肌腱蛋白C动态监测对急性心肌梗死泵衰竭患者心肌重塑及预后影响

Dynamic Monitoring of Tendon Protein C and Its Impact on Myocardial Remodeling and Prognosis in Patients with Acute Myocardial Infarction and Pump Chronic Heart Failure Complicated with Diabetes for 3 Years

摘要: 目的：分析肌腱蛋白C (TN-C)动态监测对急性心肌梗死(AMI)泵衰竭患者心肌重塑及预后影响，为临床治疗提供借鉴。方法：选取本院2022年1月~2023年12月的84例AMI泵衰竭患者，均予以左西孟旦联合生脉注射液治疗，于治疗前、后检测TN-C、心肌重塑指标[血清III型前胶原氨基末端肽(PIIINP)、IV型胶原(CIV)、层粘连蛋白(LN)]，分析其动态变化。采用Pearson相关性分析法，分析TN-C与心肌重塑指标的相关性。出院后随访1年进行预后评估，统计心血管不良事件(MACE)发生情况，将发生MACE者纳入预后不良组，未发生MACE者纳入预后良好组，对比2组的TN-C水平与心肌重塑指标。绘制受试者工作特征(ROC)曲线，分析TN-C、心肌重塑指标对预后的预测价值。结果：治疗后的TN-C、PIIINP、CIV、LN低于治疗前，P < 0.05。Pearson分析结果显示，TN-C与PIIINP、CIV、LN均呈明显的正相关性(P < 0.05)。预后不良组的TN-C、PIIINP、CIV、LN高于预后良好组，P < 0.05。TN-C水平对预后预测的AUC、灵敏度、特异度分别为0.822、83.17%、78.63%；心肌重塑指标联合检测分别为0.880、87.06%、82.52%；TN-C联合心肌重塑指标分别为0.924、91.32%、85.97%。结论：TN-C在AMI泵衰竭患者治疗前后呈动态变化，监测TN-C有助于评估心肌重塑及预后情况，具有一定的临床应用价值。

Abstract: Objective: To analyze the impact of dynamic monitoring of tendon protein C (TN-C) on myocardial remodeling and prognosis in patients with acute myocardial infarction (AMI) pump failure, and provide reference for clinical treatment. Method: 84 patients with AMI pump failure from January 2022 to December 2023 in our hospital were selected and treated with levosimendan combined with Shengmai injection. TN-C and myocardial remodeling indicators [serum type III procollagen N-terminal peptide (PIIINP), type IV collagen (CIV), and laminin (LN)] were measured before and after treatment, and their dynamic changes were analyzed. Using Pearson correlation analysis, analyze the correlation between TN-C and myocardial remodeling indicators. After discharge, a one-year follow-up was conducted for prognosis evaluation, and the occurrence of cardiovascular adverse events (MACE) was recorded. Those who experienced MACE were included in the poor prognosis group, while those who did not experience MACE were included in the good prognosis group. The TN-C levels and myocardial remodeling indicators were compared between the two groups. Draw receiver operating characteristic (ROC) curves and analyze the predictive value of TN-C and myocardial remodeling indicators for prognosis. Result: The levels of TN-C, PIIINP, CIV, and LN after treatment were lower than before treatment, P < 0.05. The Pearson analysis results showed that TN-C was significantly positively correlated with PIIINP, CIV, and LN (P < 0.05). The TN-C, PIIINP, CIV, and LN levels in the poor prognosis group were higher than those in the good prognosis group, P < 0.05. The AUC, sensitivity, and specificity of TN-C level for prognosis prediction were 0.822%, 83.17%, and 78.63%, respectively; The combined detection of myocardial remodeling indicators was 0.880, 87.06%, and 82.52%, respectively; The TN-C combined myocardial remodeling indicators were 0.924, 91.32%, and 85.97%, respectively. Conclusion: TN-C shows dynamic changes before and after treatment in patients with AMI pump failure. Monitoring TN-C can help evaluate myocardial remodeling and prognosis, and has certain clinical application value.