAI Shuangjiumei;CHENG Guanghui;LI Yingjie;WANG Hui;LI Xinjun(The First Department of Cardiology,the Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)
出处
《检验医学与临床》
2026年第3期397-403,共7页
Laboratory Medicine and Clinic
基金
河北省张家口市重点研发计划项目(2221082D)。
