血清DGLA、IGFBP5在急性心肌梗死合并心源性休克患者中的表达及临床意义OA
Serum DGLA and IGFBP5 expression and their clinical significance in patients with acute myocardial infarction com-plicated by cardiogenic shock
目的 探讨血清二高-γ-亚麻酸(DGLA)、胰岛素样生长因子结合蛋白5(IGFBP5)在急性心肌梗死合并心源性休克(AMICS)患者中的表达及临床意义.方法 前瞻性选取2023年1月—2025年5月新疆医科大学第一附属医院心脏内科收治的AMICS患者184例为AMICS组,根据入院30 d内预后将AMICS患者分为死亡亚组73例与存活亚组111例,另按照2∶1比例选取同期单纯AMI患者92例为单纯AMI组.采用酶联免疫吸附法检测血清DGLA、IGFBP5水平,计算AMICS患者主动脉内球囊反搏-休克Ⅱ(IABP-SHOCK Ⅱ)积分;Pearson相关分析AMICS患者血清DGLA、IGFBP5水平与IABP-SHOCK Ⅱ积分的相关性;多因素Logistic回归分析AMICS患者预后死亡的影响因素;受试者工作特征(ROC)曲线分析血清DGLA、IGFBP5水平对AMICS患者预后死亡的预测价值.结果 与单纯AMI 组比较,AMICS 组血清 DGLA 水平降低,IGFBP5 水平升高(t/P=12.020/＜0.001、12.938/＜0.001);AMICS 患者血清 DGLA 与 IABP-SHOCK Ⅱ积分呈负相关(r/P=-0.796/＜0.001),IGFBP5 水平与 IABP-SHOCK Ⅱ积分呈正相关(r/P=0.748/＜0.001);与存活亚组比较,死亡亚组血清DGLA水平降低,IGFBP5水平升高(t/P=53.294/＜0.001、5.723/＜0.001);多因素Logistic回归分析结果显示,IABP-SHOCK Ⅱ积分高、BLA高、NT-proBNP高、IGFBP5高为AMICS患者预后死亡的独立危险因素[OR(95％CI)=2.064(1.319～3.230)、1.392(1.091～1.775)、1.024(1.009～1.038)、1.004(1.002～1.006)],DGLA 高为独立保护因素[OR(95％CI)=0.804(0.725～0.892)];血清 DGLA、IGFBP5 水平单独及二者联合预测AMICS患者预后死亡的AUC分别为0.786、0.801、0.870,二者联合优于各自单独预测效能(Z/P=3.261/0.001、3.058/0.002).结论 AMICS患者血清DGLA水平降低、IGFBP5水平升高与预后不良密切相关,二者联合检测对AMICS患者预后有较高的预测效能.
Objective To investigate the expression and clinical significance of serum dihomo-γ-linolenic acid(DGLA)and insulin-like growth factor binding protein 5(IGFBP5)in patients with acute myocardial infarction complicated by cardiogenic shock(AMICS).Methods A total of 184 AMICS patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2023 to May 2025 were prospectively enrolled as the AMICS group,along with 92 contem-poraneous patients with AMI alone as the control group(2∶1 ratio).Serum levels of DGLA and IGFBP5 were measured using enzyme-linked immunosorbent assay.The intra-aortic balloon pump in cardiogenic shock Ⅱ(IABP-SHOCK Ⅱ)score was calculated for AMICS patients,and correlations with serum DGLA and IGFBP5 were analyzed using Pearson correlation anal-ysis.Based on 30-day outcomes after admission,AMICS patients were divided into survival and death groups.Prognostic fac-tors and the predictive performance of serum DGLA and IGFBP5 were analyzed.Results Compared with AMI patients,AMICS patients had significantly lower serum DGLA levels and significantly higher IGFBP5 levels(both P＜0.05).Serum DGLAwas negatively correlated with IABP-SHOCK Ⅱ score,while IGFBP5 was positively correlated(r=-0.796,0.748,both P＜0.001).The 30-day mortality rate of AMICS patients was 39.67％(73/184).Compared with survivors,the death group showed significantly lower DGLA levels and significantly higher IGFBP5 levels(both P＜0.05).Increased IABP-SHOCK Ⅱscore(OR=2.064,95％CI:1.319-3.230,P=0.002),lactate(OR=1.392,95％CI:1.091-1.775,P=0.008),NT-proBNP(OR=1.024,95％CI:1.009-1.038,P=0.001),and IGFBP5(OR=1.004,95％CI:1.002-1.006,P=0.001)were independent risk factors for mortality,while elevated DGLA(OR=0.804,95％CI:0.725-0.892,P＜0.001)was an independent protective factor.The area under the ROC curve(AUC)for predicting mortality using serum DGLA,IGFBP5,and their combination were 0.786,0.801,and 0.870,respectively,with sensitivities of 0.753,0.807,and 0.785,and specificities of 0.670,0.626,and 0.835.The combined prediction outperformed either marker alone(both P＜0.05).Conclusion In AMICS patients,decreased serum DGLA and increased IGFBP5 levels are independently associated with poor prognosis.The combination of serum DGLA and IGFBP5 provides superior prognostic predictive value compared with either marker alone.
热米拉·依布拉音;再努热木·艾则孜;哈斯达尔·米地里别克;巩亚楠;李艳红
830000 乌鲁木齐,新疆医科大学第一附属医院医学检验中心830000 乌鲁木齐,新疆医科大学第一附属医院急诊内科830000 乌鲁木齐,新疆医科大学第一附属医院心脏内科830000 乌鲁木齐,新疆医科大学第一附属医院医学检验中心830000 乌鲁木齐,新疆医科大学第一附属医院医学检验中心
医药卫生
急性心肌梗死心源性休克二高-γ-亚麻酸胰岛素样生长因子结合蛋白5预后
Acute myocardial infarctionCardiogenic shockDihomo-γ-linolenic acidInsulin-like growth factor binding protein 5Prognosis
《疑难病杂志》 2026 (5)
535-540,6
国家自然科学基金资助项目(82460099) National Natural Science Foundation of China(82460099)
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