Diagnostic value of HIF-1α in acute ST segment elevation myocardial infarction and its relationship with ventricular remodeling
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摘要: 目的 分析急性ST段抬高型心肌梗死(STEMI)患者体内低氧诱导因子-1α(HIF-1α)表达水平对左心室重构(VR)及远期预后的影响，以及两者间的相关性。方法 选取我院就诊的STEMI患者100例，其中男76例，女24例；检测入院时HIF-1α、CK-MB、Myo、cTNI及NT-proBNP水平。所有患者均行急诊血管再通治疗。根据术后3 d、3个月、6个月及12个月的心脏彩超的水平判断心梗后VR的发生率。以HIF-1α的中位数值(59.23 pg/mL)为界，将100例患者分为HIF-1α高表达组(50例)和低表达组(50例)，分析患者不同HIF-1α表达水平与VR的关系。对不同表达组患者进行出院后随访，并用Kaplan-Meier生存曲线分析不同表达组的3个月、6个月及12个月主要心血管不良事件(MACE)的发生情况。结果 HIF-1α高表达组入院时CK-MB、Myo、cTNI水平较低表达组明显升高，差异有统计学意义(P< 0.05)；两组患者入院时NT-proBNP比较，差异无统计学意义(P>0.05)。两组患者术后3 d左心室舒张末期内径(LVEDd)比较，差异无统计学意义(P>0.05)；但高表达组术后3 d左心室射血分数(LVEF)较低表达组明显降低，差异有统计学意义(P< 0.05)。与低表达组相比，高表达组术后3个月、6个月及12个月LVEDd明显增大，伴随LVEF明显降低(P< 0.05)。高表达组术后3个月累计发生VR患者3例(6%)，显著高于低表达组(1例，2%)；术后6个月累计发生VR 6例(12%)，显著高于低表达组(3例，6%)；随访至术后12个月，高表达组累计发生VR 10例(20%)，显著高于低表达组(5例，10%)，两组比较差异有统计学意义(P< 0.01)。外周血HIF-1α水平与术后12个月LVEDd呈正相关(r=0.75，P< 0.001)，与LVEF呈负相关(r=-0.621，P< 0.001)。高表达组随访12个月累计发生MACE 7例，显著高于低表达组(3例)，差异有统计学意义(P< 0.05)。结论 HIF-1α表达水平与心肌损伤程度、VR及MACE存在一定相关性。Abstract: Objective To analyze the correlation of peripheral blood hypoxiainducible factor-1α(HIF-1α) level in patients with acute ST segment elevation myocardial infarction (STEMI) with ventricular remodeling (VR) and major adverse cardiovascular effects (MACE).Methods A total of 100 STEMI patients (76 males and 24 females) admitted to our hospital were selected to detect the levels of HIF-1α, CK-MB, Myo, cTNI and NT-proBNP on admission.All patients were treated with emergency recanalization.The incidence of VR after acute myocardial infarction was evaluated according to the level of color doppler echocardiography at 3, 6 and 12 months after discharge.Based on the median value of HIF-1α(59.23 pg/mL), 100 patients were divided into HIF-1α high expression group and HIF-1α low expression group, and the relationship between different HIF-1α expression levels and VR was analyzed.Patients in different expression groups were followed up after discharge, and Kaplan-Meier survival curve was used to analyze the occurrence of MACE at 3, 6 and 12 months in different expression groups.Results The levels of CK-MB, Myo and cTNI in the high expression group were significantly higher than those in the low expression group at admission, and the difference was statistically significant (P< 0.05).There was no significant difference in NT-proBNP between the two groups at admission.There was no significant difference in 3 d left ventricular end-diastolic diameter (LVEDd) between 2 groups after surgery, but 3 d left ventricular ejection fraction (LVEF) in the high expression group was significantly lower than that in the low expression group, the difference was statistically significant (P< 0.05).Compared with the low expression group, the LVEDd in the high expression group was significantly increased at 3 months, 6 months and 12 months after surgery, accompanied by a significant decrease in LVEF (P< 0.05).In the high expression group, 3 patients had accumulated VR 3 months after surgery, which was significantly higher than that in the low expression group (1 case).6 months after operation, 6 cases had VR, which was significantly higher than 3 cases in the low expression group.Up to 12 months after operation, 10 cases of high expression group developed VR, which was significantly higher than 5 cases of low expression group (P< 0.01).Peripheral blood HIF-1α level was positively correlated with LVEDd 12 months after discharge (r=0.75,P< 0.001) and negatively correlated with LVEF (r=-0.621,P< 0.001).During 12 months of follow-up, 7 cases of MACE occurred in the high expression group, which was significantly higher than 3 cases in the low expression group (P< 0.05).Conclusion The expression level of HIF-1α was correlated with the degree of myocardial injury, VR and MACE.
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表 1 两组患者入院时CK-MB、Myo、cTNI及NT-proBNP水平比较
X±S 组别 例数 CK-MB/(ng·mL-1) Myo/(ng·mL-1) cTNI/(ng·mL-1) NT-proBNP/(pg·mL-1) 高表达组 50 23.3±5.71) 137.1±38.21) 2.8±0.71) 287.0±103.2 低表达组 50 17.9±4.5 98.6±29.3 1.7±0.5 291.7±98.4 与低表达组相比，1)P < 0.01。 
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表 2 两组患者术后3 d、3个月、6个月和12个月LVEDd及LVEF比较
X±S 组别 例数 术后3 d 术后3个月 术后6个月 术后12个月 LVEDd
/mmLVEF
/%LVEDd
/mmLVEF
/%LVEDd
/mmLVEF
/%LVEDd
/mmLVEF
(%)高表达组 50 49±4 53±51) 52±31) 52±31) 54±41) 50±41) 58±51) 47±41) 低表达组 50 48±5 56±4 49±4 56±3 49±5 57±5 50±3 55±3 与低表达组相比，1)P < 0.01。
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表 3 两组患者术后3个月、6个月、12个月累计VR情况对比
例 组别 例数 术后3个
月术后6个
月术后12个
月高表达组 50 31) 61) 101) 低表达组 50 1 3 5 与低表达组比较，1)P < 0.01。
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