在接受药物洗脱支架择期经皮冠状动脉介入治疗的患者中，循环卵泡抑素样 1 水平与临床参数及心血管事件的相关性。
Associations among circulating levels of follistatin-like 1, clinical parameters, and cardiovascular events in patients undergoing elective percutaneous coronary intervention with drug-eluting stents.
机构信息
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Molecular Medicine and Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
出版信息
PLoS One. 2019 Apr 29;14(4):e0216297. doi: 10.1371/journal.pone.0216297. eCollection 2019.
OBJECTIVES
Follistatin-like 1 (FSTL1) is a glycoprotein secreted by skeletal muscle cells and cardiac myocytes. Previous studies showed that serum FSTL1 concentrations were increased in acute coronary syndrome and chronic heart failure. The aim of this study was to assess the associations among plasma FSTL1 concentration, clinical parameters, and whether FSTL1 concentration could predict cardiovascular events in patients with elective percutaneous coronary intervention (PCI).
METHODS AND RESULTS
A consecutive series of 410 patients who underwent elective PCI with drug-eluting stents (DES) were enrolled between August 2004 and December 2006 at Juntendo University hospital. We measured plasma FSTL1 levels prior to elective PCI and assessed the association among FSTL1 levels, clinical parameters, and occurrence of major adverse cardiac or cerebrovascular events (MACCE) defined as cardiac death, nonfatal myocardial infarction, unstable angina, stroke, and hospitalization for heart failure. FSTL1 concentration was positively correlated with high-sensitivity C-reactive protein (hsCRP), serum creatinine, and N-terminal pro b-type natriuretic peptide (all P < 0.01). After excluding patients with creatinine clearance < 60 mL/min and hsCRP ≥ 0.2 mg/dL, the remaining 214 were followed for a median of 5.1 years. Twenty (9.3%) patients experienced MACCE. Receiver operating characteristics curve analysis estimated an FSTL1 cutoff of 41.1 ng/mL to predict MACCE occurrence. Kaplan-Meier analysis found a higher MACCE rate in patients with high (≥ 41.1 ng/mL) than with low (< 41.1 ng/mL) FSTL1 (P < 0.01). Multivariate Cox hazard analysis found that high FSTL1 was an independent predictor of MACCE (hazard ratio 4.54, 95% confidence interval: 1.45-20.07, P < 0.01).
CONCLUSION
High plasma FSTL1 may be a predictor of cardiovascular events in patients who underwent elective PCI with DES, especially with preserved renal function and low hsCRP.
目的
卵泡抑素样蛋白 1（Follistatin-like 1，FSTL1）是一种由骨骼肌细胞和心肌细胞分泌的糖蛋白。先前的研究表明，在急性冠状动脉综合征和慢性心力衰竭患者中，血清 FSTL1 浓度升高。本研究旨在评估血浆 FSTL1 浓度与临床参数之间的关系，以及 FSTL1 浓度是否可预测择期经皮冠状动脉介入治疗（Percutaneous coronary intervention，PCI）患者的心血管事件。
方法和结果
2004 年 8 月至 2006 年 12 月，我们连续纳入了在顺天堂大学医院接受药物洗脱支架（Drug-eluting stent，DES）择期 PCI 的 410 例患者。我们在择期 PCI 前测量了血浆 FSTL1 水平，并评估了 FSTL1 水平与临床参数之间的关系，以及主要不良心脏或脑血管事件（Major adverse cardiac or cerebrovascular events，MACCE）的发生情况，MACCE 定义为心脏性死亡、非致死性心肌梗死、不稳定型心绞痛、卒中和心力衰竭住院。FSTL1 浓度与高敏 C 反应蛋白（high-sensitivity C-reactive protein，hsCRP）、血清肌酐和 N 末端 pro-B 型利钠肽（N-terminal pro b-type natriuretic peptide，NT-proBNP）呈正相关（均 P < 0.01）。排除了肌酐清除率 < 60 mL/min 和 hsCRP ≥ 0.2 mg/dL 的患者后，对其余 214 例患者进行了中位时间为 5.1 年的随访。20 例（9.3%）患者发生 MACCE。受试者工作特征曲线分析估计 FSTL1 的截断值为 41.1 ng/mL，以预测 MACCE 的发生。Kaplan-Meier 分析发现，FSTL1 水平较高（≥ 41.1 ng/mL）的患者 MACCE 发生率高于 FSTL1 水平较低（< 41.1 ng/mL）的患者（P < 0.01）。多变量 Cox 风险分析发现，FSTL1 水平升高是 MACCE 的独立预测因素（风险比 4.54，95%置信区间：1.45-20.07，P < 0.01）。
结论
高血浆 FSTL1 可能是接受 DES 择期 PCI 患者心血管事件的预测指标，尤其是在肾功能正常且 hsCRP 较低的患者中。
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