血清GRP78、PHB1在急性ST段抬高型心肌梗死患者病情评估、预后预测方面的临床价值研究-东南大学学报医学版

血清GRP78、PHB1在急性ST段抬高型心肌梗死患者病情评估、预后预测方面的临床价值研究

单位：1. 安阳市人民医院心脏重症监护室, 河南安阳 455000;
2. 华中科技大学同济医学院附属协和医院心内科, 湖北武汉 430022

分类号：R542.22

出版年·卷·期（页码）：2023·42·第二期（180-187）

摘要：

目的:探究血清葡萄糖调节蛋白78(GRP78)和抗增殖蛋白1(PHB1)评估急性ST段抬高型心肌梗死患者病情及预后预测的临床价值。方法:选取2015年9月至2019年9月在安阳市人民医院接受治疗的188例急性ST段抬高型心肌梗死患者作为研究组,160例稳定型心绞痛患者作为对照组。使用全球急性冠状动脉事件注册(GRACE)风险评分将研究组患者分为低危组(79例)、中危组(72例)、高危组(37例)。采用酶联免疫吸附试验检测血清GRP78、PHB1的表达水平;Logistic回归分析急性ST段抬高型心肌梗死患者预后不良的影响因素;受试者工作特征(ROC)曲线分析血清GRP78、PHB1及二者联合对高危患者的评估效能及对患者预后不良的预测效能。结果:与对照组相比,研究组血清GRP78水平升高,且随患者病情危重程度加重而升高(P<0.05);血清PHB1水平降低,且随患者病情危重程度加重而降低(P<0.05)。血清GRP78、PHB1水平及二者联合评估高危患者的曲线下面积(AUC)分别为0.712、0.698、0.796,联合评估效能较优(P<0.05);与预后良好组比较,预后不良组患者血清GRP78水平升高(P<0.05),PHB1水平降低(P<0.05)。Logistic回归分析显示,吸烟史、左室射血分数(LVEF)、脑利钠肽(BNP)、低密度脂蛋白胆固醇(LDL-C)、肾小球滤过率估计值(eGFR)、GRP78、PHB1是急性ST段抬高型心肌梗死患者预后不良的影响因素(P<0.05)。ROC曲线分析显示,GRP78预测患者预后不良的AUC为0.738,敏感度为70.83%,特异度为76.72%;PHB1预测的AUC为0.758,敏感度为62.50%,特异度为81.03%;二者联合的AUC为0.837,敏感度为80.56%,特异度为74.14%。结论:血清GRP78、PHB1在急性ST段抬高型心肌梗死患者中异常表达,二者联合对评估急性ST段抬高型心肌梗死患者病情及预测患者不良预后具有较好效能。

Objective: To explore the clinical value of serum glucose-regulated protein 78(GRP78) and Prohibitin 1(PHB1) in evaluating the condition and prognosis of patients with acute ST-segment elevation myocardial infarction. Methods: 188 patients with acute ST-segment elevation myocardial infarction who were treated in Anyang People's Hospital from September 2015 to September 2019 were selected as the study group, and 160 patients with stable angina pectoris were selected as the control group. Using the Global Registry of Acute Coronary Events(GRACE) risk score, the patients in the study group were grouped into low-risk group(79 cases), intermediate-risk group(72 cases), and high-risk group(37 cases). The expression levels of serum GRP78 and PHB1 were detected by enzyme-linked immunosorbent assay; Logistic regression analysis was performed to analyze the influencing factors of poor prognosis in patients with acute ST-segment elevation myocardial infarction; receiver operating characteristic(ROC) curve analysis was performed to analyze the evaluation efficacy of serum GRP78, PHB1 and their combination for high-risk patients and the predictive efficacy for poor prognosis. Results: Compared with the control group, the expression level of serum GRP78 in the study group increased, and it increased with the severity of the patient's disease(P<0.05); the expression level of serum PHB1 decreased, and decreased with the severity of the patient's disease(P<0.05).The area under the curve(AUC) of serum GRP78, PHB1 and their combined assessment of high-risk patients was 0.712, 0.698, and 0.796, respectively, and the combined assessment efficacy was better(P<0.05); compared with the good prognosis group, the serum level of GRP78 in patients with poor prognosis increased(P<0.05), while the level of PHB1 decreased(P<0.05). Logistic regression analysis showed that smoking history, left ventricular ejection fraction(LVEF), brain natriuretic peptide(BNP),low density lippoproteincholesterol(LDL-C), estimated glomerular filtration rate(eGFR), GRP78 and PHB1 were the influencing factors of poor prognosis in patients with acute ST-segment elevation myocardial infarction(P<0.05). ROC curve analysis showed that the AUC of GRP78 for predicting poor prognosis was 0.738, with a sensitivity of70.83%, and a specificity of 76.72%; the AUC predicted by PHB1 was 0.758, with a sensitivity of 62.50%, and a specificity of 81.03%; the combined AUC of the two was 0.837, the sensitivity was 80.56%, and the specificity was 74.14%. Conclusion: Serum GRP78 and PHB1 are abnormally expressed in patients with acute ST-segment elevation myocardial infarction, and the combination of the two has high efficacy in evaluating the condition of patients with acute ST-segment elevation myocardial infarction and predicting the poor prognosis of patients.

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