Correlation of serum B-cell activating factor level with cardiovascular events in patients with ST segment elevation myocardial infarction
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摘要:目的
评估血清B细胞活化因子(BAFF)水平对ST段抬高型心肌梗死(STEMI)患者心血管事件的预测价值。
方法选取2020年1月-2022年6月在南通大学附属南通第三医院因STEMI入院并接受冠状动脉造影的166例患者为研究对象, 收集患者的一般资料、病史、超声心动图和实验室数据。对患者随访12个月, 记录主要不良心血管事件(MACE)发生情况。采用Cox比例风险模型评估血清BAFF水平对MACE的预测价值; 绘制血清BAFF水平预测MACE的受试者工作特征(ROC)曲线, 并计算曲线下面积(AUC)。通过ROC曲线确定血清BAFF水平的最佳截断值, 依照最佳截断值进行分组, 采用Log-rank检验绘制Kaplan-Meier曲线以分析MACE发生情况。
结果166例患者中, 26例患者在随访12个月内出现MACE, MACE发生率为15.7 %。MACE组患者年龄、甘油三酯、低密度脂蛋白、心肌肌钙蛋白Ⅰ、肌酸激酶同工酶、血清BAFF水平高于非MACE组患者, 差异有统计学意义(P < 0.05)。Cox比例风险模型结果显示, 年龄与MACE发生率呈显著正相关(HR=1.267, 95 %CI: 1.126~1.426, P < 0.001), 血清BAFF水平与MACE发生率呈显著正相关(HR=1.020, 95 %CI: 1.003~1.038, P=0.024)。血清BAFF水平预测MACE发生率的敏感度为76.2 %, 特异度为82.9 %。ROC曲线分析显示血清BAFF水平的最佳截断值为1.07 ng/mL, 据此将患者分为血清BAFF水平>1.07 ng/mL组和血清BAFF水平≤ 1.07 ng/mL组, 结果显示血清BAFF水平≤ 1.07 ng/mL组患者累积生存率高于血清BAFF水平>1.07 ng/mL组患者, 差异有统计学意义(P < 0.001)。
结论血清BAFF水平升高与STEMI患者MACE发生率增高呈显著正相关, 血清BAFF水平能够作为STEMI患者心血管事件的预测因子。
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关键词:
- B细胞活化因子 /
- ST段抬高型心肌梗死 /
- 主要不良心血管事件 /
- 血脂指标 /
- 预后
Abstract:ObjectiveTo evaluate the value of serum B-cell activating factor (BAFF) level in predicting cardiovascular events in patients with ST segment elevation myocardial infarction (STEMI).
MethodsA total of 166 patients with coronary angiography for STEMI in the Nantong Third Hospital Affiliated to Nantong University from January 2020 to June 2022 were selected as research objects, and general materials, medical history, echocardiography and laboratory data were collected. Patients were followed up for 12 months to record the incidence condition of major adverse cardiac events (MACE). The predictive value of serum BAFF level for MACE was evaluated by Cox proportional hazard model; the receiver operating characteristic (ROC) curve of serum BAFF level for prediction of MACE was drawn, and the area under curve (AUC) was calculated. The optimal cut-off value for serum BAFF level was determined by the ROC curve, the patients were grouped based on this optimal cut-off, and the Log-rank test was used to draw the Kaplan-Meier curve for analyzing the incidence of MACE.
ResultsAmong the 166 patients, 26 cases had MACE within 12 months of follow-up, and the incidence rate of MACE was 15.7 %. In the MACE group, the age and levels of triglycerides, low-density lipoprotein, cardiac troponin Ⅰ, creatine kinase isoenzyme, and serum BAFF were significantly higher than those in the non-MACE group (P < 0.05). Cox proportional hazard model analysis revealed that there was a significant positive correlation between age and incidence of MACE (HR=1.267, 95 %CI, 1.126 to 1.426, P < 0.001) as well as a significant positive association between serum BAFF level and incidence of MACE (HR=1.020, 95 %CI, 1.003 to 1.038, P=0.024). The sensitivity of serum BAFF level in predicting MACE was 76.2 %, and the specificity was 82.9 %. ROC curve analysis identified the optimal cut-off value of serum BAFF was 1.07 ng/mL, patients were divided into a group with serum BAFF>1.07 ng/mL and another with serum BAFF ≤ 1.07 ng/mL, and the cumulative survival rate in the group with serum BAFF ≤ 1.07 ng/mL was significantly higher than that in the group with serum BAFF>1.07 ng/mL (P < 0.001).
ConclusionThe increase of serum BAFF level is significantly positively correlated with the increased incidence of MACE in STEMI patients, and serum BAFF level can be used as a predictor of cardiovascular events in STEMI patients.
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表 1 2组患者一般资料比较(x±s)[n(%)]
指标 MACE组(n=26) 非MACE组(n=140) t/χ2 P 年龄/岁 69.6±8.5 64.3±10.1 2.514 0.013 性别 男 18(69.2) 91(65.0) 0.174 0.677 女 8(30.8) 49(35.0) BMI/(kg/m2) 24.1±2.9 23.5±3.3 0.867 0.387 吸烟 17(65.4) 83(59.3) 0.341 0.560 饮酒 7(26.9) 33(23.6) 0.135 0.714 高血压病 14(53.8) 71(50.7) 0.086 0.769 糖尿病 9(34.6) 40(28.6) 0.385 0.535 血脂异常 9(34.6) 43(30.7) 0.155 0.694 LVEF/% 54.5±6.7 57.1±7.2 1.709 0.089 LVEDV/mL 118.8±13.9 115.9±15.2 0.904 0.367 LVESV/mL 50.6±14.7 46.8±11.3 1.498 0.136 LVESD/mm 35.3±4.6 33.9±4.0 1.600 0.112 LAD/mm 38.4±4.2 37.1±3.4 1.723 0.087 Hb/(g/L) 130.6±17.9 138.2±20.2 1.791 0.075 PLT/(×109/L) 204.8±50.9 227.6±61.4 1.782 0.077 WBC/(×109/L) 8.9±2.4 9.2±2.9 0.497 0.620 TC/(mmol/L) 4.5±0.6 4.4±0.8 0.606 0.545 TG/(mmol/L) 1.6±0.3 1.4±0.3 3.122 0.002 LDL/(mmol/L) 3.0±0.6 2.7±0.5 2.720 0.007 HDL/(mmol/L) 1.0±0.3 1.1±0.3 1.561 0.121 cTnI/(ng/L) 36.5±11.8 24.3±10.5 5.335 < 0.001 CK-MB/(mg/L) 185.3±73.5 117.7±58.1 5.215 < 0.001 血清BAFF/(ng/mL) 1.2±0.3 0.8±0.1 12.570 < 0.001 BMI: 体质量指数; LVEF: 左心室射血分数; LVEDV: 左室舒张末期容积; LVESV: 左室收缩末期容积; LVESD: 左心室收缩末期内径; LAD: 左房内径; Hb: 血红蛋白; PLT: 血小板; WBC: 白细胞; TC: 总胆固醇; TG: 甘油三酯; LDL: 低密度脂蛋白; HDL: 高密度脂蛋白; cTnI: 心肌肌钙蛋白Ⅰ; CK-MB: 肌酸激酶同工酶; BAFF: B细胞活化因子。 
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表 2 Cox比例风险模型
危险因素 B SE Wald P HR 95%CI 年龄 0.237 0.060 15.394 < 0.001 1.267 1.126~1.426 甘油三酯 -0.025 0.473 0.003 0.959 0.976 0.386~2.468 低密度脂蛋白 -0.134 0.402 0.111 0.739 0.874 0.397~1.924 心肌肌钙蛋白Ⅰ 0.055 0.040 1.896 0.168 1.057 0.977~1.143 肌酸激酶同工酶 0.802 0.514 2.429 0.119 2.229 0.814~6.108 血清B细胞活化因子 0.020 0.009 5.075 0.024 1.020 1.003~1.038
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