是一种用于预测ST段抬高型心肌梗死患者斑块破裂的新型生物标志物。

is a Novel Biomarker for Predicting Plaque Rupture in Patients with ST-Segment Elevation Myocardial Infarction.

作者信息

Luo Xing, Zhao Chen, Wang Shengfang, Jia Haibo, Yu Bo

机构信息

Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China.

Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, 150001, People's Republic of China.

出版信息

J Inflamm Res. 2022 Mar 14;15:1889-1898. doi: 10.2147/JIR.S352509. eCollection 2022.

BACKGROUND AND AIMS

Patients with plaque rupture (PR) present with different cardiovascular risks, clinical strategies, and outcomes from those with plaque erosion (PE). However, there are lack of noninvasive biomarkers to distinguish PE from PR.

METHODS

A prospective analysis of 382 patients with ST-segment elevation myocardial infarction (STEMI) was conducted. Of these patients, 262 and 120 presented with PR and PE, respectively. An additional 83 patients diagnosed with stable angina pectoris were enrolled as control group. Peripheral blood monocytes were collected pre-percutaneous coronary intervention and used to evaluate the mRNA expression of , , , and in all patients.

RESULTS

STEMI patients had higher , , , and expression than the control patients. The mRNA levels of , , and were significantly higher in PR patients than PE; however, no significant difference was observed in between PE and PR. The areas under the receiver-operating characteristic curves for , , and for PR versus PE were 0.685, 0.747, and 0.895, respectively. At the cut-off value of 2.52, demonstrated a sensitivity of 70.61% and specificity of 93.33% for discriminating PR from PE patients. When added to the model of established clinical risk factors, significantly improved the predictive accuracy of PR. Multivariable logistic regression analysis indicated that mRNA level was independently associated with PR (odds ratio, 3.09; 95% confidence interval, 2.29-4.16; p < 0.001).

CONCLUSION

The inflammatory response of peripheral blood mononuclear cells in patients with PR was higher than that in patients with PE. TNF-α may be a potential biomarker for predicting PR that could facilitate risk stratification and management in STEMI patients.

背景与目的

斑块破裂（PR）患者与斑块侵蚀（PE）患者在心血管风险、临床策略及预后方面存在差异。然而，目前缺乏用于区分PE与PR的非侵入性生物标志物。

方法

对382例ST段抬高型心肌梗死（STEMI）患者进行前瞻性分析。其中，分别有262例和120例表现为PR和PE。另外纳入83例诊断为稳定型心绞痛的患者作为对照组。在经皮冠状动脉介入治疗前采集外周血单核细胞，用于评估所有患者中[具体基因名称未给出]、[具体基因名称未给出]、[具体基因名称未给出]和[具体基因名称未给出]的mRNA表达。

结果

STEMI患者的[具体基因名称未给出]、[具体基因名称未给出]、[具体基因名称未给出]和[具体基因名称未给出]表达高于对照组患者。PR患者中[具体基因名称未给出]、[具体基因名称未给出]和[具体基因名称未给出]的mRNA水平显著高于PE患者；然而，PE与PR患者在[具体基因名称未给出]方面未观察到显著差异。PR与PE患者相比，[具体基因名称未给出]、[具体基因名称未给出]和[具体基因名称未给出]的受试者工作特征曲线下面积分别为0.685、0.747和0.895。在截断值为2.52时，[具体基因名称未给出]区分PR与PE患者的敏感性为70.61%，特异性为93.33%。当添加到已建立的临床危险因素模型中时，[具体基因名称未给出]显著提高了PR的预测准确性。多变量逻辑回归分析表明，[具体基因名称未给出]mRNA水平与PR独立相关（比值比，3.09；95%置信区间，2.29 - 4.16；p < 0.001）。