心肺联合超声联合潜在转化生长因子结合蛋白-2对急性心肌梗死患者短期预后的预测价值及影响因素分析

Prediction value and factor analysis of cardiopulmonary ultrasound combined with LTBP-2 for short-term prognosis in patients with acute myocardial infarction

摘要:

目的 探讨心肺联合超声（CPUS）联合潜在转化生长因子结合蛋白-2（LTBP-2）对急性心肌梗死（AMI）患者短期预后的预测价值及影响因素分析。方法 选取2021年7月—2024年7月商洛市中心医院收治的AMI患者136例，患者均进行CPUS检查及LTBP-2水平检测，术后对患者随访3个月，根据随访结果将其分为预后良好组（100例）和预后不良组（36例）。采用多因素一般Logistic回归模型分析评估AMI患者预后不良的危险因素，并构建受试者工作特征（ROC）曲线评估CPUS联合LTBP-2对AMI患者短期预后的预测价值。结果 预后不良组发病至介入时间、冠状动脉三支病变率和Killips分级≥Ⅲ级占比均高于预后良好组（P <0.05）；预后不良组舒张早期峰值流速/舒张早期运动速度比值（E/e′）、左心房容积指数（LAVI）、B线数量和LTBP-2较预后良好组高，LVEF较预后良好组低（P <0.05）；多因素一般Logistic回归分析结果显示，冠状动脉三支病变［O^R =12.817（95% CI：2.217，74.088）］、Killip分级≥Ⅲ级［O^R =34.143（95% CI：4.449，262.038）］、B线数量多［O^R =1.504（95% CI：1.139，1.987）］、LTBP-2高［O^R =1.242（95% CI：1.058，1.459）］均为AMI患者预后不良的危险因素（P <0.05），LVEF高［O^R =0.827（95% CI：0.713，0.959）］为AMI患者预后不良的保护因素（P <0.05）；ROC曲线分析结果显示，LVEF、B线数量联合LTBP-2预测AMI患者短期预后的敏感性、特异性分别为86.1%（95% CI：0.705，0.953）、97.0%（95% CI：0.915，0.994），曲线下面积为0.967（95% CI：0.940，0.994）。结论 CPUS参数（LVEF、B线数量）联合LTBP-2可有效预测AMI患者短期预后，其中冠状动脉三支病变、Killip分级≥Ⅲ级、高B线数量及高LTBP-2水平均为AMI患者预后不良的危险因素，LVEF高为AMI患者预后不良的保护因素，联合检测优于单项指标。

Abstract:

Objective To investigate the predictive value and associated factors of cardiopulmonary ultrasound (CPUS) combined with latent transforming growth factor binding protein-2 (LTBP-2) for short-term prognosis in patients with acute myocardial infarction (AMI).Methods A total of 136 AMI patients admitted to Shangluo Central Hospital from July 2021 to July 2024 were enrolled. All patients underwent CPUS examination and LTBP-2 level detection. Patients were followed up for 3 months postoperatively and divided into a good prognosis group (n = 100) and a poor prognosis group (n = 36) based on follow-up results. Multivariate logistic regression analysis was used to evaluate the risk factors for poor prognosis in AMI patients, and receiver operating characteristic (ROC) curves were constructed to assess the predictive value of CPUS combined with LTBP-2 for short-term prognosis in AMI patients.Results The time from onset to intervention, incidence of three-vessel coronary artery disease, and proportion of Killip class ≥ III were higher in the poor prognosis group than in the good prognosis group (P < 0.05). The levels of E/e′, LAVI, B-line count, and LTBP-2 were higher in the poor prognosis group than in the good prognosis group, while LVEF was lower in the poor prognosis group (P < 0.05). Multivariate analysis showed that three-vessel coronary artery disease [O^R = 12.817 (95% CI: 2.217, 74.088) ], Killip class ≥ III [O^R = 34.143 (95% CI: 4.449, 262.038) ], increased B-line count [O^R = 1.504 (95% CI: 1.139, 1.987) ], and elevated LTBP-2 level [O^R = 1.242 (95% CI: 1.058, 1.459) ] were risk factors for poor prognosis in AMI patients (P < 0.05), whereas higher LVEF [O^R = 0.827 (95% CI: 0.713, 0.959) ] was a protective factor against poor prognosis (P < 0.05). ROC analysis showed that the sensitivity and specificity of LVEF, B-line count, and LTBP-2 combined in predicting short-term prognosis in AMI patients were 86.1% (95% CI: 0.705, 0.953) and 97.0% (95% CI: 0.915, 0.994), respectively, with an AUC of 0.967 (95% CI: 0.940, 0.994).Conclusion CPUS parameters (LVEF, B-line count) combined with LTBP-2 can effectively predict short-term prognosis in AMI patients. Three-vessel coronary artery disease, Killip class ≥ III, high B-line count, and elevated LTBP-2 are risk factors, while LVEF is a protective factor. The combined assessment is superior to assessment using individual indicators.