Abstract:

Objective　To investigate the relationships between serum signal peptide CUB epidermal growth factor domain containing protein-1 (SCUBE1) and Sestrin2 levels and microvascular obstruction in patients with acute ST segment elevation myocardial infarction (ASTEMI) after percutaneous coronary intervention (PCI). Methods　The medical records of 182 ASTEMI patients treated in Xi'an Central Hospital from July 2021 to June 2023 were retrospectively analyzed. All the patients underwent PCI after admission, and serum SCUBE1 and Sestrin2 levels were detected by enzyme-linked immunosorbent assay (ELISA) before surgery. One week after surgery, the microvascular occlusion was evaluated by cardiac magnetic resonance examination (MRI), and the patients were divided into an occurrence group and a non-occurrence group. The risk factors of microvascular obstruction in ASTEMI patients after PCI were screened by the logistic regression model, and the efficacy of serum SCUBE1 and Sestrin2 in predicting microvascular obstruction in ASTEMI patients after PCI were evaluated by the receiver operating characteristic curve (ROC). Independent sample t test and χ² test were used for statistical analysis. Results　Among 182 patients with ASTEMI treated by PCI, 72 patients had microvascular occlusion, with an incidence of 39.56%. In the occurrence group, there were 42 males and 30 females, aged (53.06±7.51) years, with a body mass index of (23.61±0.94) kg/m². In the non-occurrence group, there were 69 males and 41 females, aged (52.79±6.68) years, with a body mass index of (23.73±0.86) kg/m². The left ventricular ejection fraction in the occurrence group was lower than that in the non-occurrence group, and the infarct size, troponin T, serum SCUBE1, and serum Sestrin2 were higher than those in the non-occurrence group (all P<0.05). Logistic regression analysis showed that left ventricular ejection fraction (OR=0.271, 95%CI: 0.117-0.627), infarct size (OR=4.651, 95%CI: 2.009-10.764), troponin T (OR=3.773, 95%CI: 1.630-8.733), serum SCUBE1 (OR=4.491, 95%CI: 1.943-10.171), and serum Sestrin2 (OR=4.358, 95%CI: 1.882-10.087) were influencing factors for microvascular obstruction in ASTEMI patients after PCI (all P<0.05). The sensitivities, specificities, and areas under the curves of serum SCUBE1 and Sestrin2 alone and combined for microvascular obstruction in ASTEMI patients after PCI were 0.719, 0.783, 0.801, 0.800, 0.725, 0.824, 0.771 (95%CI: 0.674-0.867), 0.764 (95%CI: 0.669-0.860), and 0.882 (95%CI: 0.815-0.948), respectively. Conclusion　Serum SCUBE1 and Sestrin2 can be used to predict the occurrence of coronary microvascular occlusion in patients with ASTEMI after PCI, with good predictive efficacy.

Key words:

Acute ST-segment elevation myocardial infarction, Microvascular obstruction, Signal peptide CUB epidermal growth factor domain containing protein-1, Sestrin2

摘要：

目的　探讨血清信号肽-CUB-表皮生长因子结构域包含蛋白-1（SCUBE1）及Sestrin2与急性ST段抬高型心肌梗死（ASTEMI）患者经皮冠状动脉介入治疗（PCI）术后微血管阻塞的关系。方法　回顾性分析2021年7月至2023年6月于西安市中心医院接受治疗的182例ASTEMI患者的病历资料。所有患者入院后均行PCI，术前采用酶联免疫吸附试验（ELISA）检测血清SCUBE1及Sestrin2水平。术后1周，复查心脏磁共振评价微血管阻塞情况，将患者分为发生组和未发生组。采用logistic回归模型筛查ASTEMI患者PCI术后发生微血管阻塞的危险因素，绘制受试者操作特征曲线（ROC）评价血清SCUBE1及Sestrin2预测ASTEMI患者PCI术后发生微血管阻塞的效能。采用独立样本t检验、χ²检验进行统计学分析。结果　182例行PCI的ASTEMI患者中，发生微血管阻塞72例，发生率为39.56%。发生组男42例，女30例，年龄（53.06±7.51）岁，体重指数（23.61±0.94）kg/m²。未发生组男69例，女41例，年龄（52.79±6.68）岁，体重指数（23.73±0.86）kg/m²。发生组的左心室射血分数低于未发生组，梗死范围大于未发生组，肌钙蛋白T、血清SCUBE1、血清Sestrin2水平均高于未发生组（均P<0.05）。logistic回归分析发现，左心室射血分数（OR=0.271，95%CI：0.117～0.627）、梗死范围（OR=4.651，95%CI：2.009～10.764）、肌钙蛋白T（OR=3.773，95%CI：1.630～8.733）、血清SCUBE1（OR=4.491，95%CI：1.943～10.171）、血清Sestrin2（OR=4.358，95%CI：1.882～10.087）是ASTEMI患者PCI术后发生微血管阻塞的影响因素（均P<0.05）。血清SCUBE1、Sestrin2单一及联合预测ASTEMI患者PCI术后发生微血管阻塞的灵敏度为0.719、0.783、0.801，特异度为0.800、0.725、0.824，曲线下面积为0.771（95%CI：0.674～0.867）、0.764（95%CI：0.669～0.860）、0.882（95%CI：0.815～0.948）。结论　血清SCUBE1、Sestrin2可用于预测ASTEMI患者PCI术后冠状动脉微血管阻塞的发生，效能良好。

关键词:

急性ST段抬高型心肌梗死, 微血管阻塞, 信号肽-CUB-表皮生长因子结构域包含蛋白-1, Sestrin2