RT-3DE联合血清Galectin-3及可溶性sST2对急性心肌梗死患者经皮冠状动脉介入术预后的评估价值

Evaluation value of RT-3DE combined with serum galectin-3 and soluble sST2 in prognosis of acute myocardial infarction patients undergoing percutaneous coronary intervention

摘要:

目的 分析实时三维超声心动图（RT-3DE）联合血清半乳糖凝集素-3（Galectin-3）及可溶性生长刺激表达基因2蛋白（sST2）对急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）预后的评估价值。方法 选取2022年1月—2024年1月在中山市小榄人民医院接受PCI治疗的102例AMI患者作为研究对象，所有患者术前行RT-3DE检查，记录左室舒张末期容积（LEDV）、左室收缩末期容积（LESV）、左室射血分数（LVEF）等左室功能指标，并检测血清Galectin-3、sST2水平。术后对患者进行为期1年的随访，将发生死亡、卒中、支架内血栓、再发心肌梗死、靶血管再次血运重建及大出血的患者设为预后不良组（42例），其他患者为预后良好组（60例）。比较两组患者RT-3DE检查结果及血清Galectin-3、sST2水平。采用多因素一般Logistic回归模型分析患者预后不良的风险因素。绘制受试者工作特征（ROC）曲线评估RT-3DE联合血清Galectin-3、sST2对AMI患者PCI预后的评估价值。结果 术前预后不良组LEDV、LESV、Galectin-3及sST2水平均高于预后良好组（P <0.05），LVEF水平低于预后良好组（P <0.05）。多因素一般Logistic回归分析结果显示：LEDV高［O^R =1.076（95% CI：1.005，1.151）］、LESV高［O^R =1.290（95% CI：1.075，1.549）］、LVEF低［O^R =0.749（95% CI：0.630，0.890）］、Galectin-3高［O^R =1.281（95% CI：1.096，1.498）］、sST2高［O^R =1.312（95% CI：1.146，1.502）］均是患者预后不良的危险因素（P <0.05）。ROC曲线分析结果表明，RT-3DE联合血清Galectin-3及sST2对AMI患者PCI预后的预测价值较高，其敏感性为92.9%（95% CI：0.805，0.985），特异性为90.0%（95% CI：0.795，0.962），曲线下面积为0.969（95% CI：0.942，0.997）。结论 RT-3DE联合血清Galectin-3、sST2可有效评估AMI患者PCI预后。

Abstract:

Objective To analyze the evaluation value of real-time three-dimensional echocardiography (RT-3DE) combined with serum galectin-3 (Galectin-3) and soluble growth stimulation expressed gene 2 protein (sST2) in the prognosis of acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI).Methods A total of 102 AMI patients who underwent PCI in our hospital from January 2022 to January 2024 were selected as the research objects. All patients underwent preoperative RT-3DE examination to record left ventricular function indicators including left ventricular end-diastolic volume (LEDV), left ventricular end-systolic volume (LESV), and left ventricular ejection fraction (LVEF). Serum levels of Galectin-3 and sST2 were detected. Patients were followed up for 1 year after surgery. Those with death, stroke, in-stent thrombosis, recurrent myocardial infarction, re-revascularization, or bleeding were assigned to the poor prognosis group（n = 42）, and the others to the good prognosis group. RT-3DE results, Galectin-3 and sST2 levels were compared between the two groups（n = 60）. Logistic regression was used to analyze risk factors for poor prognosis, and ROC curve was adopted to evaluate the predictive value of RT-3DE combined with serum Galectin-3 and soluble sST2 for the prognosis of AMI patients after PCI.Results Specifically, the preoperative levels of LEDV, LESV, Galectin-3 and sST2 in the poor prognosis group were significantly higher than those in the good prognosis group(P < 0.05), while the LVEF level was significantly lower(P < 0.05). Results of logistic regression analysis indicated that elevated LEDV [O^R = 1.076 (95% CI: 1.005, 1.151) ], elevated LESV [O^R = 1.290 (95% CI: 1.075, 1.549) ], decreased LVEF [O^R = 0.749 (95% CI: 0.630, 0.890) ], elevated Galectin-3 [O^R = 1.281 (95% CI: 1.096, 1.498) ] and elevated sST2 [O^R = 1.312 (95% CI: 1.146, 1.502) ] were all independent risk factors for poor prognosis in patients (P < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that real-time three-dimensional echocardiography (RT-3DE) combined with serum Galectin-3 and sST2 had high predictive value for the prognosis of AMI patients after PCI, with a sensitivity of 92.9% (95% CI: 0.805, 0.985) and a specificity of 90.0% (95% CI: 0.795, 0.962) and the area under the curve of 0.969（95% CI：0.942，0.997）.Conclusion RT-3DE combined with serum Galectin-3 and sST2 can effectively evaluate the prognosis of acute myocardial infarction patients undergoing PCI.