Fang Caoyang, Chen Zhenfei, Zhang Jing, Pan Jianyuan, Jin Xiaoqin, Yang Mengsi, Huang Luyao
Graduate School, Bengbu Medical College, Longzi Lake District, Bengbu, Anhui 233030, China.
Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230011, China.
Cardiol Res Pract. 2022 Aug 23;2022:4905954. doi: 10.1155/2022/4905954. eCollection 2022.
Acute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease that poses a great threat to the life and health of patients. Therefore, early diagnosis is important for STEMI patient treatment and prognosis. The purpose of this study was to investigate the value of serum YKL-40 and TNF- in the diagnosis of STEMI.
From October 2020 to February 2022, 120 patients with STEMI were admitted to the Chest Pain Center of the Second People's Hospital of Hefei, and 81 patients with negative coronary angiography were selected as the control group. Serum YKL-40 and TNF- concentrations were measured by sandwich ELISA. Pearson correlation was used to analyze the correlation between serum YKL-40, TNF-, and serum troponin I (cTnI) in STEMI patients; multivariate logistic regression analysis was used to screen independent risk factors for STEMI. Three diagnostic models were constructed: cTnI univariate model (model ), combined serum YKL-40 and TNF- model other than cTnI (model ), and combined cTnI and serum YKL-40 and TNF- model (model ). We assessed the clinical usefulness of the diagnostic model by comparing AUC with decision curve analysis (DCA).
Serum YKL-40 and TNF- in the STEMI group were significantly higher than those in the control group ( < 0.001). On Pearson correlation analysis, there was a significant positive correlation between serum YKL-40, TNF-, and cTnI levels in STEMI patients. Multivariate logistic regression analysis showed that serum YKL-40 and TNF- were independent risk factors for the development of STEMI. The results of ROC analysis showed that the area under the curve (AUC) of serum YKL-40 for predicting the occurrence of STEMI was 0.704. The AUC of serum TNF- for predicting the occurrence of STEMI was 0.852. The AUC of cTnI as a traditional model, model , for predicting the occurrence of STEMI was 0.875. Model predicted STEMI with an AUC of 0.851. The addition of serum YKL-40 and serum TNF- to the traditional diagnostic model composed of cTnI constituted a new diagnostic model; that is, the AUC of model for predicting the occurrence of STEMI was 0.930. Model had a better net benefit between a threshold probability of 70-95% for DCA.
In this study, we demonstrate the utility of serum YKL-40 and TNF- as diagnostic markers for STEMI and the clinical utility of diagnostic models by combining serum YKL-40 and TNF- with cTnI.
急性ST段抬高型心肌梗死（STEMI）是一种严重的心血管疾病，对患者的生命和健康构成巨大威胁。因此，早期诊断对STEMI患者的治疗和预后至关重要。本研究的目的是探讨血清YKL-40和肿瘤坏死因子-α（TNF-α）在STEMI诊断中的价值。
2020年10月至2022年2月，120例STEMI患者入住合肥市第二人民医院胸痛中心，选取81例冠状动脉造影阴性患者作为对照组。采用夹心酶联免疫吸附测定法（ELISA）检测血清YKL-�0和TNF-α浓度。采用Pearson相关性分析STEMI患者血清YKL-40、TNF-α与血清肌钙蛋白I（cTnI）之间的相关性；采用多因素logistic回归分析筛选STEMI的独立危险因素。构建了三个诊断模型：cTnI单变量模型（模型1）、除cTnI外联合血清YKL-40和TNF-α模型（模型2）以及联合cTnI与血清YKL-40和TNF-α模型（模型3）。通过比较曲线下面积（AUC）与决策曲线分析（DCA）评估诊断模型的临床实用性。
STEMI组血清YKL-40和TNF-α显著高于对照组（P<0.001）。Pearson相关性分析显示，STEMI患者血清YKL-40、TNF-α与cTnI水平呈显著正相关。多因素logistic回归分析表明，血清YKL-40和TNF-α是STEMI发生的独立危险因素。ROC分析结果显示，血清YKL-40预测STEMI发生的曲线下面积（AUC）为0.704。血清TNF-α预测STEMI发生的AUC为0.852。作为传统模型的cTnI预测STEMI发生的AUC为0.875。模型2预测STEMI的AUC为0.851。在由cTnI组成的传统诊断模型中加入血清YKL-40和血清TNF-α构成了一个新的诊断模型；即模型3预测STEMI发生的AUC为0.930。对于DCA，模型3在阈值概率为70%-95%之间具有更好的净效益。
在本研究中，我们证明了血清YKL-40和TNF-α作为STEMI诊断标志物的实用性以及将血清YKL-40和TNF-α与cTnI联合使用的诊断模型的临床实用性。
