摘要
目的探讨血清可溶性肿瘤坏死因子受体-1(sTNFR-1)、sTNFR-2与冠状动脉易损斑块不稳定性及急性心肌梗死(AMI)的关系。方法选取2021年5月-2024年5月咸阳市第一人民医院心血管内科收治的易损斑块阳性患者120例为病例组,根据随访3个月是否发生AMI分为AMI亚组(n=44)和非AMI亚组(n=76)。另选取同期医院健康体检者80例为健康对照组。采用酶联免疫吸附法检测血清sTNFR-1、sTNFR-2及高敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平,荧光免疫层析法检测心肌肌钙蛋白I(cTnI)水平,冠状动脉造影检查斑块纤维帽厚度;Pearson法分析血清sTNFR-1、sTNFR-2与hs-CRP、TNF-α、cTnI、斑块纤维帽厚度的相关性;多因素Logistic回归分析易损斑块阳性患者发生AMI的影响因素;受试者工作特征(ROC)曲线评估血清sTNFR-1、sTNFR-2水平对易损斑块阳性患者发生AMI的预测价值。结果病例组sTNFR-1、sTNFR-2、hs-CRP、TNF-α及cTnI高于健康对照组(t/P=26.083/<0.001,23.779/<0.001,31.925/<0.001,29.491/<0.001,29.473/<0.001);血清sTNFR-1、sTNFR-2与hs-CRP、TNF-α、cTnI呈正相关(sTNFR-1:r/P=0.681/<0.001,0.634/<0.001,0.707/<0.001;sTNFR-2:r/P=0.672/<0.001,0.619/<0.001,0.673/<0.001),与斑块纤维帽厚度呈负相关(sTNFR-1:r/P=-0.723/<0.001;sTNFR-2:r/P=-0.706/<0.001);有高血压史及血清hs-CRP、TNF-α、cTnI、sTNFR-1、sTNFR-2升高是易损斑块阳性患者发生AMI独立危险因素[OR(95%CI)=1.464(1.139~1.881),1.660(1.037~2.658),1.483(1.174~1.872),1.516(1.236~1.859),1.598(1.217~2.099),1.496(1.225~2.827)],斑块纤维帽厚度增加是AMI保护因素[OR(95%CI)=0.583(0.412~0.828)];血清sTNFR-1、sTNFR-2及二者联合预测AMI的AUC分别为0.797、0.765、0.893,二者联合预测价值大于单一指标(Z/P=1.771/0.012,2.261/0.002)。结论血清sTNFR-1、sTNFR-2水平升高介导了冠状动脉易损斑块破裂过程,早期检测两指标可辅助临床评估冠状动脉易损斑块不稳定性,从而预测AMI发生风险。
Objective To explore the association between serum soluble tumor necrosis factor receptor-1(sTNFR-1),serum soluble tumor necrosis factor receptor-1(sTNFR-2)and coronary artery vulnerable plaque instability and acute myocardial infarction(AMI).Methods A total of 120 patients with positive vulnerable plaque admitted to Xianyang First People's Hospital from May 2021 to May 2024 were selected as the case group,and they were divided into AMI subgroup(n=44)and non-AMI subgroup(n=76)according to the occurrence of AMI,80 healthy subjects were selected as the healthy control group.The levels of serum sTNFR-1,sTNFR-2,high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay,the level of cardiac troponin I(cTnI)was detected by fluorescence immunochromatography,the thickness of plaque fibrous cap was examined by coronary angiography.Pearson product moment correlation analysis was used to analyze the correlation between serum sTNFR-1,sTNFR-2 and hs-CRP,TNF-α,cTnI,plaque fibrous cap thickness;Logistic regression analysis was used to analyze the relationship between serum sTNFR-1,sTNFR-2 and AMI,the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum sTNFR-1 and sTNFR-2 for AMI.Results The levels of sTNFR-1,sTNFR-2,hs-CRP,TNF-αand cTnI in the case group were higher than those in the control group(t/P=26.083/<0.001,23.779/<0.001,31.925/<0.001,29.491/<0.001,29.473/<0.001);Serum sTNFR-1 and sTNFR-2 were positively correlated with hs-CRP,TNF-αand cTnI(sTNFR-1:r/P=0.681/<0.001,0.634/<0.001,0.707/<0.001;sTNFR-2:r/P=0.672/<0.001,0.619/<0.001,0.673/<0.001),and negatively correlated with the thickness of plaque fibrous cap(r/P=-0.723/<0.001,-0.706/<0.001);With a history of hypertension,elevated serum hs-CRP,TNF-α,cTnI,sTNFR-1 and sTNFR-2 were independent risk factors for AMI[OR(95%CI)=1.464(1.139-1.881),1.660(1.037-2.658),1.483(1.174-1.872),1.516(1.236-1.859),1.598(1.217-2.099),1.496(1.225-2.827)],increased fibrous cap thickness was a protective factor for AMI[OR(95%CI)=0.583(0.412-0.828)];the AUC of serum sTNFR-1,sTNFR-2 and the combination of the two in predicting AMI were 0.797,0.765 and 0.893,respectively.The combined predictive value of the two was greater than that of the single index(Z/P=1.771/0.012,2.261/0.002).Conclusion The up-regulation of serum sTNFR-1 and sTNFR-2 expression mediates the process of coronary vulnerable plaque rupture.Early detection of the two indicators can assist clinical evaluation of coronary vulnerable plaque instability,thus predicting the risk of AMI.
作者
焦文萍
高琳
李伟程
周丽媛
梁森
卞妮娜
王秋峰
Jiao Wenping;Gao Lin;Li Weicheng;Zhou Liyuan;Liang Sen;Bian Nina;Wang Qiufeng(Department of Internal Medicine-Cardiovascular,Xianyang First People's Hospital,Shaanxi,Xianyang 712000,China)
出处
《疑难病杂志》
2025年第3期274-279,共6页
Chinese Journal of Difficult and Complicated Cases
基金
陕西省卫生健康科研项目(2021C008)。
