Diagnostic value of serum sST2 and DcR3 combined with dynamic electrocardiogram in silent myocardial ischemia

doi:10.11958/20242260

Abstract

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

CLC Number:

R542.2

Figures/Tables 7

References 20

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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	-