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超越肌钙蛋白:新型标志物在非ST段抬高型心肌梗死中的新兴诊断意义

Beyond troponins: Emerging diagnostic significance of novel markers in NSTEMI.

作者信息

Varshney Amit, Ram Vidya S, Kumar Pankaj

机构信息

Department of General Medicine, Noida International Institute of Medical Sciences, Gautam Budh Nagar, Uttar Pradesh, India.

Department of Medicine, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India.

出版信息

Glob Cardiol Sci Pract. 2024 Aug 1;2024(4):e202433. doi: 10.21542/gcsp.2024.33.

Abstract

This study aims to comprehensively analyze a multiple-marker panel consisting of 55 morphofunctional and biochemical markers in 123 patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). The goal of this study was to identify novel pathogenetic landmarks and diagnostic predictors associated with NSTEMI. The study includes 123 patients diagnosed with NSTEMI based on ESC Guidelines criteria. Clinical characteristics, morphofunctional markers, and serum levels of 53 biochemical markers related to inflammation, oxidative stress, endothelial dysfunction, cellular injury, hemostasis, and myocardial remodeling were assessed. A control group of 47 healthy individuals was included for comparison. NSTEMI patients exhibited an activated inflammatory status, oxidative stress, and endothelial dysfunction. Notable increases in inflammation markers, alterations in adipokines, and changes in oxidative stress markers were observed. Endothelial dysfunction markers indicated vascular remodeling and dysfunction. Cellular injury markers, including cMyBP-C, suggested myocardial necrotic injury. Hemostasis markers showed impaired anticoagulant systems, and ECM remodeling markers indicated increased matrix metalloproteinases. The multiple-marker panel provides insights into novel pathogenetic entities associated with NSTEMI. Markers such as MPO, MMP-8, E-selectin, PhA2, Ang 2, FE, MF, and cMyBP-C demonstrate potential diagnostic and prognostic value. This comprehensive analysis enhances our understanding of NSTEMI pathogenesis and offers potential targets for therapeutic interventions.

摘要

本研究旨在全面分析由55种形态功能和生化标志物组成的多标志物组,研究对象为123例被诊断为非ST段抬高型心肌梗死(NSTEMI)的患者。本研究的目的是确定与NSTEMI相关的新的发病机制标志和诊断预测指标。该研究纳入了123例根据欧洲心脏病学会(ESC)指南标准诊断为NSTEMI的患者。评估了临床特征、形态功能标志物以及与炎症、氧化应激、内皮功能障碍、细胞损伤、止血和心肌重塑相关的53种生化标志物的血清水平。纳入47名健康个体作为对照组进行比较。NSTEMI患者表现出炎症状态激活、氧化应激和内皮功能障碍。观察到炎症标志物显著增加、脂肪因子改变以及氧化应激标志物变化。内皮功能障碍标志物表明血管重塑和功能障碍。包括cMyBP-C在内的细胞损伤标志物提示心肌坏死性损伤。止血标志物显示抗凝系统受损,细胞外基质重塑标志物表明基质金属蛋白酶增加。多标志物组为与NSTEMI相关的新发病机制实体提供了见解。髓过氧化物酶(MPO)、基质金属蛋白酶-8(MMP-8)、E-选择素、磷脂酸2(PhA2)、血管生成素2(Ang 2)、铁蛋白(FE)、甲胎蛋白(MF)和cMyBP-C等标志物具有潜在的诊断和预后价值。这种全面分析增强了我们对NSTEMI发病机制的理解,并为治疗干预提供了潜在靶点。

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