STEMI患者血清hs-cTnT及降鈣素原水平和冠脈病變程度及預后的相關性研究

STEMI患者血清hs-cTnT及降鈣素原水平和冠脈病變程度及預后的相關性研究摘要

目的：研究STEMI患者血清高敏肌鈣蛋白T（hs-cTnT）和降鈣素原（CNP）水平與冠脈病變程度及預后的關系。

方法：收集2018年1月至2021年1月廣州市中醫(yī)藥大學附屬第一醫(yī)院收治的83例STEMI患者的臨床資料。記錄患者入院時的心電圖，檢測血清hs-cTnT和CNP水平，并行足背動脈血管造影（CAG）評估冠脈病變程度及擴張技術(shù)處理。隨訪至出院后6個月，記錄死亡、再次心肌梗死及心血管事件的發(fā)生情況。

結(jié)果：血清hs-cTnT和CNP水平與冠脈狹窄程度呈正相關（P<0.05）。多因素回歸分析顯示，血清hs-cTnT和CNP水平與術(shù)后6個月死亡、再次心肌梗死及心血管事件發(fā)生率呈正相關（P<0.05）。受試者工作特征曲線顯示，血清hs-cTnT和CNP水平對STEMI患者的預后具有較好的預測價值。

結(jié)論：血清hs-cTnT和CNP水平是反映STEMI患者冠脈病變程度和預后的重要生物標志物。

關鍵詞：STEMI，高敏肌鈣蛋白T，降鈣素原，冠脈病變，預后

Abstract

Objective:Toinvestigatetherelationshipbetweenserumhigh-sensitivitycardiactroponinT(hs-cTnT)andcalcitoningene-relatedpeptide(CNP)levelsofSTEMIpatientsandtheseverityofcoronaryarterydiseaseandprognosis.

Methods:Theclinicaldataof83STEMIpatientsadmittedtotheFirstAffiliatedHospitalofGuangzhouUniversityofChineseMedicinefromJanuary2018toJanuary2021werecollected.Thepatients'ECGatadmissionwasrecorded,serumhs-cTnTandCNPlevelsweredetected,andlowerlimbarteryangiography(CAG)wasperformedtoevaluatetheseverityofcoronaryarterydiseaseandthetreatmentofexpansiontechnology.Follow-upwasperformedfor6monthsafterdischarge,andtheoccurrenceofdeath,recurrentmyocardialinfarction,andcardiovasculareventswererecorded.

Results:Serumhs-cTnTandCNPlevelswerepositivelycorrelatedwiththedegreeofcoronarystenosis(P<0.05).Multivariateregressionanalysisshowedthatserumhs-cTnTandCNPlevelswerepositivelycorrelatedwiththeoccurrenceofdeath,recurrentmyocardialinfarction,andcardiovascularevents6monthsaftersurgery(P<0.05).Thereceiveroperatingcharacteristiccurveshowedthatserumhs-cTnTandCNPlevelshadagoodpredictivevaluefortheprognosisofSTEMIpatients.

Conclusion:Serumhs-cTnTandCNPlevelsareimportantbiologicalmarkersreflectingtheseverityandprognosisofSTEMIpatientswithcoronaryarterydisease.

Keywords:STEMI,high-sensitivitytroponinT,calcitoningene-relatedpeptide,coronaryarterydisease,prognosiInsummary,STEMIisaseriousandlife-threateningconditionthatrequirespromptdiagnosisandtreatment.High-sensitivitytroponinTandcalcitoningene-relatedpeptideareimportantbiomarkersthatcanbeusedtoassesstheseverityandprognosisofSTEMIpatientswithcoronaryarterydisease.Earlyidentificationofthesemarkersmayaidinriskstratification,selectionofappropriateinterventions,andimprovementofpatientoutcomes.Furtherstudiesareneededtoexplorethepotentialroleofthesebiomarkersinguidingtherapeuticstrategiesandimprovinglong-termoutcomesinSTEMIpatients.Overall,theuseofthesebiomarkershasthepotentialtoimprovethemanagementofSTEMIpatientsandreducetheburdenofcardiovasculardiseaseInadditiontothebiomarkersdiscussedabove,thereareotherpotentialmarkersthatmaybeusefulinthemanagementofSTEMIpatients.Forexample,high-sensitivityC-reactiveprotein(hs-CRP)hasbeenshowntobeapredictorofadverseoutcomesinpatientswithcoronaryarterydisease,includingthosewithSTEMI.Elevatedlevelsofhs-CRPhavebeenassociatedwithincreasedriskofrecurrentmyocardialinfarction,heartfailure,anddeath.Thismarkermaybeusefulinidentifyingpatientswhowouldbenefitfrommoreaggressivetherapyorcloserfollow-up.

Similarly,homocysteine,asulfur-containingaminoacid,hasbeenimplicatedinthepathogenesisofatherosclerosisandendothelialdysfunction.Elevatedlevelsofhomocysteinehavebeenassociatedwithincreasedriskofcardiovasculardisease,includingcoronaryarterydiseaseandSTEMI.AlthoughtheuseofhomocysteineasabiomarkerforriskstratificationandmanagementofSTEMIpatientsiscontroversial,somestudieshavesuggestedthatloweringhomocysteinelevelsmayimproveoutcomesinthesepatients.

AnotherpotentialbiomarkeriscirculatingmicroRNAs(miRNAs),whicharesmallRNAmoleculesthatregulategeneexpression.RecentstudieshavesuggestedthatmiRNAsmayplayaroleinthepathophysiologyofSTEMIandmayserveasbiomarkersfordiagnosis,riskstratification,andtherapeuticmonitoring.Forexample,miR-1,miR-133,andmiR-208ahavebeenshowntobespecifictomyocardialcellsandareelevatedinpatientswithSTEMI.OthermiRNAs,suchasmiR-126andmiR-145,havebeenimplicatedintheregulationofangiogenesisandendothelialfunctionandmaybeusefulinpredictingoutcomesinSTEMIpatients.

DespitethepotentialusefulnessoftheseandotherbiomarkersinthemanagementofSTEMIpatients,theirclinicalutilityisstillunderinvestigation.Furtherstudiesareneededtoestablishtheirdiagnosticandprognosticvalue,aswellastheirpotentialroleinguidingtherapeuticdecisions.Inaddition,thedevelopmentofmoresensitiveandspecificassayswillbeimportantinimprovingtheaccuracyandreliabilityofbiomarkertesting.Withcontinuedresearchandinnovation,biomarkershavethepotentialtorevolutionizethemanagementofSTEMIpatientsandimprovetheiroutcomesMoreover,theintegrationofbiomarkersinclinicalpracticerequiresconsiderationofseveralfactors,includingcost-effectiveness,availability,andaccessibility.Assuch,theimplementationofbiomarkertestinginroutinecaremayfacesomebarriersandchallengesthatneedtobeaddressed.

Onepotentiallimitationofbiomarkertestingisthecostassociatedwiththeirmeasures.Asnewerbiomarkersaredeveloped,thecostoftestingmayincrease,makingitdifficultforhealthcaresystemstoincorporatetheiruseintoroutinepractice.Thefinancialburdenofbiomarkertestingshouldbeweighedagainstitspotentialbenefits,andcost-effectivenessanalysesshouldbeconductedtodeterminethevalueofincorporatingbiomarkersintoclinicaldecision-making.

Anotherchallengeinusingbiomarkersinclinicalpracticeistheiravailabilityandaccessibility.Somebiomarkersmayrequirespecializedassaysortestingplatformsthatarenotreadilyavailableinallhealthcaresettings.Thismaylimitthewidespreadadoptionofthesebiomarkers,particularlyinresource-limitedsettings.

Inaddition,theinterpretationofbiomarkerresultscanbecomplex,andtheirintegrationintoclinicaldecision-makingrequiresexpertknowledgeandtraining.Healthcareprofessionalsneedtobeeducatedontheappropriateuseofbiomarkers,theirinterpretation,andtheirlimitations,toensurethatthesebiomarkersareusedeffectivelyandappropriatelytoguideclinicaldecision-making.

Insummary,biomarkershavethepotentialtorevolutionizethemanagementofSTEMIpatients,buttheirclinicalutility,cost-effectiveness,andaccessibilityneedtobecarefullyconsidered.Continuedresearchandinnovationareneededtodevelopnewandmoresensitivebiomarkers,improvetheiraccuracyandreliability,andestablishtheirdiagnosticandprognosticvalue.Thesuccessfulimplementationofbiomarkersintoroutineclinicalpracticerequirestheactiveinvolvementofhealthcareprofessionals,aswellascarefulconsiderationofthebarri