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目的探讨Nod样受体蛋白3(NLRP3)对急性心肌梗死患者预后的预测价值,为NLRP3的临床应用提供依据。方法 155例因急性心肌梗死人院治疗患者为研究对象,收集临床资料,分离外周血单个核细胞,以免疫印迹法(Western blotting)定量测定NLRP3水平,测定B型钠尿肽前体(NT-proBNP)及左室射血分数(LVEF)。根据1年随访结果,将研究对象分为无不良心血管事件(MACE)组(115例)及MACE组(42例),观察患者预后与NLRP3表达水平的关系。结果两组患者的年龄、性别、体质量指数(BMI)、吸烟、低密度脂蛋白胆固醇(LDL-C)、阿司匹林使用率、氯吡格雷使用率、他汀使用率比较,差异无统计学意义(P<0.05)。与无MACE组相比,MACE组NLRP3在外周血单个核细胞中的表达显著升高,NT-proBNP水平显著升高;此外LVEF较低,血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)及β受体阻断剂使用率较低,有高血压病史患者比例较低,而糖尿病病史患者比例较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析表明,NLRP3[OR=8.752,95%CI(2.052,37.333),P=0.003]、NT-proBNP[OR=1.020,95%CI(1.000,1.043),P=0.032]、糖尿病史[OR=6.536,95%CI(2.511,17.013),P<0.001]可作为冠心病不良预后的独立预测因子。结论 NLRP3的表达水平与急性心肌梗死患者1年后的临床结果相关,能够预测急性心肌梗死患者的预后。
Objective To investigate the predictive value of Nod-like receptor 3 (NLRP3) in the prognosis of patients with acute myocardial infarction (AMI) and provide the basis for the clinical application of NLRP3. Methods 155 cases of acute myocardial infarction hospitalized patients were selected as the research object. Clinical data were collected and peripheral blood mononuclear cells (PBMCs) were isolated. The level of NLRP3 was determined by Western blotting. The levels of NT- proBNP) and left ventricular ejection fraction (LVEF). According to the result of one-year follow-up, the subjects were divided into two groups: MACE group (115 cases) and MACE group (42 cases). The relationship between prognosis and NLRP3 expression was observed. Results There were no significant differences in age, sex, body mass index (BMI), smoking, LDL-C, aspirin use, clopidogrel use, and statin use between the two groups P <0.05). The expression of NLRP3 in peripheral blood mononuclear cells was significantly increased and the level of NT-proBNP was significantly increased in MACE group compared with no MACE group. In addition, LVEF was lower and angiotensin-converting enzyme inhibitor / angiotensin receptor antagonist (ACEI / ARB) and β-blockers were lower in patients with hypertension, a lower proportion of patients with history of diabetes, and a higher proportion of patients with history of diabetes, the difference was statistically significant (P <0.05). Multivariate logistic regression analysis showed that NLRP3 [OR = 8.752,95% CI (2.052,37.333), P = 0.003], NT-proBNP [OR = 1.020,95% CI (1.000,1.043), P = 0.032] History [OR = 6.536, 95% CI (2.511, 17.013), P <0.001] was an independent predictor of poor prognosis in patients with coronary heart disease. Conclusion The expression level of NLRP3 correlates with the clinical outcome of patients with acute myocardial infarction at 1 year and can predict the prognosis of patients with acute myocardial infarction.