| GPX4水平与急性冠状动脉综合征病人临床特征、危险分层及其预后相关性研究 |
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| 引用本文： | 包炳蔚,丁丝雨,季春斐,姚卓亚,钱少环,路桥,李正,高大胜,史晓俊,王洪巨,李妙男.GPX4水平与急性冠状动脉综合征病人临床特征、危险分层及其预后相关性研究[J].蚌埠医学院学报,2022,47(7):841-846. |
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| 作者姓名： | 包炳蔚 丁丝雨 季春斐 姚卓亚 钱少环 路桥 李正 高大胜 史晓俊 王洪巨 李妙男 |
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| 作者单位： | 蚌埠医学院第一附属医院 心血管内科, 安徽 蚌埠 233004 |
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| 基金项目： | 国家自然科学基金项目81970313蚌埠医学院512人才培育计划by51201317蚌埠医学院自然科学研究重点项目2020byzd109蚌埠医学院512人才培育计划by51201105 |
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| 摘 要： | 目的探讨血浆谷胱甘肽过氧化物酶4(GPX4)水平与急性冠状动脉综合征(ACS)病人临床特征、危险分层及预后之间的相关性。方法拟行冠状动脉造影病人404例，依据病史、生化检验指标、影像学检查结果及冠状动脉造影检查结果分为ACS组(n=316)和对照组(CON组，n=88)。并将ACS组病人分为不稳定型心绞痛组(UAP组，n=261)和急性心肌梗死组(AMI组，n=55)。依据TIMI危险分层将ACS组病人分为高危组(n=36)、中危组(n=227)和低危组(n=53)。采用酶联免疫吸附法检测病人血浆GPX4水平。出院后对ACS组病人进行平均21个月的随访，追踪有无主要心血管不良事件(MACEs)的发生，其中4例失访，将病人分为MACEs组(n=30)和非MACEs组(n=282), 依据ACS组病人GPX4水平中位数将病人分为GPX4≥101.90 ng/mL组(n=158)和GPX4 < 101.90 ng/mL组(n=158)。结果ACS组病人血浆GPX4水平低于对照组(P < 0.05)。ROC曲线显示血浆GPX4水平可以辅助ACS的诊断，曲线下面积(AUC)为0.828(0.778~0.878)，其最佳截断点为128.78 ng/mL，特异性为64.8%，敏感性为90.0%。在TIMI危险分层中，与高危组和中危组相比，低危组血浆GPX4水平升高(P < 0.05)，ROC曲线显示血浆GPX4水平可以辅助判断ACS病人是否处于TIMI危险分层中的低危状态AUC为0.665(0.577~0.754)，最佳截断值为127.06 ng/mL，敏感度为37.7%，特异性为95.0%(P < 0.05)。MACEs组病人血清GPX4水平低于非MACEs组(P < 0.05)。Kaplan-Meier曲线中GPX4 < 101.90 ng/mL组和GPX4≥101.90 ng/mL组中生存时间的差异无统计学意义(P < 0.05)。血浆GPX4水平升高是MACEs发生的保护因素(P < 0.05)。结论血浆GPX4水平对ACS病人临床诊断、TIMI危险分层及远期预后的判断均有参考价值。
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| 关 键 词： | 急性冠状动脉综合征 谷胱甘肽过氧化物酶4 TIMI危险分层 临床预后 |
| 收稿时间： | 2021-10-11 |
Study on the correlation between the plasma level of glutathione peroxidase 4 and clinical characteristics,risk stratification and prognosis of patients with acute coronary syndrome |
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| Affiliation: | Department of Cardiovascular Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China |
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| Abstract: | ObjectiveTo explore the correlation between the plasma level of glutathione peroxidase 4(GPX4) and clinical characteristics, risk stratification and prognosis of patients with acute coronary syndrome(ACS).MethodsA total of 404 patients scheduled by coronary angiography were divided into the ACS group(n=316) and control group(n=88) according to the medical history, biochemical examination, results of imaging examination and coronary angiography.The ACS group was subdivided into the unstable angina pectoris group(UAP group, n=261) and acute myocardial infarction group(AMI group, n=55).According to TIMI risk stratification, the ACS patients were divided into the high-risk group(n=36), medium-risk group(n=227) and low-risk group(n=53).The plasma levels of GPX4 in all cases were determined by enzyme linked immunosorbent assay.The ACS group was followed up for an average of 21 months after discharge for major adverse cardiovascular events(MACEs), 4 cases were lost to follow-up, and the other patients were divided into the MACEs group(n=30) and non-MACEs group(n=282).The ACS group were divided into the GPX4≥101.90 ng/mL group(n=158) and GPX4 < 101.90 ng/mL group(n=158) according to the median GPX4 level of pateints.ResultsThe serum levels of GPX4 in ACS group were lower than that in control group(P < 0.05).The results of ROC curve showed that serum level of GPX4 could assist the diagnosis of ACS.The area under curve(AUC) was 0.828(0.778-0.878), the optimal cut-off value was 128.78 ng/mL, the specificity was 64.8%, and the sensitivity was 90.0%.In TIMI risk stratification, the serum level of GPX4 in low-risk group was higher than that in high-risk and medium-risk groups(P < 0.05).The results of ROC curve showed that the serum level of GPX4 could assist in determining whether ACS patients were in low-risk state in TIMI risk stratification, and the AUC was 0.665(0.577-0.754).The optimal cut-off value was 127.06 ng/mL, the sensitivity was 37.7%, and the specificity was 95.0%(P < 0.05).The level of GPX4 in MACEs group was lower than that in non-MACEs group(P < 0.05).There was no statistical significance in the survival time between GPX4 < 101.90 ng/mL group and GPX4≥101.90 ng/mL group in Kaplan-Meier curve.The serum level of GPX4 increasing was a protective factor for MACEs(P < 0.05).ConclusionsThe serum level of GPX4 has reference value in the clinical diagnosis, TIMI risk stratification and long-term prognosis of ACS patients. |
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