Zhang Yifan, Zhang Lili, Chen Zhong
Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Cardiovasc Diagn Ther. 2023 Apr 28;13(2):345-354. doi: 10.21037/cdt-22-520. Epub 2023 Mar 21.
Soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin-1 receptor family, binds IL-33, preventing its interaction with membrane-bound form ST2 (ST2L), thereby blocking its protection against atherosclerosis. High-density lipoprotein cholesterol (HDL-C), a variety of lipoproteins with mean size of 8-10 nm and density of 1.063-1.21 g/mL, not only acts as lipid transporters that transport cholesterol reversely, but also carries a variety of proteins and microRNAs endowing it with the ability to prevent cardiovascular disease. Most studies on the relationship between sST2 and coronary heart disease (CHD) are limited to acute myocardial infarction (AMI). The present study set out to investigate the association between the sST2/HDL-C ratio and angina pectoris.
A retrospective single-center cohort study was conducted and a total of 250 patients with chest pain that formed a convenience series, hospitalized between January 2018 and August 2020, were enrolled. Patients with AMI, acute and chronic heart failure, structural heart disease, renal insufficiency [estimate glomerular filtration rate (eGFR) <60 mL/min/1.73 m], rheumatic immune diseases, malignant tumors and severe infections were excluded. Patients with missing data were also excluded. Two hundred and nine patients were finally enrolled. Levels of sST2, HDL-C and sST2/HDL-C ratio were measured and calculated after admission. The angina pectoris was diagnosed by combining clinical features, coronary angiography results and cardiac troponin I levels. The diagnosis value of sST2/HDL-C on angina pectoris was analyzed by binary logistic analysis and the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) assesses.
Patients with stable angina pectoris (SAP) or unstable angina pectoris (UAP) accounted for a larger proportion (28.8% . 42.9%, P=0.035) in patients with the higher sST2/HDL-C ratio. Binary logistics regression showed that for every unit of sST2/HDL-C increase, the risk of angina pectoris increased by 38.8% (OR =1.388, P=0.018). By subgroup analysis, a stronger association was found in non-diabetic patients (OR =1.551, P=0.006), non-hypertension patients (OR =1.700, P=0.025), non-smokers (OR =1.527, P=0.049) and patients aged <65 y (OR =1.693, P=0.019). ROC curve showed that AUC was higher [0.643 (0.566, 0.719) . 0.618 (0.540, 0.696)] and the sensitivity of diagnosis increased significantly (84.0% . 49.3%) by combining sST2/HDL-C with risk factors of CHD.
A higher ratio of sST2/HDL-C was associated with an increased risk of angina pectoris. sST2/HDL-C combined with CHD risk factors showed increased diagnostic value in identifying angina pectoris.
Clinical trial: ChiCTR-DDD-17013908.
可溶性致瘤性抑制因子2（sST2）是白细胞介素-1受体家族成员，可与白细胞介素-33（IL-33）结合，阻止其与膜结合形式的ST2（ST2L）相互作用，从而阻断其对动脉粥样硬化的保护作用。高密度脂蛋白胆固醇（HDL-C）是多种脂蛋白，平均大小为8 - 10 nm，密度为1.063 - 1.21 g/mL，不仅作为逆向转运胆固醇的脂质转运体，还携带多种蛋白质和微小RNA，使其具有预防心血管疾病的能力。大多数关于sST2与冠心病（CHD）关系的研究仅限于急性心肌梗死（AMI）。本研究旨在探讨sST2/HDL-C比值与心绞痛之间的关联。
进行一项回顾性单中心队列研究，纳入2018年1月至2020年8月期间因胸痛入院的250例患者，形成一个便利样本系列。排除急性心肌梗死、急慢性心力衰竭、结构性心脏病、肾功能不全[估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²]、风湿免疫疾病、恶性肿瘤及严重感染患者。也排除有缺失数据的患者。最终纳入209例患者。入院后测定并计算sST2、HDL-C水平及sST2/HDL-C比值。结合临床特征、冠状动脉造影结果及心肌肌钙蛋白I水平诊断心绞痛。采用二元逻辑回归分析sST2/HDL-C对心绞痛的诊断价值，并绘制受试者工作特征（ROC）曲线及计算曲线下面积（AUC）进行评估。
sST2/HDL-C比值较高的患者中，稳定型心绞痛（SAP）或不稳定型心绞痛（UAP）患者占比更大（28.8%对42.9%，P = 0.035）。二元逻辑回归显示，sST2/HDL-C每增加一个单位，心绞痛风险增加38.8%（OR = 1.388，P = 0.018）。亚组分析显示，在非糖尿病患者（OR = 1.551，P = 0.006）、非高血压患者（OR = 1.700，P = 0.025）、非吸烟者（OR = 1.527，P = 0.049）及年龄<65岁的患者（OR = 1.693，P = 0.019）中关联更强。ROC曲线显示，AUC更高[0.643（0.566，0.719）对0.618（0.540，0.696）]，且将sST2/HDL-C与冠心病危险因素相结合时，诊断敏感性显著提高（84.0%对49.3%）。
较高的sST2/HDL-C比值与心绞痛风险增加相关。sST2/HDL-C与冠心病危险因素相结合在识别心绞痛方面显示出更高的诊断价值。
临床试验：ChiCTR-DDD-17013908。
