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目的 探究血清摄食抑制因子1(nesfatin-1,NSF-1)、甲壳质酶蛋白40(chitinase protein 40,YKL-40)及脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)水平与急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后左心室重构和临床转归的关系。方法 前瞻性收集2024年9月至2025年1月沧州市中心医院收治的行PCI的STEMI患者123例，依据术后随访6个月临床转归结果分为预后良好组78例（痊愈和好转）和预后不佳组45例（恶化和死亡）。比较两组左心室重构指标及血清NSF-1、YKL-40、Lp-PLA2水平，采用Pearson相关性分析STEMI患者PCI术后血清NSF-1、YKL-40、Lp-PLA2水平与左心室重构指标的相关性，多因素logistic回归分析影响STEMI患者PCI术后预后情况的危险因素，ROC曲线分析血清NSF-1、YKL-40、Lp-PLA2水平对预后的预测价值。结果 预后不佳组左心室舒张末期容积（left ventricular end-diastolic volume,LVEDV）、左心室收缩末期容积（left ventricular end-systolic volume,LVESV）、YKL-40、Lp-PLA2水平明显高于预后良好组，左心室射血分数（left ventricular ejection fraction,LVEF）、NSF-1水平明显低于预后良好组，差异有统计学意义（P<0.01）。Pearson相关性分析显示，STEMI患者PCI术后血清NSF-1水平与LVEDV、LVESV呈负相关，与LVEF呈正相关（P<0.01）；血清YKL-40、Lp-PLA2水平与LVEDV、LVESV呈正相关，与LVEF呈负相关（P<0.01）。多因素logistic回归分析显示，血清NSF-1水平是STEMI患者PCI术后预后的保护因素，YKL-40、Lp-PLA2是STEMI患者PCI术后预后的危险因素（P<0.05,P<0.01）。ROC曲线分析显示，血清NSF-1、YKL-40、Lp-PLA2联合预测STEMI患者PCI术后的曲线下面积明显高于单独预测（0.917 vs 0.864、0.807、0.778,P<0.01）。结论 血清NSF-1、YKL-40、Lp-PLA2水平与STEMI患者PCI术后左心室重构和临床转归有关，各指标联合预测可以更好地对预后不佳进行评估。
Abstract：Objective To explore the relationship between the levels of serum nesfatin-1(NSF-1), chitinase protein 40(YKL-40), and lipoprotein-associated phospholipase A2(Lp-PLA2) and left ventricular remodeling as well as clinical outcomes in patients with ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI). Methods A total of 123 STEMI patients undergoing PCI in our hospital from September 2024 to January 2025 were prospectively enrolled. They were divided into a good prognosis group(78 cases, including recovery and improvement) and a poor prognosis group(45 cases, including deterioration and death) based on the clinical outcomes of 6-month follow-up. The left ventricular remodeling indicators and the levels of serum NSF-1, YKL-40, and Lp-PLA2 were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between the serum levels of above biomarkers and left ventricular remodeling indicators in STEMI patients after PCI. Multivariate logistic regression analysis was used to identify the risk factors affecting the prognosis of STEMI patients after PCI. ROC curve analysis was used to evaluate the predictive value of above serum biomarker levels for prognosis. Results The left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), and serum levels of YKL-40 and Lp-PLA2 were significantly higher, while left ventricular ejection fraction(LVEF) and NSF-1 level were obviously lower in the poor prognosis group than the good prognosis group(P<0.01). Pearson correlation analysis showed that in the STEMI patients after PCI, the serum NSF-1 level was negatively correlated with LVEDV and LVESV and positively with LVEF(P<0.01); the serum YKL-40 and Lp-PLA2 levels were positively correlated with LVEDV and LVESV and negatively correlated with LVEF(P<0.01). Multivariate logistic regression analysis showed that NSF-1 was a protective factor for the prognosis of STEMI patients after PCI, while YKL-40 and Lp-PLA2 were independent risk factors(P<0.05, P<0.01). ROC curve analysis revealed that the AUC value of the combined prediction of serum NSF-1, YKL-40, and Lp-PLA2 for the prognosis of STEMI patients after PCI was significantly higher than that of single predictions(0.917 vs 0.864, 0.807, 0.778, P<0.01). Conclusion The serum levels of NSF-1, YKL-40 and Lp-PLA2 are related to left ventricular remodeling and clinical outcomes in STEMI patients after PCI. Their combination shows better prediction for poor prognosis.
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基本信息:
中图分类号:R542.22
引用信息:
[1]安跃振,于倩,刘帅,等.相关血清生物标志物与急性ST段抬高型心肌梗死患者介入治疗术后临床转归的关系[J].中华老年心脑血管病杂志,2026,28(01):4-8.
基金信息:
河北省医学科学研究课题（20251547）
2026-01-09
2026-01-09