2024 年第 8 期 第 0 卷

血浆类花生酸对急性冠状动脉综合征患者不良心血管事件的预测价值

The predictive value of plasma eicosanoids in the adverse cardiovascular events of patients with acute coronary syndromes

作者：倪慧檀鑫杜杰

英文作者：Ni Hui Tan Xin Du Jie

单位：首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心血管生物研究室教育部重塑相关心血管疾病重点实验室心血管重大疾病防治协同创新中心,北京100029

英文单位：Beijing Anzhen Hospital Capital Medical University Cardiovascular Biology Laboratory Beijing Institute of Heart Lung and Blood Vessel Diseases Key Laboratory of Remodeling-related Cardiovascular Diseases Ministry of Education Collaborative Innovation Center for Cardiovascular Disorders Beijing 100029 China

关键词：急性冠状动脉综合征；类花生酸；不良心血管事件

英文关键词：Acutecoronarysyndromes；Eicosanoids；Adversecardiovascularevents

• 摘要：

• 目的 探讨血浆类花生酸对急性冠状动脉综合征（ACS）患者不良心血管事件的预测价值。方法 回顾性分析2019年6—12月就诊于首都医科大学附属北京安贞医院住院行血运重建治疗的ACS患者309例，中位随访时间3.8（3.6，3.9）年。根据患者有无不良心血管事件分为事件组（33例）和非事件组（276例）。采用高效液相色谱串联质谱方法测定患者血浆74种类花生酸水平，对患者评估全球急性冠状动脉事件注册(GRACE)评分。筛选2组患者有明显差异的类花生酸，利用受试者工作特征（ROC）曲线分析得到血浆类花生酸预测不良心血管事件的截断值。采用Cox回归方法和Kaplan-Meier生存曲线分析类花生酸是否为ACS患者发生不良心血管事件的危险因素。利用ROC曲线分析类花生酸、GRACE评分单独及联合预测不良心血管事件的效能。结果 事件组患者的血浆15-羟基二十碳四烯酸（15-HETE）、15-氧代二十碳四烯酸（15-oxo-ETE）和14,15-环氧二十碳三烯酸(14,15-DHET)水平均高于非事件组(均P＜0.05)。Cox回归分析显示，经多因素校正以后，15-HETE≥0.84 μg/L、14,15-DHET≥0.20 μg/L是ACS患者血运重建后不良心血管事件发生的独立危险因素(均P＜0.05)。Kaplan-Meier曲线显示，15-HETE≥0.84 μg/L、14,15-DHET≥0.20 μg/L水平的患者发生不良心血管事件的风险更高(均Log-rank P＜0.01)。ROC曲线分析结果显示，GRACE评分单独及血浆15-HETE、14,15-DHET水平和GRACE评分三者联合预测ACS患者血运重建后发生不良心血管事件的曲线下面积分别为0.699和0.712，GRACE评分联合15-HETE、14,15-DHET预测的曲线下面积大于GRACE评分单独预测（P＜0.05）。结论 血浆15-HETE、14,15-DHET高水平是ACS患者血运重建后不良心血管事件风险的预测因子，二者联合 GRACE评分可以提高对不良心血管事件的预测效能。

• Objective To investigate the predictive value of plasma eicosanoids in predicting adverse cardiovascular events in patients with acute coronary syndromes(ACS). Methods  Totally 309 hospitalized patients with ACS were retrospective analyzed, admitted to Beijing Anzhen Hospital, Capital Medical University for revascularization treatment from June to December 2019, with a median follow-up time of 3.8（3.6，3.9）years. Patients were divided into event group (33 cases) and non-event group (276 cases) based on the occurrence of adverse cardiovascular events. High performance liquid chromatography tandem mass spectrometry was used to determine 74 types of patient′s plasma eicosanoids levels, and patient′s global registry of acute coronary events risk (GRACE) score was performed. Differential eicosanoids were screened out in the two groups, patients were divided into different groups according to the cut-off of plasma eicosanoids from receiver operating characteristic(ROC) curve analysis. The effects of eicosanoids on the prognosis of ACS patients were evaluated by multivariate Cox regression analysis and Kaplan-Meier plots, and the value of eicosanoids and GRACE score in predicting adverse cardiovascular events was analyzed by ROC curve. Results  The plasma 15-hydroxyeicosatetraenoic acid (15-HETE), 15-oxoeicosatetraenoic acid (15-oxo-ETE) and 14, 15-dihydroxyeicosatrienoic acid (14, 15-DHET) of patients in the event group were significantly higher than those in the non-event group (all P＜0.05). Cox regression analysis showed that after adjusting for multivariate factors, 15-HETE≥0.84 μg/L and 14, 15-DHET≥0.20 μg/L were independent risk factors for adverse cardiovascular events in ACS patients after revascularization(both P＜0.05). A Kaplan-Meier curve showed patients in 15-HETE≥0.84 μg/L and 14,15-DHET≥0.20 μg/L, were more likely to experience adverse events (both Log-rank P＜0.01). The ROC curve analysis showed that the area under the curve predicted by GRACE score alone and 15-HETE, 14, 15-DHET and GRACE scores in combination for adverse cardiovascular events in ACS patients after revascularization were 0.699 and 0.712 respectively. The area under the curve predicted by GRACE score combined with 15-HETE and 14, 15-DHET was larger than that predicted by GRACE score alone (P＜0.05). Conclusions  High levels of plasma 15-HETE and 14, 15-DHET are independent risk factors for the risk of adverse cardiovascular events in patients with ACS after revascularization, and have certain predictive value for adverse cardiovascular events.