血清Trx1、FGL2与急性心肌梗死后心力衰竭患者预后的关系

摘要 目的：探讨血清硫氧还蛋白1（Trx1）、纤维蛋白原样蛋白2（FGL2）与急性心肌梗死后心力衰竭患者预后的关系。方法：选择2019年10月至2020年5月我院收治的158例急性心肌梗死后心力衰竭患者作为观察组，并根据心功能Killip分级分为Ⅱ级组54例、Ⅲ级组57例、Ⅳ级组47例。另选择同期我院收治的102例急性心肌梗死患者作为对照组。入院后采用酶联免疫吸附法（ELISA）检测所有患者血清Trx1、FGL2水平；观察组患者出院后随访2年，并根据是否出现主要不良心血管事件（MACE）将患者分为预后不良组和预后良好组。采用多因素Logistic回归分析影响急性心肌梗死后心力衰竭患者预后的相关因素，采用受试者工作特征（ROC）曲线评估血清Trx1、FGL2对急性心肌梗死后心力衰竭患者预后的预测价值。结果：观察组血清FGL2水平明显高于对照组，血清Trx1水平明显低于对照组（P<0.05）；心功能Killip分级Ⅳ级组患者血清Trx1水平明显低于Ⅱ级组、Ⅲ级组（P<0.05），血清FGL2水平明显高于Ⅱ级组、Ⅲ级组（P<0.05）。预后不良组患者血清Trx1、LVEF均明显低于预后良好组，而年龄、血清FGL2及血尿酸、血肌酐、N末端B型利钠肽原（NT-proBNP）均明显高于预后良好组（P<0.05），两组心功能Killip分级比例比较差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，年龄（较高）、心功能Killip分级为Ⅳ级、Trx1下降、FGL2升高均是影响急性心肌梗死后心力衰竭患者预后的危险因素（P<0.05）。ROC曲线结果显示，血清Trx1、FGL2预测急性心肌梗死后心力衰竭患者预后的曲线下面积分别为0.807、0.811，两者联合检测预测急性心肌梗死后心力衰竭患者预后的曲线下面积为0.889。结论：急性心肌梗死后心力衰竭患者血清中Trx1水平降低，FGL2水平升高，且血清Trx1、FGL2水平与患者心功能分级及预后密切相关，可作为评估急性心肌梗死后心力衰竭患者预后的辅助性指标。

Relationship between Serum Trx1, FGL2 and Prognosis of Patients with Heart Failure after Acute Myocardial Infarction

ABSTRACT Objective: To investigate the relationship between serum thioredoxin 1 (Trx1), fibrinogen like protein 2 (FGL2) and the prognosis of patients with heart failure after acute myocardial infarction. Methods: 158 patients with heart failure after acute myocardial infarction who were admitted to our hospital from October 2019 to may 2020 were selected as the observation group, and they were divided into 54 patients in grade II group, 57 patients in grade III group and 47 patients in grade IV group according to Killip classification of cardiac function. In addition, 102 patients with acute myocardial infarction who were admitted to our hospital in the same period were selected as the control group. After admission, serum Trx1 and FGL2 levels were detected by enzyme-linked immunosorbent assay (ELISA). Patients in the observation group were followed up for 2 years after discharge, and they were divided into poor prognosis group and good prognosis group according to whether there were major adverse cardiovascular events (MACE). Multivariate Logistic regression was used to analyze the relevant factors affecting the prognosis of patients with heart failure after acute myocardial infarction, and the predictive value of serum Trx1 and FGL2 on the prognosis of patients with heart failure after acute myocardial infarction was evaluated using the receiver operating characteristi(ROC) curve. Results: The serum FGL2 level in the observation group was significantly higher than that in the control group, and the serum Trx1 level was significantly lower than that in the control group(P<0.05). The serum Trx1 level in the Killip grade IV group was significantly lower than that in grade II group and grade III group(P<0.05), and the serum FGL2 level was significantly higher than that in the grade II group and grade III group(P<0.05). The serum Trx1 and LVEF in the poor prognosis group were significantly lower than those in the good prognosis group, while the age, serum FGL2, serum uric acid, serum creatinine and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were significantly higher than those in the good prognosis group (P<0.05). There was a statistically significant difference between the two groups in the proportion of Killip grading of cardiac function (P<0.05). Multivariate Logistic regression analysis showed that age(higher), Killip grade IV of cardiac function, decrease of Trx1 and increase of FGL2 were all risk factors affecting the prognosis of patients with heart failure after acute myocardial infarction (P<0.05). ROC curve results showed that the areas under curve of serum Trx1 and FGL2 predicting the prognosis of patients with heart failure after acute myocardial infarction were 0.807 and 0.811 respectively, and the areas under curve of combined detection of the two predicting the prognosis of patients with heart failure after acute myocardial infarction were 0.889. Conclusion: The serum Trx1 level in patients with heart failure after acute myocardial infarction decrease, and FGL2 level increase, and the serum Trx1 and FGL2 levels are closely related to the classification of cardiac function and prognosis of patients, which can be used as auxiliary indicators to evaluate the prognosis of patients with heart failure after acute myocardial infarction.