血清sST2、DcR3联合动态心电图对无症状性心肌缺血的诊断价值

doi:10.11958/20242260

摘要/Abstract

摘要：

目的探讨血清可溶性生长刺激表达基因2蛋白（sST2）、诱捕受体3（DcR3）联合动态心电图（DCG）对无症状性心肌缺血（SMI）的诊断价值。方法纳入冠心病患者85例并作为观察组，其中经心肌灌注显像确诊SMI患者61例（SMI组），有症状心肌缺血组24例（有症状组）；另纳入84例因不明原因胸痛就诊的患者，经心肌灌注显像确诊无冠心病，作为对照组。酶联免疫吸附测定法检测血清sST2、DcR3水平；受试者工作特征（ROC）曲线分析血清sST2、DcR3与DCG对SMI的诊断价值；多因素Logistic回归分析SMI的影响因素。结果观察组患者血清sST2水平高于对照组[（55.61±7.12）μg/L vs.（14.22±3.64）μg/L]，DcR3水平低于对照组[（0.68±0.11）μg/L vs.（1.24±0.21）μg/L，P<0.05]。SMI组患者血清sST2水平高于有症状组[（59.28±7.12）μg/L vs.（46.28±8.15）μg/L]，DcR3水平低于有症状组[（0.63±0.11）μg/L vs.（0.81±0.14）μg/L，P<0.05]。SMI组心率高于有症状组，缺血持续时间与ST段下降幅度低于有症状组（P<0.05）。ROC曲线分析结果显示，血清sST2、DcR3及DCG单独或联合诊断冠心病患者SMI的曲线下面积（AUC）分别为0.826、0.882、0.773、0.958，三者联合诊断SMI优于单独诊断（Z分别为3.188、2.225、2.770，P<0.05）。sST2和DcR3是SMI发生的影响因素（P<0.05）。结论血清sST2升高、DcR3降低与SMI发生关系密切，且血清sST2、DcR3联合DCG对SMI具有一定的诊断价值。

关键词: 心肌缺血, 心电描记术，便携式, 可溶性生长刺激表达基因2蛋白, 诱捕受体3, 动态心电图, 无症状性心肌缺血

Abstract:

Objective To investigate the diagnostic value of serum soluble growth stimulation expressed gene 2 (sST2), decoy receptor 3 (DcR3) and dynamic electrocardiogram (DCG) for asymptomatic myocardial ischemia (SMI). Methods Eighty-five patients with coronary heart disease were selected as observation subjects (the observation group). Sixty-one SMI patients were confirmed by coronary angiography (the SMI group). Among them, there were 24 cases with symptomatic myocardial ischemia (the symptomatic myocardial ischemia group). During the same period, 84 patients with unexplained chest pain who were examined in our hospital and without coronary heart disease were selected as the control group. ELISA was applied to detect serum levels of sST2 and DcR3. ROC was used to analyze the diagnostic value of serum sST2, DcR3 and DCG for SMI. Multivariate Logistic regression was applied to analyze the influencing factors of SMI. Results The serum level of sST2 was higher in the observation group than that in the control group[(55.61±7.12) μg/L vs. (14.22±3.64) μg/L], while the level of DcR3 was lower than that in the control group[(0.68±0.11) μg/L vs. (1.24±0.21) μg/L](P<0.05). The serum level of sST2 was higher in the SMI group than that in the symptomatic myocardial ischemia group[(59.28± 7.12) μg/L vs. (46.28±8.15) μg/L], while the level of DcR3 was lower than that in the symptomatic myocardial ischemia group[(0.63±0.11) μg/L vs. (0.81±0.14) μg/L] (P<0.05). The heart rate of the SMI group was higher than that of the symptomatic myocardial ischemia group, and the duration of ischemia and the decrease in ST segment were lower than those of the symptomatic myocardial ischemia group (P<0.05). ROC curve results showed that the AUC values of serum sST2, DcR3 and DCG alone and in their combination for diagnosing SMI in patients with coronary heart disease were 0.826, 0.882, 0.773, and 0.958, respectively, and the combined diagnosis of SMI was superior to individual diagnosis (Z=3.188, 2.225, 2.770, P<0.05). sST2 and DcR3 were influencing factors of SMI occurrence (P<0.05). Conclusion The increased serum sST2 and the decreased DcR3 are closely related to the occurrence of SMI, and the combination of serum sST2 and DcR3 with DCG has certain diagnostic value for SMI.

Key words: myocardial ischemia, electrocardiography, ambulatory, soluble growth stimulation expressed gene 2, decoy receptor 3, dynamic electrocardiogram, asymptomatic myocardial ischemia

中图分类号:

R542.2

图/表 7

参考文献 20

[1]	王成立, 黄涛, 梁哲勇. 嘌呤受体P2X配体门控离子通道7与老年高血压合并冠心病患者心肌缺血的关系[J]. 中华老年心脑血管病杂志, 2023, 25(9):905-908.
	WANG C L, HUANG T, LIANG Z Y. Relationship between purinergic P2X ligand-gated ion channel 7 and myocardial ischemia in elderly patients with hypertension and coronary heart disease[J]. Chin J Cardio-Cerebrovascular Disease, 2023, 25(9):905-908. doi:10.3969/j.issn.1009-0126.2023.09.003.
[2]	崔利军, 于朋伟, 田刚, 等. CZT-SPECT测定心肌血流量和血流储备对冠状动脉重度狭窄的预测价值[J]. 临床心血管病杂志, 2023, 39(2):129-134.
	CUI L J, YU P W, TIAN G, et al. Predictive value of myocardial blood flow and flow reserve measured by CZT-SPECT in severe coronary artery stenosis[J]. J Clin Cardiol, 2023, 39(2):129-134. doi:10.13201/j.issn.1001-1439.2023.02.011.
[3]	BEETLER D J, BRUNO K A, DI FLORIO D N, et al. Sex and age differences in sST2 in cardiovascular disease[J]. Front Cardiovasc Med, 2022,9:1073814. doi:10.3389/fcvm.2022.1073814.
[4]	陶学娇, 卢均坤, 陈嘉辉, 等. FIB-4、sST2水平与心力衰竭及其严重程度的相关性分析[J]. 新医学, 2023, 54(8):569-573.
	TAO X J, LU J K, CHEN J H, et al. Correlation analysis of FIB-4 and sST2 levels with heart failure and its severity[J]. New Medicine, 2023, 54(8):569-573. doi:10.3969/j.issn.0253-9802.2023.08.008.
[5]	奚春艳, 杜佩珊, 王琪, 等. 血清Sulfatide、DcR3与急性ST段抬高型心肌梗死患者心肌损伤和出院后短期主要不良心血管事件的关系[J]. 疑难病杂志, 2023, 22(1):1-7.
	XI C Y, DU P S, WANG Q, et al. Relationship between serum Sulfatide and DcR3 levels and myocardial injury and short-term major adverse cardiovascular events after discharge in patients with acute ST-segment elevation myocardial infarction[J]. J Difficult Diseases, 2023, 22(1):1-7. doi:10.3969/j.issn.1671-6450.2023.01.001.
[6]	姜小琴, 苟代文. 动态心电图联合增强CT对冠心病心肌缺血的诊断价值研究[J]. 中国CT和MRI杂志, 2022, 20(9):79-80.
	JIANG X Q, GOU D W. The value of dynamic electrocardiogram combined with enhanced CT in the diagnosis of myocardial ischemia in coronary heart disease[J]. Chin J CT & MRI, 2022, 20(9):79-80. doi:10.3969/j.issn.1672-5131.2022.09.029.
[7]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南[J]. 中华心血管病杂志, 2010, 38(8):675-690.
	Chinese Society of Cardiology,Editorial Board of Chinese Journal of Cardiology. Guidelines for the diagnosis and treatment of acute ST-segment elevation myocardial infarction[J]. Chin J Cardiol, 2010, 38(8):675-690. doi:10.3760/cma.j.issn.0253-3758.2010.08.002.
[8]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会, 中国医师协会循证专业委员会, 等. 无症状成年人心血管病危险评估中国专家共识[J]. 中华心血管病杂志, 2013, 41(10):820-825.
	Chinese Society of Cardiology,Editorial Committee of Chinese Journal of Cardiology, Evidence-based Medicine Committee of Chinese Medical Doctor Association, et al. Chinese expert consensus on cardiovascular disease risk assessment in asymptomatic adults[J]. Chin J Cardiol, 2013, 41(10):820-825. doi:10.3760/cma.j.issn.0253-3758.2013.10.003.
[9]	BOSONE D, FOGARI R, RAMUSINO M C, et al. Ambulatory 24-h ECG monitoring and cardiovascular autonomic assessment for the screening of silent myocardial ischemia in elderly type 2 diabetic hypertensive patients[J]. Heart Vessels, 2017, 32(5):507-513. doi:10.1007/s00380-016-0898-7.
[10]	高国亮, 严国平, 史亮亮, 等. 动态心电图与常规心电图诊断无症状性心肌缺血伴发心律失常的临床效果对比研究[J]. 中国医学装备, 2023, 20(2):68-71.
	GAO G L, YAN G P, SHI L L, et al. Comparison of dynamic electrocardiogram and conventional electrocardiogram in the diagnosis of silent myocardial ischemia with arrhythmia[J]. Chinese Medical Equipment, 2023, 20(2):68-71. doi:10.3969/j.issn.1672-8270.2023.02.014.
[11]	王萍, 龙滔, 邵江. 两种血清标志物联合24 h动态心电图对老年冠心病并发无症状心肌缺血的诊断价值[J]. 中华老年心脑血管病杂志, 2020, 22(9):934-937.
	WANG P, LONG T, SHAO J. Diagnostic value of two serum markers combined with 24 h dynamic electrocardiogram in elderly patients with coronary heart disease complicated with asymptomatic myocardial ischemia[J]. Chin J Cardio-Cerebrovascular Disease, 2020, 22(9):934-937. doi:10.3969/j.issn.1009-0126.2020.09.010.
[12]	刘晔, 王敬, 赵春娟, 等. 血清sST2、cfDNA预测重症肺炎患儿并发心肌损害的价值[J]. 标记免疫分析与临床, 2023, 30(1):86-90.
	LIU Y, WANG J, ZHAO C J, et al. The value of serum sT2,cfDNA in predicting myocardial damage in children with severe pneumonia[J]. Marker Immunoassay & Clinic, 2023, 30(1):86-90. doi:10.11748/bjmy.issn.1006-1703.2023.01.016.
[13]	ROY I, JOVER E, MATILLA L, et al. Soluble ST2 as a new oxidative stress and inflammation marker in metabolic syndrome[J]. Int J Environ Res Public Health, 2023, 20(3):2579-2583. doi:10.3390/ijerph20032579.
[14]	LUO G, QIAN Y, SHENG X, et al. Elevated serum levels of soluble ST2 are associated with plaque vulnerability in patients with non-ST-elevation acute coronary syndrome[J]. Front Cardiovasc Med, 2021,8:688522. doi:10.3389/fcvm.2021.688522.
[15]	ZHANG Y, FAN Z, LIU H, et al. Correlation of plasma soluble suppression of tumorigenicity-2 level with the severity and stability of coronary atherosclerosis[J]. Coron Artery Dis, 2020, 31(7):628-635. doi:10.1097/MCA.0000000000000851.
[16]	ZHANG J, CHEN Z, MA M, et al. Soluble ST2 in coronary artery disease:clinical biomarkers and treatment guidance[J]. Front Cardiovasc Med, 2022,9:924461. doi:10.3389/fcvm.2022.924461.
[17]	DOUSTKAMI H, AVESTA L, BABAPOUR B, et al. Correlation of serum decoy receptor 3 and interleukin-6 with severity of coronary artery diseases in male acute myocardial infarction patients[J]. Acta Biomed, 2021, 92(5):e2021285. doi:10.23750/abm.v92i5.9711.
[18]	CHEN X, WANG R, CHEN W, et al. Decoy receptor-3 regulates inflammation and apoptosis via PI3K/AKT signaling pathway in coronary heart disease[J]. Exp Ther Med, 2019, 17(4):2614-2622. doi:10.3892/etm.2019.7222.
[19]	SOLIMAN E Z. Silent myocardial infarction and risk of heart failure:current evidence and gaps in knowledge[J]. Trends Cardiovasc Med, 2019, 29(4):239-244. doi:10.1016/j.tcm.2018.09.004.
[20]	IYNGKARAN P, CHAN W, LIEW D, et al. Risk stratification for coronary artery disease in multi-ethnic populations:are there broader considerations for cost efficiency?[J]. World J Methodol, 2019, 9(1):1-19. doi:10.5662/wjm.v9.i1.1.

组别	n	心率/ （次/min）	缺血持续时间/min	ST段下降幅度/mm
SMI组	61	89.42±8.21	13.36±1.12	1.86±0.42
有症状组	24	76.15±6.45	22.54±1.28	2.33±0.51
t		7.092^＊＊	32.795^＊＊	4.254^＊＊

组别	n	心率/ （次/min）	缺血持续时间/min	ST段下降幅度/mm
SMI组	61	89.42±8.21	13.36±1.12	1.86±0.42
有症状组	24	76.15±6.45	22.54±1.28	2.33±0.51
t		7.092^＊＊	32.795^＊＊	4.254^＊＊

组别	n	性别		BMI/（kg/m²）	SYNTAX评分/分	合并心脏重构	病变血管部位
组别	n	男	女	BMI/（kg/m²）	SYNTAX评分/分	左主干	左前降支	左回旋支	右冠状动脉
SMI组	61	28（45.90）	33（54.10）	22.27±3.14	24.95±6.52	5（8.20）	26（42.62）	9（14.75）	21（34.43）	8（13.11）
有症状组	24	10（41.67）	14（58.33）	22.39±2.97	27.83±6.91	2（8.33）	10（41.67）	4（16.67）	8（33.33）	2（8.33）
t或χ²		0.125		0.148	1.803	0.379	0.051
组别	血管病变支数	高脂血症	高血压	糖尿病	吸烟史	饮酒史	LVEF	LVEDd/mm	LVESd/mm
组别	单支	高脂血症	高血压	糖尿病	吸烟史	饮酒史	LVEF	LVEDd/mm	LVESd/mm
SMI组	35（57.38）	14（22.95）	18（29.51）	13（21.31）	18（29.51）	16（26.23）	0.453±0.046	60.27±6.14	41.61±4.27
有症状组	11（45.83）	5（20.83）	10（41.67）	8（33.33）	9（37.50）	8（33.33）	0.436±0.044	62.35±6.29	43.37±4.48
t或χ²	0.924	0.044	1.153	1.338	0.508	0.429	0.001	1.396	1.689
组别	TG/（mmol/L）		SBP/mmHg		DBP/mmHg		LDL-C/（mmol/L）		HDL-C/（mmol/L）
SMI组	1.61±0.12		126.11±18.21		82.15±13.34		4.46±1.12		1.33±0.11
有症状组	1.56±0.23		131.56±19.11		83.83±13.15		4.51±1.19		1.38±0.25
t	1.028		1.225		0.528		0.188		0.943

组别	n	性别		BMI/（kg/m²）	SYNTAX评分/分	合并心脏重构	病变血管部位
组别	n	男	女	BMI/（kg/m²）	SYNTAX评分/分	左主干	左前降支	左回旋支	右冠状动脉
SMI组	61	28（45.90）	33（54.10）	22.27±3.14	24.95±6.52	5（8.20）	26（42.62）	9（14.75）	21（34.43）	8（13.11）
有症状组	24	10（41.67）	14（58.33）	22.39±2.97	27.83±6.91	2（8.33）	10（41.67）	4（16.67）	8（33.33）	2（8.33）
t或χ²		0.125		0.148	1.803	0.379	0.051
组别	血管病变支数	高脂血症	高血压	糖尿病	吸烟史	饮酒史	LVEF	LVEDd/mm	LVESd/mm
组别	单支	高脂血症	高血压	糖尿病	吸烟史	饮酒史	LVEF	LVEDd/mm	LVESd/mm
SMI组	35（57.38）	14（22.95）	18（29.51）	13（21.31）	18（29.51）	16（26.23）	0.453±0.046	60.27±6.14	41.61±4.27
有症状组	11（45.83）	5（20.83）	10（41.67）	8（33.33）	9（37.50）	8（33.33）	0.436±0.044	62.35±6.29	43.37±4.48
t或χ²	0.924	0.044	1.153	1.338	0.508	0.429	0.001	1.396	1.689
组别	TG/（mmol/L）		SBP/mmHg		DBP/mmHg		LDL-C/（mmol/L）		HDL-C/（mmol/L）
SMI组	1.61±0.12		126.11±18.21		82.15±13.34		4.46±1.12		1.33±0.11
有症状组	1.56±0.23		131.56±19.11		83.83±13.15		4.51±1.19		1.38±0.25
t	1.028		1.225		0.528		0.188		0.943

指标	AUC	95%CI	敏感度/%	特异度/%	截断值
sST2	0.826	0.728~0.900	70.49	87.50	53.92 μg/L
DcR3	0.882	0.794~0.942	78.69	87.50	0.71 μg/L
DCG	0.773	0.669~0.857	75.41	79.17	-
联合预测	0.958	0.891~0.990	91.80	91.67	-