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急性心肌梗死患者外周血H2S的表达及临床意义
作者:王世亚  刘晓峰  颜永进  顾顺忠 
单位:南通大学附属海安市人民医院 心内科, 江苏 海安 226000
关键词:急性心肌梗死 H2S 诊断 预后 
分类号:R542.22
出版年·卷·期(页码):2021·49·第二期(129-133)
摘要:

目的:探讨急性心肌梗死(AMI)患者外周血硫化氢(H2S)的表达及临床意义。方法:选取2016年1月—2018年1月在南通大学附属海安医院就诊的AMI患者58例为AMI组,稳定心绞痛(SAP)患者28例为SAP组,选择同期30例健康体检者作为对照组。采用ELISA法检测各组血清H2S水平,ROC曲线评估H2S对AMI诊断及预测主要心血管不良事件(MACE)的价值,采用Cox单因素及多因素回归分析影响AMI患者预后的相关因素。结果:AMI组外周血H2S及心肌肌钙蛋白Ⅰ(cTnI)显著高于SAP组及对照组,差异有统计学意义(P<0.05);诊断AMI时cTnI、H2S的ROC曲线下面积(AUC)分别为0.877、0.805;联合检测AUC为0.918,高于单项检测。单项检测时cTnI敏感性为78.7%,H2S的敏感性为66.5%;二者联合检测诊断AMI敏感性提高到90.6%;外周血H2S预测MACE的AUC为0.797,敏感性为82.2%,特异性为84.6%;高H2S组MACE发生率显著高于低H2S组(χ2=7.803,P=0.005);Cox多因素回归分析结果显示左室射血分数(LVEF)及H2S与AMI患者预后关系密切。结论:AMI患者外周血H2S的表达水平可以作为AMI诊断和预后的新型生物标志物。

Objective:To explore the expression and clinical significance of H2S in peripheral blood of patients with acute myocardial infarction(AMI).Methods: The research subjects were selected from January 2016 to January 2018 at the Hai'an Hospital Affiliated to Nantong University, 58 patients with acute myocardial infarction were selected as the AMI group, 28 patients with stable angina pectoris(SAP) were selected as the SAP group. At the same time, 30 healthy patients were selected as the control group. The level of H2S in peripheral blood was detected by ELISA. ROC curve was used to evaluate the value of H2S in the diagnosis and prediction of major adverse cardiovascular events(MACE) in acute myocardial infarction. Cox univariate and multivariate regression analysis were used to analyze the relevant factors affecting the prognosis of patients with acute myocardial infarction. Results:Peripheral blood H2S and cTnI in AMI group were significantly higher than those in SAP group and control group, the difference was statistically significant (P<0.05); The area under the ROC curve(AUC) of cTnI and H2S when diagnosing AMI was 0.877 and 0.805, respectively; the combined test AUC was 0.918, which was higher than that of the single test. The sensitivity of cTnI was 78.7% and the sensitivity of H2S was 66.5% in the single test; the combined detection and diagnosis of AMI had an AUC of 0.918 and the sensitivity increased to 90.6%; The AUC of peripheral blood H2S predicted MACEwas 0.797, sensitivity was 82.2%, specificity was 84.6%; The incidence of MACE in the high H2S group was significantly higher than that in the low H2S group (χ2=7.803, P=0.005); Cox multivariate regression analysis showed that LVEF and H2S were closely related to the prognosis of patients with AMI.Conclusion: The expression level of H2S in peripheral blood of patients with acute myocardial infarction can be used as a new biomarker for diagnosis and prognosis of AMI.

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