血清BDNF和CA125水平对急性心肌梗死患者病情及预后的评估价值

目的分析血清脑源性神经营养因子(BDNF)和糖类蛋白125(CA125)水平对急性心肌梗死(AMI)患者病情及预后的评估价值。方法选取2016年12月-2018年6月北京中医药大学孙思邈医院心血管内科收治的AMI患者136例作为研究组,选取同期门诊健康体检正常者50例作为健康对照组。采用酶联免疫吸附法检测血清BDNF水平,电化学发光免疫分析法检测CA125水平。随访1年记录不良心血管事件发生情况,比较不良心脏事件亚组和无不良心脏事件亚组患者血清BDNF和CA125水平。采用Logistic回归分析急性心肌梗死患者预后影响因素。结果研究组心率及血清BDNF、CA125、c-TnI、BNP水平均高于健康对照组(t=10.196、22.142、12.302、7.301、49.705,P均<0.001)。随访1年发生心脏不良事件38例(27.94%),不良心脏事件亚组患者血清BDNF、CA125水平均高于无不良心脏事件亚组患者(t=3.258、4.496,P均<0.001)。BDNF预测AMI患者1年不良心血管事件发生率的ROC曲线下面积(AUC)为0.871,当BNDF截点值为3.87 ng/ml时预测AMI患者1年不良心血管事件敏感度为84.1%,特异度为82.9%,约登指数为0.670。CA125的AUC为0.746,当CA125截点值为42.54 U/ml时预测AMI患者1年不良心血管事件的敏感度为83.2%,特异度为81.5%,约登指数为0.647。Logistic回归分析结果显示,高龄(OR=1.89,95%CI 1.02~3.51)、心率快(OR=1.77,95%CI 1.06~2.95)、高水平BDNF(OR=4.76,95%CI 2.38~9.56)、高水平CA125(OR=3.49,95%CI 1.71~7.12)、高水平cTnI(OR=3.80,95%CI 1.654~8.750)、高水平BNP(OR=4.90,95%CI 2.23~10.77)为AMI后不良心血管事件的危险因素。结论 AMI患者血清BDNF、CA125水平明显增高,且高水平BDNF、CA125是AMI患者发生不良预后的风险因素,提示二者可作为评估AMI患者病情及预后的预测因子。

Evaluation of serum BDNF and CA125 levels in patients with acute myocardial infarction

Objective To analyze the value of serum brain-derived neurotrophic factor(BDNF) and carbohydrate protein 125(CA125) levels in the evaluation of the condition and prognosis of patients with acute myocardial infarction(AMI).Methods From December 2016 to June 2018,136 AMI patients admitted to the cardiovascular department of Sun Simiao Hospital of Beijing University of traditional Chinese Medicine were selected as the study group,and 50 healthy outpatients with normal physical examination were selected as the control group.Serum BDNF and CA125 were detected by ELISA and ECLIA respectively.The incidence of adverse cardiovascular events was recorded and the serum BDNF and CA125 levels were compared between the two groups.Logistic regression was used to analyze the prognostic factors of patients with acute myocardial infarction.Results The heart rate and serum BDNF,CA125,cTnI,and BNP levels in the study group were higher than those in the healthy control group(t=10.196,22.142,12,302,7.301,49.705,P <0.001).There were 38 cardiac adverse events(27.94%) in the 1-year follow-up.The serum levels of BDNF and CA125 in the patients with adverse cardiac events were higher than those in the patients without adverse cardiac events(t=3.258,4.496,P <0.001).The area under the ROC curve(AUC) predicted by BDNF to predict the incidence of 1-year adverse cardiovascular events in AMI patients was 0.871.When the BNDF cut-off value was 3.87 ng/ml,the one-year adverse cardiovascular event sensitivity was 84.1%,the specificity was 82.9%,and the Jordan index was 0.670.The AUC of CA125 was 0.746.When the CA125 cut-off value was 42.54 U/ml,the sensitivity for predicting one-year adverse cardiovascular events in AMI patients was 83.2%,the specificity was 81.5%,and the Jordan index was 0.647.Logistic regression analysis results show that advanced age(OR=1.89,95% CI 1.02~3.51),fast heart rate(OR=1.77,95% CI 1.06~2.95),high level BDNF(OR=4.76,95% CI2.38~9.56) High level CA125(OR=3.49,95% CI 1.71~7.12),high level cTnI(OR=3.80,95% CI 1.654~8.750),high level BNP(OR=4.90,95% CI 2.23~10.77) are AMI Risk factors for adverse cardiovascular events.Conclusion The levels of serum BDNF and CA125 were significantly increased in patients with AMI,and the high levels of BDNF and CA125 were risk factors for adverse prognosis in patients with AMI,suggesting that they could be used as predictors for evaluating the condition and prognosis of patients with AMI.