经PCI治疗急性ST段抬高型心肌梗死患者血浆的代谢组学研究

Metabonomic research on blood of patients treated with PCI after acute ST-elevation myocardial infarction

摘要:

目的 通过对经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者的血液进行靶向代谢组学研究，探究与STEMI预后可能相关的标志物，为及早开通闭塞冠状动脉带来的获益提供代谢组学方面的依据。方法 选取2019年3月－2019年9月锦州医科大学附属第一医院STEMI患者43例，按照血管开通时间结合住院及出院随访期间（1个月）心脏事件发生情况将其分为A、B两组。用干血点法结合直接进样质谱代谢组学检测患者入院时、PCI术后第2天及术后1个月时的血液代谢物；构建主成分分析（PCA）及正交偏最小二乘判别分析（OPLS-DA）模型，筛选差异代谢物；记录两组患者术后住院期间及术后1个月随访时心脏彩超左室射血分数（LVEF），并将其与差异代谢物进行相关性分析。结果 A组患者平均住院时间短于B组，心衰及心律失常率低于B组（P <0.05）；PCA模型显示代谢物在术后1个月区分聚类趋势明显，将其进一步行OPLS-DA分析后，最终筛选出14个差异代谢物（包括4个氨基酸和10个肉碱）；代谢物与LVEF呈负相关（P <0.05）。结论 越早开通STEMI患者闭塞冠状动脉，心血管不良事件发生越少；心肌缺血、缺氧时间越长，血液中亮氨酸、缬氨酸（支链氨基酸）及长链酰基肉碱类物质含量越高，高代谢物可能与心肌梗死后心功能不全有关。

Abstract:

Objective To explore possible markers associated with the prognosis of STEMI to provide metabolomic evidence for the benefits of early access to occlusive coronary arteries.Method Forty-three STEMI patients were included and divided into groups A and B, according to the time of vascular opening and the occurrence of cardiac events during the hospitalization and discharge follow-up period (1 month). A dried blood spot method integrated with direct infusion mass spectrometry (MS) metabolomic analysis was applied for the detection of metabolite toward patients with STEMI at admission, first days after PCI，and 1 month after PCI; PCA and OPLS-DA were used to construct a differential model to screen related differential metabolites. The LVEF of the two groups was recorded during postoperative hospital stay and followed up 1 month after PCI, and its correlation with differential metabolites was analyzed.Result The average length of hospital stay in group A was shorter than that in group B, and the rate of heart failure and arrhythmia was lower than that in group B (P < 0.05); PCA model showed that the clustering trend of metabolites was obvious 1 month after PCI, after further OPLS-DA analysis, 14 differential metabolites were screened, including 4 amino acids and 10 carnitine; The metabolites were negatively correlated with LVEF.Conclusions The earlier you open STEMI patients with occluded coronary arteries, the less likely you are to have AEs with cardiac dysfunction; myocardial ischemia and hypoxia lasted a long time, and the content of valine (branched amino acid) and acylcarnitine in blood was relatively high. High metabolites may be related to cardiac dysfunction after myocardial infarction.