Prediction of serum indexes of major adverse cardiovascular events in acute myocardial infarction
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摘要:目的
分析血清可溶性细胞间黏附分子-1（sICAM-1）、可溶性血管细胞间黏附分子-1（sVCAM-1）与可溶性微纤维相关蛋白4（sMFAP4）对急性心肌梗死经皮冠状动脉介入治疗（PCI）术后主要不良心血管事件（MACE）的预测价值。
方法选取收治的166例急性心肌梗死PCI术后患者纳入病例组，另于同期选取166例健康志愿者纳入对照组。采用酶联免疫法检测血清sICAM-1、sVCAM-1与sMFAP4水平并比较组间差异。随访1年，剔除10例患者后，将病例组分为MACE组（n=42）和无MACE组（n=113）。比较MACE组和无MACE组的一般资料。采用Logistic回归分析法明确MACE的影响因素；绘制受试者工作特征（ROC）曲线，以曲线下面积（AUC）评价相关指标预测MACE的效能。
结果MACE的发生率为27.10%。病例组血清sICAM-1、sVCAM-1与sMFAP4水平高于对照组，且MACE组高于无MACE组，差异有统计学意义（P < 0.05）。有吸烟史（OR=3.688，95%CI：1.107~12.286）、有饮酒史（OR=3.364，95%CI：1.238~9.139）、合并高血压（OR=4.255，95%CI：1.250~14.483）、合并2型糖尿病（OR=4.208，95%CI：1.051~16.856）、合并高脂血症（OR=5.238，95%CI：1.440~19.061）、Gensini评分（OR=5.579，95%CI：1.355~22.968）、血小板计数（PLT）（OR=0.519，95%CI：0.281~0.961）、血清sICAM-1（OR=5.013，95%CI：1.859~13.514）、sVCAM-1（OR=4.826，95%CI：1.769~13.164）、sMFAP4（OR=4.745，95%CI：1.372~16.407）水平、术中无复流（OR=2.962，95%CI：1.107~7.924）和无侧支循环形成（OR=3.225，95%CI：1.173~8.867）均是MACE发生的影响因素。血清sICAM-1、sVCAM-1、sMFAP4水平预测病例组MACE的Cut-off值分别为331.53 ng/mL、473.20 ng/mL、30.63 U/L，灵敏度分别为80.95%、76.19%、78.57%，特异度分别为94.69%、97.35%、88.50%，AUC分别为0.835（95%CI：0.767~0.890）、0.794（95%CI：0.722~0.855）、0.824（95%CI：0.754~0.880）。血清sICAM-1、sVCAM-1与sMFAP4预测MACE的灵敏度、特异度和AUC均高于或大于Gensini评分（P < 0.05）；上述血清指标联合预测病例组MACE的灵敏度、特异度、AUC分别为100.00%、94.69%、0.956（95%CI：0.910~0.982），联合预测的灵敏度与AUC均高于或大于单独预测（P < 0.05）。
结论急性心肌梗死患者的血清sICAM-1、sVCAM-1与sMFAP4水平升高，三者均与PCI术后MACE有关，且三者对MACE的预测价值优于Gensini评分，三者联合预测的价值更高。
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关键词:
- 可溶性细胞间黏附分子-1 /
- 可溶性血管细胞间黏附分子-1 /
- 可溶性微纤维相关蛋白4 /
- 急性心肌梗死 /
- 经皮冠状动脉介入治疗 /
- 主要不良心血管事件
Abstract:ObjectiveTo analyze the predictive value of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular intercellular adhesion molecule-1 (sVCAM-1) and soluble microfiber associated protein 4 (sMFAP4) for major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in acute myocardial infarction.
MethodsA total of 166 patients with acute myocardial infarction after PCI were included in case group, and 166 healthy volunteers were included in control group during the same period. Enzyme-linked immunosorbent assay was used to detect serum levels of sICAM-1, sVCAM-1 and sMFAP4, and the differences between groups were compared. After being followed-up for 1 year, the case group was divided into MACE group (n=42) and non-MACE (n=113) group after removing 10 cases. General information was compared between the MACE group and the non-MACE group. Logistic regression analysis was used to identify the influencing factors for MACE; receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was used to evaluate the efficacy of relevant indicators in predicting MACE.
ResultsThe incidence of MACE was 27.10%. The serum levels of sICAM-1, sVCAM-1 and sMFAP4 in the case group were significantly higher than those in the control group, and those in the MACE group were significantly higher than those in the non-MACE group (P < 0.05). Smoking history (OR=3.688, 95%CI, 1.107 to 12.286), drinking history (OR=3.364, 95%CI, 1.238 to 9.139), combined hypertension (OR=4.255, 95%CI, 1.250 to 14.483), combined type 2 diabetes (OR=4.208, 95%CI, 1.051 to 16.856), combined hyperlipidemia (OR=5.238, 95%CI, 1.440 to 19.061), Gensini score (OR=5.579, 95%CI, 1.355 to 22.968), blood platelet count (PLT) (OR=0.519, 95%CI, 0.281 to 0.961), serum sICAM-1 (OR=5.013, 95%CI, 1.859 to 13.514), sVCAM-1 (OR=4.826, 95%CI, 1.769 to 13.164) as well as sMFAP4 (OR=4.745, 95%CI, 1.372 to 16.407) and no reflow during surgery (OR=2.962, 95%CI, 1.107 to 7.924), no collateral circulation formation (OR=3.225, 95%CI, 1.173 to 8.867) were all influencing factors for the occurrence of MACE. Serum sICAM-1, sVCAM-1 and sMFAP4 levels predicted the cut-off value of MACE in the case group were 331.53 ng/mL, 473.20 ng/mL and 30.63 U/L, respectively, the sensitivity was 80.95%, 76.19% and 78.57%, respectively, the specificity was 94.69%, 97.35%, 88.50%, respectively, and the AUC was 0.835 (95%CI, 0.767 to 0.890), 0.794 (95%CI, 0.722 to 0.855), 0.824(95%CI, 0.754 to 0.880), respectively. The sensitivity, specificity and AUC of serum sICAM-1, sVCAM-1 and sMFAP4 to predict MACE were larger or higher than those of Gensini score (P < 0.05); the sensitivity, specificity and AUC of the above serum indexes combined to predict the occurrence of MACE in the case group were 100.00%, 94.69% and 0.956 (95%CI, 0.910 to 0.982), respectively, and the sensitivity and AUC of the combined prediction were higher or larger than those of the single prediction (P < 0.05).
ConclusionSerum sICAM-1, sVCAM-1 and sMFAP4 levels are increased in patients with acute myocardial infarction, all of which are related to MACE after PCI. The MACE prediction value of the three is better than Gensini score, and the combined prediction value of the three is higher.
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表 1 2组血清sICAM-1、sVCAM-1与sMFAP4水平比较(x±s)
组别 n sICAM-1/(ng/mL) sVCAM-1/(ng/mL) sMFAP4/(U/L) 病例组 155 318.63±42.01* 435.67±58.69* 30.04±5.19* 对照组 162 170.03±31.08 196.54±33.62 12.51±2.04 sICAM-1: 可溶性细胞间黏附分子-1; sVCAM-1: 可溶性血管细胞间黏附分子-1; sMFAP4: 可溶性微纤维相关蛋白4。与对照组比较, * P < 0.05。 
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表 2 MACE组与无MACE组一般资料比较(x±s)[n(%)]
一般资料 分类 MACE组(n=42) 无MACE组(n=113) χ2/t P 性别 男 27(64.29) 79(69.91) 0.448 0.503 女 15(35.71) 34(30.09) 年龄/岁 66.12±10.38 64.86±10.07 0.687 0.493 体质量指数/(kg/m2) 23.31±4.47 22.02±4.01 1.725 0.087 吸烟史 有 28(66.67) 48(42.48) 7.169 0.007 无 14(33.33) 65(57.52) 饮酒史 有 20(47.62) 31(27.43) 5.651 0.017 无 22(52.38) 82(72.57) 合并高血压 是 29(69.05) 51(45.13) 7.012 0.008 否 13(30.95) 62(54.87) 合并2型糖尿病 是 31(73.81) 60(53.10) 5.419 0.020 否 11(26.19) 53(46.90) 合并高脂血症 是 36(85.71) 74(65.49) 6.081 0.014 否 6(14.29) 39(34.51) ST段抬高 是 18(42.86) 52(46.02) 0.124 0.725 否 24(57.14) 61(53.98) Gensini评分/分 83.50±12.07 58.41±10.02 13.087 < 0.001 WBC/(×109/L) 12.03±2.15 11.79±2.09 0.631 0.529 PLT/(×109/L) 210.20±29.75 245.86±33.69 6.038 < 0.001 Scr/(μmol/L) 83.18±8.55 81.67±7.99 1.026 0.307 sICAM-1/(ng/mL) 397.68±45.86 289.25±40.04 14.395 < 0.001 sVCAM-1/(ng/mL) 552.44±61.73 392.27±55.06 15.570 < 0.001 sMFAP4/(U/L) 38.89±6.88 26.75±5.04 12.011 < 0.001 LVEF/% 49.95±6.20 53.63±7.11 2.961 0.004 发病至到院时间/h 5.15±1.23 3.46±0.78 13.265 < 0.001 植入支架长度/mm 16.32±3.23 14.28±2.79 3.873 < 0.001 植入支架压力/mmHg 13.10±2.04 11.08±2.06 5.440 < 0.001 术中无复流 是 10(23.81) 1(0.88) 24.407 < 0.001 否 32(76.19) 112(99.12) 侧支循环形成 是 7(16.67) 43(38.05) 6.409 0.011 否 35(83.33) 70(61.95) WBC: 白细胞; PLT: 血小板; Scr: 血肌酐; sICAM-1: 可溶性细胞间黏附分子-1; sVCAM-1: 可溶性血管细胞间黏附分子-1; sMFAP4: 可溶性微纤维相关蛋白4; LVEF: 左室射血分数。
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表 3 变量赋值
变量 赋值 变量 赋值 吸烟史 无=0, 有=1 血清sICAM-1水平 自测值 饮酒史 无=0, 有=1 血清sVCAM-1水平 自测值 合并高血压 否=0, 是=1 血清sMFAP4水平 自测值 合并2型糖尿病 否=0, 是=1 术中无复流 否=0, 是=1 合并高脂血症 否=0, 是=1 侧支循环形成 是=0, 否=1 Gensini评分 自测值 MACE 否=0, 是=1 PLT 自测值 — —
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表 4 病例组PCI术后MACE危险因素的Logistic回归分析
因素 β SE Wald P OR(95%CI) 吸烟史 1.305 0.614 4.517 0.013 3.688(1.107~12.286) 饮酒史 1.213 0.510 5.657 0.007 3.364(1.238~9.139) 合并高血压 1.448 0.625 5.368 0.009 4.255(1.250~14.483) 合并2型糖尿病 1.437 0.708 4.120 0.018 4.208(1.051~16.856) 合并高脂血症 1.656 0.659 6.315 0.001 5.238(1.440~19.061) Gensini评分 1.719 0.722 5.669 0.007 5.579(1.355~22.968) PLT -0.655 0.314 4.351 0.016 0.519(0.281~0.961) 血清sICAM-1水平 1.612 0.506 10.149 < 0.001 5.013(1.859~13.514) 血清sVCAM-1水平 1.574 0.512 9.451 < 0.001 4.826(1.769~13.164) 血清sMFAP4水平 1.557 0.633 6.050 0.002 4.745(1.372~16.407) 术中无复流 1.086 0.502 4.680 0.015 2.962(1.107~7.924) 无侧支循环形成 1.171 0.516 5.150 0.010 3.225(1.173~8.867)
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表 5 不同指标或方法对病例组发生MACE的预测价值
指标或方法 Cut-off值 灵敏度/% 特异度/% AUC(95%CI) sICAM-1 331.53 ng/mL 80.95 94.69 0.835(0.767~0.890) sVCAM-1 473.20 ng/mL 76.19 97.35 0.794(0.722~0.855) sMFAP4 30.63 U/L 78.57 95.58 0.824(0.754~0.880) Gensini评分 78分 57.14 88.50 0.653(0.573~0.728) 血清指标联合 — 100.00 94.69 0.956(0.910~0.982)
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