ST2在心肌梗死中的预后价值。

Prognostic value of ST2 in myocardial infarction.

作者信息

Mzoughi Khadija, Chouaieb Sonia, Zairi Ihsen, Fredj Soumaya, Ben Kilani Mouna, Berriri Soumaya, Zili Mohamed, Kraiem Sondos

出版信息

Tunis Med. 2019 Feb;97(2):335-343.

PMID:31539092

Abstract

INTRODUCTION

Soluble Suppression of Tumorigenicity 2 (ST2) is a biomarker of myocardial fibrosis increasingly recognized as a predictor of morbidity and mortality in heart failure. Its role in the prognosis after a myocardial infarction has not been validated to date.

AIM

To evaluate the prognostic value of ST2 for in-hospital morbidity and mortality after myocardial infarction.

METHODS

We conducted a longitudinal prospective study including 74 patients admitted for an acute uncomplicated cardiac myocardial infarction at Habib Thameur hospital between April and October 2016. ST2 blood samples were drawn until 72 hours post admission .The primary endpoint was the occurrence of a major cardiovascular event during hospitalization.

RESULTS

Patients' mean age was 61.28 ± 13 years-old with a sex ratio of 1.8. The reason for admission was acute coronary syndrome with persistent ST segment elevation in 54% of cases and non-ST segment elevation acute myocardial infarction in 46% of cases. The ST2 assay was positive in 78% of cases with a mean value of 122.43 ± 95.72 ng/ ml. Left ventricular dysfunction was observed in 47% of cases. Fifteen per cent of the patients had a 3 vessel-disease, 24% a 2 vessel-disease and 34% a 1 vessel-disease. Twenty-six percent had at least one major cardiovascular event. In-hospital mortality was 10%. In multivariate analysis, ST2 was an independent factor associated with the occurrence of major cardiovascular events (RR = 2, p = 0.04). The cutoff value of ST2 of 35 ng/ml had a sensitivity of 95%, a specificity of 30% (AUC = 0.672, CI 0.546-0.798, p = 0.024), a negative predictive value of 100% and a positive value of 33%. A significant correlation was found between ST2 and troponin, blood glucose on admission, CRP and left ventricular ejection fraction (respectively: r = 0.398, p <0.0001, r = 0.281, p = 0.015, r = 0.245, p = 0.039, r = -0.401, p <0.0001).

CONCLUSION

The measurement of ST2 after a myocardial infarction constitutes a new prognostic indicator of in-hospital morbidity and mortality.

摘要

引言

可溶性肿瘤抑制因子2（ST2）是心肌纤维化的生物标志物，越来越被认为是心力衰竭发病率和死亡率的预测指标。其在心肌梗死后预后中的作用迄今尚未得到验证。

目的

评估ST2对心肌梗死后院内发病率和死亡率的预后价值。

方法

我们进行了一项纵向前瞻性研究，纳入了2016年4月至10月期间在哈比卜·塔穆尔医院因急性非复杂性心脏心肌梗死入院的74例患者。入院后72小时内采集ST2血样。主要终点是住院期间发生重大心血管事件。

结果

患者的平均年龄为61.28±13岁，性别比为1.8。入院原因是急性冠状动脉综合征伴持续性ST段抬高的病例占54%，非ST段抬高急性心肌梗死的病例占46%。ST2检测阳性率为78%，平均值为122.43±95.72 ng/ml。47%的病例观察到左心室功能障碍。15%的患者有三支血管病变，24%有两支血管病变，34%有一支血管病变。26%的患者发生了至少一次重大心血管事件。院内死亡率为10%。多因素分析显示，ST2是与重大心血管事件发生相关的独立因素（RR = 2，p = 0.04）。ST2的临界值为35 ng/ml时，敏感性为95%，特异性为30%（AUC = 0.672，CI 0.546 - 0.798，p = 0.024），阴性预测值为100%，阳性预测值为33%。发现ST2与肌钙蛋白、入院时血糖、CRP和左心室射血分数之间存在显著相关性（分别为：r = 0.398，p <0.0001，r = 0.281，p = 0.015，r = 0.245，p = 0.039，r = -0.401，p <0.0001）。