心肌梗死后血清γ-谷氨酰转移酶活性的预后价值

Prognostic value of serum gamma-glutamyl transferase activity after myocardial infarction.

作者信息

Emdin M, Passino C, Michelassi C, Titta F, L'abbate A, Donato L, Pompella A, Paolicchi A

机构信息

CNR Institute of Clinical Physiology, National Research Council, Pisa, Italy.

出版信息

Eur Heart J. 2001 Oct;22(19):1802-7. doi: 10.1053/euhj.2001.2807.

DOI:10.1053/euhj.2001.2807

PMID:11549302

Abstract

AIMS

Serum gamma-glutamyl transferase activity (gamma-GT) is able to catalyse low-density lipoprotein oxidation and has been detected in coronary atherosclerotic plaques. gamma-GT has been documented as an independent risk factor for cardiac mortality in middle-aged men. The purpose of this study is to determine the prognostic value of gamma-GT in patients with coronary artery disease.

METHODS AND RESULTS

In a prospective study, gamma-GT and other cardiac risk factors were evaluated in 469 consecutive subjects with angiographically documented coronary artery disease, using mortality and mortality plus non-fatal myocardial infarction as end-points. gamma-GT showed an independent prognostic value beyond known established risk factors in the subgroup of 262 patients with previous myocardial infarction. At a 6-year follow-up, cardiac mortality was 25.2% in patients with gamma-GT >40 U x l(-1)vs 13.9% in those with gamma-GT <40 U x l(-1)(P=0.038). When both cardiac mortality and non-fatal myocardial infarction were considered as end-points, these events were recorded in 32.7% of patients with gamma-GT >40 U x l(-1)and in 20.4% of those with levels <40 U x l(-1)(P=0.031). Excess mortality and non-fatal infarction in patients with high gamma-GT levels were concentrated in the first 2 years of follow-up (P=0.014). The association of gamma-GT values >40 U x l(-1), previous myocardial infarction, and multiple vessel disease identified a subgroup of 168 patients with the highest risk of cardiac events at 6 years (P=0.024). The relationship between gamma-GT levels and cardiac events remained significant after adjustment for cardiac risk factors, and possible confounders, including alcohol consumption. gamma-GT did not show significant prognostic value in the 207 patients without previous myocardial infarction.

CONCLUSION

gamma-GT is an independent cardiac risk factor in ischaemic patients with established coronary atherosclerosis and previous myocardial infarction.

摘要

目的

血清γ-谷氨酰转移酶活性（γ-GT）能够催化低密度脂蛋白氧化，且已在冠状动脉粥样硬化斑块中检测到。γ-GT已被证明是中年男性心脏死亡的独立危险因素。本研究的目的是确定γ-GT在冠心病患者中的预后价值。

方法与结果

在一项前瞻性研究中，对469例经血管造影证实患有冠状动脉疾病的连续受试者进行了γ-GT和其他心脏危险因素评估，以死亡以及死亡加非致命性心肌梗死作为终点。在262例既往有心肌梗死的患者亚组中，γ-GT显示出超越已知既定危险因素的独立预后价值。在6年随访时，γ-GT>40 U×l⁻¹的患者心脏死亡率为25.2%，而γ-GT<40 U×l⁻¹的患者为13.9%（P=0.038）。当将心脏死亡和非致命性心肌梗死均视为终点时，这些事件在γ-GT>40 U×l⁻¹的患者中记录为32.7%，而在水平<40 U×l⁻¹的患者中为20.4%（P=0.031）。γ-GT水平高的患者的额外死亡和非致命性梗死集中在随访的前2年（P=0.014）。γ-GT值>40 U×l⁻¹、既往心肌梗死和多支血管病变的联合确定了一个168例患者的亚组，其在6年时发生心脏事件的风险最高（P=0.024）。在对心脏危险因素以及包括饮酒在内的可能混杂因素进行调整后，γ-GT水平与心脏事件之间的关系仍然显著。γ-GT在207例无既往心肌梗死的患者中未显示出显著的预后价值。