AMI合并左室射血分数降低的心力衰竭患者血清sNEP、DNMT1水平及其与心肌损伤指标、预后的关系OA

Objective To investigate the serum levels of soluble neprilysin(sNEP)and DNA methyltrans-ferase 1(DNMT1)in patients with acute myocardial infarction(AMI)complicated with heart failure with re-duced left ventricular ejection fraction(HFrEF)and their relationship with myocardial injury indicators and prognosis.Methods A total of 177 patients with AMI complicated with HFrEF who underwent percutaneous coronary intervention(PCI)in the hospital from March 2021 to April 2024 were selected as the AMI compli-cated with HFrEF group.AMI patients with HFrEF were divided into poor prognosis group and good progno-sis group according to the prognosis after 1 year of follow-up.A total of 177 patients accept PCI with simple AMI admitted to the hospital during the same period were selected as the AMI group.Spearman/Pearson cor-relation was used to analyze the correlation between serum sNEP and DNMT1 levels and myocardial injury in-dicators[cardiac troponin I(cTnI),myoglobin(MYO),creatine kinase isoenzyme(CK-MB)]in AMI patients with HFrEF.Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in AMI patients with HFrEF.The receiver operating characteristic(ROC)curve was drawn to analyze the pre-dictive value of serum sNEP,DNMT1 alone and their combination for the poor prognosis of AMI patients with HFrEF.Results The levels of sNEP,DNMT1,cTnI,MYO and CK-MB in AMI with HFrEF group were higher than those in AMI group,and the differences were statistically significant(P<0.05).Spearman/Pear-son correlation analysis showed that sNEP and DNMT1 serum levels of AMI patients with HFrEF were posi-tively correlated with cTnI,MYO and CK-MB levels(P<0.05).The incidence of poor prognosis in AMI pa-tients with HFrEF was 44.07%(78/177)after 1 year of follow-up after PCI.The age of the poor prognosis group was older than that of the good prognosis group,the time from onset to admission was longer than that of the good prognosis group,the LVEF was lower than that of the good prognosis group,and the levels of cT-nI,MYO,CK-MB,N-terminal precursor type B titanium natriuretic(NT-proBNP),sNEP and DNMT1 were higher than those of the good prognosis group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that increased age,prolonged time from onset to admission,increased levels of NT-proBNP,sNEP and DNMT1 were independent risk factors for poor prognosis in AMI patients with HFrEF(P<0.05).Increased LVEF was an independent protective factor for poor prognosis in AMI patients with HFrEF(P<0.05).The area under the curve(AUC)of sNEP,DNMT1 and SNEP com-bined with DNMT1 in predicting poor prognosis of AMI patients with HFrEF were 0.836,0.826 and 0.922,respectively.ROC curve analysis showed that the AUC of sNEP combined with DNMT1 in predicting poor prognosis of AMI patients with HFrEF was greater than that of SNEP or DNMT1 alone(Z=3.620,3.851,P<0.001).Conclusion Serum sNEP and DNMT1 levels are increased in AMI patients with HFrEF,which are posi-tively correlated with myocardial injury indicators and are risk factors for poor prognosis of patients.The combination of serum sNEP and DNMT1 has a good predictive value for poor prognosis of patients,and can be used as an auxiliary indicator for prognosis evaluation.