Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
J Am Coll Cardiol. 2012 Jul 24;60(4):339-45. doi: 10.1016/j.jacc.2012.04.017.
The aim of this study was to investigate the prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in a large population of patients with ST-segment elevation myocardial infarction.
NGAL is a glycoprotein released by damaged renal tubular cells and is a sensitive maker of both clinical and subclinical acute kidney injury. New data have demonstrated that NGAL is also stored in granules of mature neutrophils, and recent data suggest that NGAL may also be involved in the development of atherosclerosis. NGAL is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease and healthy subjects. However, the prognostic value of NGAL has never been studied in patients with myocardial infarction.
We included 584 consecutive ST-segment elevation myocardial infarction patients admitted to the heart center of Gentofte University Hospital, Denmark, and treated with primary percutaneous coronary intervention, from September 2006 to December 2008. Blood samples were drawn immediately before primary percutaneous coronary intervention. Plasma NGAL levels were measured using a time-resolved immunofluorometric assay. The endpoints were all-cause mortality (n = 69) and the combined endpoints (n = 116) of major adverse cardiac events (MACE) defined as cardiovascular mortality and admission due to recurrent myocardial infarction or heart failure. The median follow-up time was 23 months (interquartile range, 20 to 24 months).
Patients with high NGAL (>75th percentile) had increased risk of all-cause mortality and MACE compared with patients with low NGAL (log-rank test, p < 0.001). After adjustment for confounding risk factors chosen by backward elimination by Cox regression analysis, high NGAL remained an independent predictor of all-cause mortality and MACE (hazard ratio: 2.00; 95% confidence interval: 1.16 to 3.44; p = 0.01 and hazard ratio: 1.51; 95% confidence interval: 1.00 to 2.30; p = 0.05, respectively).
High plasma NGAL independently predicts all-cause mortality and MACE in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention.
本研究旨在探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在 ST 段抬高型心肌梗死患者中的预后作用。
NGAL 是一种由受损肾小管细胞释放的糖蛋白，是临床和亚临床急性肾损伤的敏感标志物。新数据表明，NGAL 也储存在成熟中性粒细胞的颗粒中，最近的数据表明，NGAL 可能也参与动脉粥样硬化的发生。与稳定性冠状动脉疾病患者和健康受试者相比，心肌梗死患者的 NGAL 显著增加。然而，NGAL 在心肌梗死患者中的预后价值从未被研究过。
我们纳入了 2006 年 9 月至 2008 年 12 月丹麦 Gentofte 大学医院心脏中心收治的 584 例连续 ST 段抬高型心肌梗死患者，并接受了经皮冠状动脉介入治疗。在经皮冠状动脉介入治疗前立即采集血样。采用时间分辨免疫荧光分析测定血浆 NGAL 水平。终点为全因死亡率（n=69）和主要不良心脏事件（MACE）的复合终点（n=116），定义为心血管死亡率和因复发性心肌梗死或心力衰竭再次入院。中位随访时间为 23 个月（四分位间距，20 至 24 个月）。
与 NGAL 水平低的患者相比，NGAL 水平高（>75 百分位数）的患者全因死亡率和 MACE 的风险增加（对数秩检验，p<0.001）。通过 Cox 回归分析向后消除选择的混杂风险因素进行调整后，高 NGAL 仍然是全因死亡率和 MACE 的独立预测因素（危险比：2.00；95%置信区间：1.16 至 3.44；p=0.01 和危险比：1.51；95%置信区间：1.00 至 2.30；p=0.05）。
在接受经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者中，高血浆 NGAL 独立预测全因死亡率和 MACE。
