摘要
目的 探讨急性心肌梗死(AMI)患者血清可溶性肿瘤坏死因子受体1(sTNFR1)、白细胞分化抗原-137(CD137)水平变化对心血管不良事件(MACE)的影响及发生MACE的影响因素.方法 前瞻性选取2019年10月至2022年3月商洛市中心医院收治的AMI患者120例作为观察组,并根据AMI患者MACE发生情况分为MACE组(n=25)及非MACE组(n=95),另选取同期来我院体检的健康者120名作为对照组.收集AMI患者一般资料与临床特征:性别、年龄、体重指数、合并糖尿病、高脂血症、高血压、Killip心功能分级、饮酒史、吸烟史、左心室射血分数、预后危险[心肌梗死溶栓(TIMI)评分]、脑钠肽、肌钙蛋白T水平.比较观察组与对照组、MACE组与非MACE组的血清sTNFR1、CD137水平.采用Pearson相关性分析法分析sTNFR1、CD137与AMI后MACE发生的相关性.采用单因素分析和多因素Logistics回归分析对影响AMI后MACE的因素进行分析.结果 观察组sTNFR1、CD137水平分别为(372.53+65.26)μg/L、(125.75±23.67)pg/mL,均高于对照组[(231.56±46.80)μg/L、(71.43±11.57)pg/mL],差异均有统计学意义(P＜0.05).MACE 组 sTNFR1、CD137 水平分别为(398.64±45.73)μg/L、(154.56±23.57)pg/mL,均高于非 MACE组[(347.83±61.72)μg/L、(106.84±20.65)pg/mL],差异均有统计学意义(P＜0.05).Pearson 相关分析结果显示,sTNFR1、CD137与AMI后MACE发生情况呈正相关(P＜0.05).非MACE组与MACE组患者性别、体重指数、饮酒史、左心室射血分数比较,差异均无统计学意义(P＞0.05),非MACE组与MACE组患者年龄、合并糖尿病、高脂血症、高血压、Killip心功能分级、吸烟史、TIMI评分、脑钠肽、肌钙蛋白T水平比较,差异均有统计学意义(P＜0.05).以合并MACE为因变量,结果显示,心功能分级、吸烟史、TIMI、脑钠肽、sTNFR1、CD137为AMI后MACE的独立危险因素(P＜0.05).结论 AMI患者MACE发生后会导致sTNFR1、CD137水平升高,且心功能分级、吸烟史、TIMI评分、脑钠肽、sT-NFR1、CD137为AMI后MACE的独立危险因素.
Abstract
Objective To investigate the effects of changes in serum soluble tumor necrosis factor receptor 1(sTNFR1)and leukocyte differentiation antigen-137(CD137)levels on MACE and the influencing factors of MACE in patients with acute myocardial infarction(AMI).Methods One hundred and twenty AMI patients admitted to Shangluo Central Hospital from October 2019 to March 2022 were prospectively se-lected as the observation group.According to the incidence of major adverse cardiovascular events(MACE)in AMI patients,they were divided in-to the MACE group(n=25)and non MACE group(n=95).In addition,120 healthy individuals who underwent physical examinations during the same period in our hospital were selected as the control group.The general data and clinical characteristics of AMI patients were collected:gender,age,body mass index,diabetes mellitus,hyperlipidemia,hypertension,Killip cardiac function classification,drinking history,smoking history,left ventricular ejection fraction,prognostic risk[thrombolysis in myocardial infarction(TIM1)score],brain natriuretic peptide,troponin T level.The levels of serum sTNFR1 and CD137 in the observation group and the control group,on-MACE group and MACE group were com-pared.The correlation between sTNFR1,CD137 and MACE after AMI was analyzed using Pearson correlation analysis.The factors affecting MACE after AMI were analyzed by univariate analysis and multivariate Logistics regression analysis.Results The levels of sTNFR1 and CD137 in the observation group were(372.53±65.26)μg/L,(125.75±23.67)pg/mL,which were higher than those in the matched group[(231.56±46.80)μg/L,(71.43±11.57)pg/mL],the differences were statistically significant(P＜0.05);the levels of sTNFR1 and CD137 in the MACE group were(398.64±45.73)μg/L and(154.56±23.57)pg/mL,respectively,which were higher than those in the non MACE group[(347.83±61.72)μg/L,(106.84±20.65)pg/mL],the differences were statistically significant(P＜0.05).The Pearson correlation analy-sis results showed that sTNFR1 and CD137 were positively correlated with the occurrence of MACE after acute myocardial infarction(P＜0.05);there was no statistically significant difference in gender,body mass index(BMI),drinking history and left ventricular ejection fraction between the non MACE group and the MACE group(P＞0.05).The age,combined diabetes,hyperlipidemia,hypertension,Killip heart function classi-fication,smoking history,risk factors of prognosis with acute coronary syndrome(TIMI)score the levels of brain natriuretic peptide(BNP)and troponin T showed significant differences(P＜0.05);using the combined MACE as the dependent variable,the results showed that heart func-tion grade,smoking history,TIMI,BNP,sTNFR1,and CD137 were independent risk factors for MACE after acute myocardial infarction(P＜0.05).Conclusion AMI MACE causes increased sTNFR1 and CD137 levels,and cardiac function grade,smoking history,TIMI score,BNP,sTNFR1,and CD137 were independent risk factors for MACE after AMI.
基金项目
陕西省自然科学基础研究计划项目(2020JM-665)
维普
万方数据