内脂素-1水平可预测ST段抬高型心肌梗死患者的血管造影无复流现象。
Nesfatin-1 Levels Predict Angiographic No-Reflow in Patients with ST-Segment Elevation Myocardial Infarction.
作者信息
Sivri Serkan, Sökmen Erdoğan, Çelik Mustafa, Güçlü Kenan
机构信息
Department of Cardiology.
Department of Biochemistry, Ahi Evran University Training and Research Hospital, Kirsehir, Turkey.
出版信息
Acta Cardiol Sin. 2020 Jul;36(4):318-325. doi: 10.6515/ACS.202007_36(4).20200207A.
BACKGROUND
Nesfatin-1 is a novel peptide possessing pleiotropic metabolic effects. No-reflow phenomenon (NR) is a poor prognostic indicator occurring in around 30% of all patients undergoing primary percutaneous coronary interventions (pPCI). Inflammation and complexity of coronary artery disease (CAD) play pivotal roles in the pathogenesis of NR. In this study, we investigated the relationship between admission serum nesfatin-1 level, NR and complexity of CAD assessed by SYNTAX-1 (SS-1) and SYNTAX-2 (SS-2) scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI.
METHODS
A total of 174 STEMI patients who underwent pPCI were included in the study and divided into NR (n = 36) and normal flow (n = 138) groups. Serum nesfatin-1 was measured by enzyme-linked immunosorbent assay. Seventy-eight consecutive age-, gender- and co-morbidity-matched patients undergoing coronary angiography with < 50% stenosis comprised the control group.
RESULTS
Nesfatin-1 levels were significantly lower in the NR group compared to the normal flow and control groups (10.8 ± 6.6 ng/mL vs. 34.9 ± 24 ng/mL vs. 43.6 ± 23.2 ng/mL, respectively, p < 0.001). Nesfatin-1 was significantly and inversely correlated with SS-1 and SS-2 scores (r = -0.709 and r = -0.655, respectively, both p < 0.001). Multivariate logistic regression analysis showed that nesfatin-1 [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.708-0.936, p = 0.004] and glomerular filtration rate (OR = 0.94, 95% CI = 0.892-0.989, p = 0.018) were independently associated with NR. In the receiver operating characteristic analysis, nesfatin-1 < 15.21 ng/mL predicted NR with 78.4% sensitivity and 72.2% specificity (area under the curve = 0.809, 95% CI = 0.701-0.918, p < 0.001).
CONCLUSIONS
Admission nesfatin-1 level is a potent predictor of NR in STEMI patients undergoing pPCI. Additionally, nesfatin-1 has a robust and negative correlation with the complexity of CAD.
背景
Nesfatin-1是一种具有多种代谢作用的新型肽。无复流现象（NR）是一种预后不良的指标，在所有接受直接经皮冠状动脉介入治疗（pPCI）的患者中约有30%会出现。冠状动脉疾病（CAD）的炎症和复杂性在NR的发病机制中起关键作用。在本研究中，我们调查了接受pPCI的ST段抬高型心肌梗死（STEMI）患者入院时血清nesfatin-1水平、NR与通过SYNTAX-1（SS-1）和SYNTAX-2（SS-2）评分评估的CAD复杂性之间的关系。
方法
本研究共纳入174例接受pPCI的STEMI患者，分为NR组（n = 36）和正常血流组（n = 138）。采用酶联免疫吸附测定法测量血清nesfatin-1。78例年龄、性别和合并症匹配且冠状动脉造影狭窄<50%的连续患者组成对照组。
结果
与正常血流组和对照组相比，NR组的nesfatin-1水平显著降低（分别为10.8±6.6 ng/mL、34.9±24 ng/mL和43.6±23.2 ng/mL，p<0.001）。Nesfatin-1与SS-1和SS-2评分显著负相关（r分别为-0.709和-0.655，均p<0.001）。多因素逻辑回归分析显示，nesfatin-1[比值比（OR）=0.81，95%置信区间（CI）=0.708 - 0.936，p = 0.004]和肾小球滤过率（OR = 0.94，95%CI = 0.892 - 0.989，p = 0.018）与NR独立相关。在受试者工作特征分析中，nesfatin-1<15.21 ng/mL预测NR的敏感性为78.4%，特异性为72.2%（曲线下面积=0.809，95%CI = 0.701 - 0.918，p<0.001）。
结论
入院时nesfatin-1水平是接受pPCI的STEMI患者NR的有力预测指标。此外，nesfatin-1与CAD复杂性呈强烈负相关。
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