【摘要】 目的探讨外周血中核因子-κB(NF-κB)和五聚素3(PTX3)与急性冠脉综合征(ACS)并发室性心律失常的关系。方法选取2018年3月至2020年3月哈尔滨医科大学附属第一医院收治的ACS患者136例,根据心电监护结果将其分为单纯ACS组(对照组,92例)和ACS并发室性心律失常组(研究组,44例),同期以性别、年龄等为匹配条件招募30例健康志愿者作为健康组,比较3组外周血中NF-κB、PTX3表达水平。采用Logistic多元回归分析筛选影响ACS并发室性心律失常的相关因素,采用Pearson相关分析外周血NF-κB、PTX3水平与影响ACS并发室性心律失常相关因素的关系,并绘制受试者工作特征曲线(ROC)分析外周血NF-κB、PTX3对ACS并发室性心律失常的诊断价值。结果研究组、对照组NF-κB、PTX3水平均高于健康组(P<0.05);研究组NF-κB、PTX3水平均高于对照组(P<0.05)。研究组左心房内径(LA)、左室阶段性运动异常占比、脑利钠肽前体(pro-BNP)、肌酸激酶(CK)、心肌肌钙蛋白(cTnI)、C反应蛋白(CRP)均大于对照组(P<0.05)。Logistic多元回归分析显示NF-κB、PTX3、LA、cTnI均是影响ACS并发室性心律失常的相关因素(P<0.05)。NF-κB与PTX3、LA、cTnI均呈正相关性(r=0.426、0.431、0.442,P<0.05);PTX3与LA、cTnI均呈正相关性(r=0.485、0.477,P<0.05)。外周血NF-κB、PTX3诊断ACS并发室性心律失常的最佳截断点分别为65.00pg/mL、1546.56pg/mL,ROC曲线下面积(AUC)分别为0.820、0.826,灵敏度分别为81.82%、84.09%,特异度分别为77.17%、75.00%,准确度分别为78.68%、77.94%;二者联合诊断的AUC为0.848,敏感度、特异度和准确度分别为93.18%、73.91%、80.15%。结论 ACS并发室性心律失常患者外周血NF-κB、PTX3均呈高表达,二者均是影响ACS并发室性心律失常的相关因素,并对该病具有良好诊断价值。更多还原

【Abstract】 Objective To investigate the relationship between nuclear factor-κB(NF-κB)and pentraxin 3(PTX3)in peripheral blood and ventricular arrhythmias complicated by acute coronary syndrome(ACS).Methods One hundred and thirty-six patients with ACS admitted to the hospital from March 2018 to March 2020 were selected and divided into the ACS-only group(control group,92 cases)and the group with ACS complicated by ventricular arrhythmias(study group,44 cases)according to the ECG monitoring results,and 30 healthy volunteers were recruited as the healthy group during the same period with matching conditions of gender and age,etc.The three groups were compared in terms of peripheral blood NF-κB,PTX3 expression levels in peripheral blood of the three groups were compared.Logistic multiple regression analysis was used to screen the correlates affecting ventricular arrhythmias complicated by ACS,Pearson correlation analysis was used to analyze the relationship between peripheral blood NF-κB and PTX3 levels and factors associated with the influence of ACS complicating ventricular arrhythmias.The diagnostic value of peripheral blood NF-κB and PTX3 on ventricular arrhythmias complicated by ACS was also analyzed by plotting the subject operating characteristic curve(ROC).Results NF-κB and PTX3 levels were higher in the study and control groups than in the healthy group(P<0.05).The levels of NF-κB and PTX3 were higher in the study group than in the control group(P<0.05).The left atrial internal diameter(LA),the percentage of left ventricular phase motion abnormalities,brain natriuretic peptide precursor(pro-BNP),creatine kinase(CK),cardiac troponin(cTnI),and C-reactive protein(CRP)were greater in the study group than in the control group(P<0.05).Logistic multiple regression analysis showed that NF-κB,PTX3,LA,and cTnI were all associated factors affecting ventricular arrhythmias complicated by ACS(P<0.05).NF-κB was positively correlated with PTX3,LA,and cTnI(r=0.426,0.431,0.442,P<0.05),PTX3 was positively correlated with LA and cTnI(r=0.485,0.477,P<0.05).The optimal cut-off points for the diagnosis of ventricular arrhythmias complicated by ACS were 65.00 pg/mL and 546.56 pg/mL for peripheral blood NF-κB and PTX3,respectively,with an area under the ROC curve(AUC)of 0.820 and 0.826,sensitivity of 81.82%and 84.09%,and specificity of 77.17%and 75.00%,and accuracy of 78.68%and 77.94%,respectively.The AUC for the combined diagnosis of the two was 0.848,the sensitivity,specificity and accuracy were 93.18%,73.91%,and 80.15%,respectively.Conclusion Patients with ACS complicated by ventricular arrhythmias showed high expression of peripheral blood NF-κB and PTX3,both of which are relevant factors affecting ACS complicated by ventricular arrhythmias and have good diagnostic value for the disease.更多还原