Abstract:

Objective　To analyze the clinical value of serum tumor necrosis factor-associated protein 9 (CTRP9) and growth differentiation factor 15 (GDF-15) in predicting ventricular arrhythmia (VA) in patients with acute myocardial infarction (AMI). Methods　This study was a retrospective study. A total of 120 patients with AMI admitted to Xi'an Central Hospital from April 2021 to August 2023 were selected, including 65 males and 55 females, aged 35-74 (55.63±4.86) years. The levels of GDF-15 and CTRP9 were detected by enzyme-linked immunosorbent assay (ELISA) before treatment, and symptomatic treatments such as anti-infection, anticoagulation, thrombolysis, vasodilation, blood sugar control, and diuretics were administered. The patients were divided into an occurrence group and a non-occurrence group based on the presence of VA. The basic data and serological indices of the two groups were compared to analyze the influencing factors of VA occurrence in AMI patients and the predictive value of CTRP9 and GDF-15 for VA occurrence. t test and χ² test were used. Results　After treatment, 26 cases (21.67%) of 120 patients with AMI had VA. The proportion of Killip grade 3-4 in the occurrence group was higher than that in the non-occurrence group [69.23% (18/26) vs. 34.04% (32/94)], with a statistically significant difference (χ²=10.38, P<0.05). The levels of GDF-15 and white blood cell count in the occurrence group were higher than those in the non-occurrence group, but the CTRP9 level was lower than that in the non-occurrence group [(3.24±0.45) μg/L vs. (2.86±0.37) μg/L, (13.22±2.85) ×10⁹/L vs. (11.94±2.63) ×10⁹/L, (8.62±1.78) μg/L vs. (10.57±2.06) μg/L], with statistically significant differences (t=4.42, 2.16, and 4.39, all P<0.05). The results of logistic regression analysis showed that Killip grade (OR=5.486, 95%CI 1.603-18.776), GDF-15 level (OR=10.871, 95%CI 2.345-50.400), WBC level (OR=1.329, 95%CI 1.055-1.647), and CTRP9 (OR=0.607, 95%CI 0.437-0.842) were the influencing factors for VA in AMI patients (all P<0.05). The receiver operating characteristic curve (ROC) analysis showed that the sensitivities of GDF-15, CTRP9, and their combination in the prediction of VA in AMI patients were 60.00%, 63.30%, 90.00%, and the specificities were 73.30%, 66.70%, and 86.70%. The value of combined GDF-15 and CTRP9 in predicting the occurrence of VA in AMI patients was the highest (the area under the curve was 0.894). Conclusion　Changes in GDF-15 and CTRP9 levels are associated with the occurrence of VA in AMI patients, and combined detection can predict the risk of VA in AMI patients early.

Key words:

Acute myocardial infarction, Ventricular arrhythmia, CTRP9, GDF-15, Forecast

摘要：

目的　分析血清肿瘤坏死因子相关蛋白9（CTRP9）、生长分化因子15（GDF-15）联合对急性心肌梗死（AMI）患者室性心律失常（VA）的预测价值。方法　该研究为回顾性研究，选取西安市中心医院2021年4月至2023年8月收治的120例AMI患者，其中男65例，女55例，年龄35～74（55.63±4.86）岁。于治疗前采用酶联免疫吸附法检测患者GDF-15、CTRP9水平，给予患者抗感染、抗凝、溶栓、扩张血管、控制血糖、利尿剂等对症治疗。根据治疗后48 h患者有无发生VA分为发生组和未发生组，对比两组患者基础资料和血清学指标，分析AMI患者发生VA的影响因素，以及CTRP9、GDF-15对发生VA的预测价值。统计学方法采用t检验、χ²检验。结果　经治疗后，26例（21.67%）AMI患者发生VA。发生组Killip分级3～4级比例高于未发生组［69.23%（18/26）比34.04%（32/94）］，差异有统计学意义（χ²=10.38，P<0.05）。发生组GDF-15、白细胞计数均高于未发生组，CTRP9水平低于未发生组［（3.24±0.45）μg/L比（2.86±0.37）μg/L、（13.22±2.85）×10⁹/L比（11.94±2.63）×10⁹/L、（8.62±1.78）μg/L比（10.57±2.06）μg/L］，差异均有统计学意义（t=4.42、2.16、4.39，均P<0.05）。logistic回归分析结果显示：Killip分级（OR=5.486，95%CI 1.603～18.776）、GDF-15水平（OR=10.871，95%CI 2.345～50.400）、WBC水平（OR=1.329，95%CI 1.055～1.647）、CTRP9水平（OR=0.607，95%CI 0.437～0.842）是AMI患者发生VA的影响因素（均P<0.05）。受试者操作特征曲线（ROC）分析显示，GDF-15、CTRP9、二者联合预测AMI患者发生VA的灵敏度分别为60.00%、63.30%、90.00%，特异度分别为73.30%、66.70%、86.70%，GDF-15、CTRP9联合预测AMI患者发生VA的价值较高（曲线下面积为0.894）。结论　GDF-15、CTRP9水平变化与AMI患者发生VA相关，联合检测能够早期预测AMI患者VA的发生风险。

关键词:

急性心肌梗死, 室性心律失常, 肿瘤坏死因子相关蛋白9, 生长分化因子15, 预测