冠心病患者sST2、Gal-3水平与心肌纤维化的相关性研究

Correlation of soluble growth stimulation expressed gene 2 and galectin-3 with myocardial fibrosis in patients with coronary artery disease

摘要:

目的 探讨冠心病（coronary artery disease，CAD）患者可溶性生长刺激表达基因2蛋白（soluble growth stimulation expressed gene 2，sST2）、半乳糖凝集素-3（galectin-3，Gal-3）与心肌纤维化（myocardial fibrosis，MF）的关系，指导临床缺血性MF的评估。方法 以顺序入选2021年9月至2022年9月在重庆医科大学附属第二医院科住院的冠心病受试者56例非冠心病患者31例为研究对象，根据心血管磁共振-延迟钆增强（cardiovascular magnetic resonance-late gadolinium enhancement，CMR-LGE）将冠心病组分为心肌纤维化（LGE阳性）亚组和非心肌纤维化（LGE阴性）亚组。收集所有受试者的一般临床资料。所有受试者均通过酶联免疫吸附法测定血清sST2、Gal-3水平。分析sST2、Gal-3与CMR-LGE结果的相关性。结果 ①CAD组患者sST2、Gal-3、血压、肌酐、尿酸、室间隔厚、糖化血红蛋白、CAS评分高于非CAD组患者（P<0.05），而肾小球滤过率、高密度脂蛋白低于非CAD患者（P<0.05）。②LGE阳性亚组sST2、Gal-3、B型利钠肽原水平较LGE阴性亚组高（P<0.05），高密度脂蛋白较LGE阴性亚组低（P<0.05）。③LGE与sST2（r_s=0.338，P=0.011）、Gal-3（r_s=0.428，P=0.001）、B型利钠肽原（r_s=0.364，P=0.006）呈正相关，与高密度脂蛋白（r_s=-0.339，P=0.011）呈负相关，纳入控制变量进行偏相关分析得出LGE与sST2（r=0.312，P=0.037）、Gal-3（r=0.419，P=0.004）独立相关。④sST2、Gal-3以及两者联合检测心肌纤维化的敏感度分别是65%、87%、70%，特异度分别是81%、56%、87%，sST2、Gal-3预测有无心肌纤维化的最佳临界值分别是36.01 ng/mL、13.04 ng/mL。结论 sST2、Gal-3可用于预测缺血性心肌纤维化，与CMR-LGE评估心肌纤维化具有高度一致性。

Abstract:

Objective To investigate the correlation of soluble growth stimulation expressed gene 2（sST2） and galectin-3（Gal-3） with myocardial fibrosis（MF） in patients with coronary artery disease（CAD），and to guide the evaluation of ischemic MF in clinical practice.Methods A total of 56 patients with CAD and 31 patients without CAD who were hospitalized in our department from September 2021 to September 2022 were enrolled as subjects，and according to the results of cardiovascular magnetic resonance-late gadolinium enhancement（CMR-LGE），the CAD group was further divided into MF（LGE positive） subgroup and non-MF（LGE negative） subgroup. General clinical data were collected from all subjects，and ELISA was used to measure the serum levels of sST2 and Gal-3. The correlation of sST2 and Gal-3 with CMR-LGE results was analyzed.Results Compared with the non-CAD group，the CAD group had significantly higher levels of sST2 and Gal-3，blood pressure，creatinine，uric acid，interventricular septum thickness，glycosylated hemoglobin，and CAS score（P<0.05） and significantly lower glomerular filtration rate and high-density lipoprotein（P<0.05）. Compared with the LGE-negative subgroup，the LGE-positive subgroup had significantly higher levels of sST2，Gal-3，and pro-B-type natriuretic peptide（P<0.05） and a significantly lower level of high-density lipoprotein（P<0.05）. LGE was positively correlated with sST2（r_s=0.338，P=0.011），Gal-3（r_s=0.428，P=0.001），and pro-B-type natriuretic peptide（r_s=0.364，P=0.006） and was negatively correlated with high-density lipoprotein（r_s=-0.339，P=0.011），and the partial correlation analysis with control variables showed that LGE was independently correlated with sST2（r=0.312，P=0.037） and Gal-3（r=0.419，P=0.004）. The analysis showed that sST2 or Gal-3 used alone or in combination had a sensitivity of 65%，87%，and 70%，respectively，and a specificity of 81%，56%，and 87%，respectively，in detecting MF，and sST2 and Gal-3 had an optimal cut-off value of 36.01 ng/mL and 13.04 ng/mL，respectively，in predicting the presence or absence of ischemic MF.Conclusion This study shows that sST2 and Gal-3 can be used to predict ischemic MF and are highly consistent with CMR-LGE in evaluating MF.