低血清丁酰胆碱酯酶活性作为急性心肌梗死患者死亡率的预后标志物与心功能不良相关。
Low Serum-Butyrylcholinesterase Activity as a Prognostic Marker of Mortality Associates with Poor Cardiac Function in Acute Myocardial Infarction.
作者信息
Sun Limin, Qi Ximing, Tan Qiang, Yang Hongmei, Qi Xiangqian
出版信息
Clin Lab. 2016;62(6):1093-9. doi: 10.7754/clin.lab.2015.151013.
BACKGROUND
Recently, butyrylcholinesterase (BChE) activity seems to have an independent prognostic role in acute coronary syndrome (ACS). However, the underlying mechanisms remain unclear. A previous study showed that serum BChE activity had a diagnostic value for chronic heart failure. This raises a question: whether BChE activity is associated with cardiac function in ACS, and if so, is this association related to the predictive value of BChE? The aim of this study was to determine the association between BChE activity with cardiac function assessed by Killip class and left ventricular ejection fraction (LVEF) in acute myocardial infarction (AMI) and to evaluate the independent prognostic role of BChE with consideration of these two indicators.
METHODS
A total of 350 consecutive patients with AMI were retrospectively included. Serum BChE activity was measured upon admission. All patients were divided into two groups according to median value of BChE activity. All-cause death was defined as endpoint. The prognostic value of mortality was assessed by using Cox regression analysis.
RESULTS
BChE activity was higher in patients with low Killip class (I or II) than that in those with high Killip class (III and IV) (7.0 +/- 1.3 or 7.0 +/- 1.5 vs. 6.2 +/- 1.6, p < 0.01). BChE activity was positively correlated with LVEF (r = 0.24, p < 0.001). During a mean follow-up period of 29 +/- 7 months, 25 patients died. BChE activity was significantly higher in surviving patients compared with non-surviving ones (7.0 +/- 1.4 vs. 5.7 +/- 1.3, p < 0.001). The survival rates were 89% and 97%, respectively, in the low and high groups of BChE activity. In a multivariate Cox proportional hazards regression analysis, after adjusting for potential confounders, BChE activity was an independent predictor of mortality after myocardial infarction [Hazard Ratio (HR) 0.65, 95% CI 0.46 - 0.91; p = 0.0131. However, when introducing Killip class and LVEF into the model, BChE activity was not in the equation.
CONCLUSIONS
Low BChE activity as a predictor of mortality in AMI might be related to its association with poor cardiac function.
背景
最近，丁酰胆碱酯酶（BChE）活性似乎在急性冠状动脉综合征（ACS）中具有独立的预后作用。然而，其潜在机制仍不清楚。先前的一项研究表明，血清BChE活性对慢性心力衰竭具有诊断价值。这就提出了一个问题：BChE活性在ACS中是否与心功能相关，如果是，这种关联是否与BChE的预测价值有关？本研究的目的是确定急性心肌梗死（AMI）患者中BChE活性与通过Killip分级和左心室射血分数（LVEF）评估的心功能之间的关联，并考虑这两个指标来评估BChE的独立预后作用。
方法
回顾性纳入350例连续的AMI患者。入院时测定血清BChE活性。所有患者根据BChE活性的中位数分为两组。将全因死亡定义为终点。采用Cox回归分析评估死亡率的预后价值。
结果
Killip分级低（I或II级）的患者BChE活性高于Killip分级高（III和IV级）的患者（7.0±1.3或7.0±1.5对6.2±1.6，p<0.01）。BChE活性与LVEF呈正相关（r = 0.24，p<0.001）。在平均29±7个月的随访期内，25例患者死亡。存活患者的BChE活性显著高于未存活患者（7.0±1.4对5.7±1.3，p<0.001）。BChE活性低组和高组的生存率分别为89%和97%。在多变量Cox比例风险回归分析中，在调整潜在混杂因素后，BChE活性是心肌梗死后死亡率的独立预测因子[风险比（HR）0.65，95%置信区间0.46 - 0.91；p = 0.013]。然而，当将Killip分级和LVEF纳入模型时，BChE活性不在方程中。
结论
低BChE活性作为AMI死亡率的预测因子可能与其与心功能不良的关联有关。
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