STEMI患者血清hs-cTnT及降钙素原水平和冠脉病变程度及预后的相关性研究

STEMI患者血清hs-cTnT及降钙素原水平和冠脉病变程度及预后的相关性研究摘要

目的：研究STEMI患者血清高敏肌钙蛋白T（hs-cTnT）和降钙素原（CNP）水平与冠脉病变程度及预后的关系。

方法：收集2018年1月至2021年1月广州市中医药大学附属第一医院收治的83例STEMI患者的临床资料。记录患者入院时的心电图，检测血清hs-cTnT和CNP水平，并行足背动脉血管造影（CAG）评估冠脉病变程度及扩张技术处理。随访至出院后6个月，记录死亡、再次心肌梗死及心血管事件的发生情况。

结果：血清hs-cTnT和CNP水平与冠脉狭窄程度呈正相关（P<0.05）。多因素回归分析显示，血清hs-cTnT和CNP水平与术后6个月死亡、再次心肌梗死及心血管事件发生率呈正相关（P<0.05）。受试者工作特征曲线显示，血清hs-cTnT和CNP水平对STEMI患者的预后具有较好的预测价值。

结论：血清hs-cTnT和CNP水平是反映STEMI患者冠脉病变程度和预后的重要生物标志物。

关键词：STEMI，高敏肌钙蛋白T，降钙素原，冠脉病变，预后

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