2026 年第 9 期 第 21 卷

急性心肌梗死合并射血分数降低型心力衰竭患者血清对称二甲基精氨酸和磷酸甘油酸变位酶2的表达及临床意义

Expression and clinical significance of serum symmetric dimethylarginine and phosphoglyceromutase 2 in patients with acute myocardial infarction complicated with heart failure with reduced ejection fraction

作者：宋小英1何勇2齐茗1郭娅娅1张月2

英文作者：Song Xiaoying1 He Yong2 Qi Ming1 Guo Yaya1 Zhang Yue2

单位：1延安大学附属医院心血管病中心，延安716000；2陕西省核工业二一五医院心血管内科，咸阳712000

英文单位：1Cardiovascular Disease Center Yan′an University Affiliated Hospital Yan′an 716000 China; 2Department of Cardiovascular Medicine No.215 Hospital of Shaanxi Nuclear Industry Xianyang 712000 China

关键词：急性心肌梗死；射血分数降低；心力衰竭；对称二甲基精氨酸；磷酸甘油酸变位酶2

英文关键词：Acutemyocardialinfarction;Reducedejectionfraction;Heartfailure;Symmetricdimethylarginine;Phosphoglyceromutase2

• 摘要：

• 目的 探讨血清对称二甲基精氨酸（SDMA）、磷酸甘油酸变位酶2（PGAM2）在急性心肌梗死（AMI）合并射血分数降低型心力衰竭患者中的表达水平及临床意义。方法 以2021年2月至2025年2月延安大学附属医院收治的129例AMI合并射血分数降低型心力衰竭患者为病例组，根据Killip分级将患者分为Ⅱ级（51例）、Ⅲ级（46例）、Ⅳ级（32例），根据出院后6个月随访结果将患者分为预后良好组（80例）、预后不良组（49例）；于同期随机选取129例体检健康者为对照组。采用酶联免疫吸附试验法测定血清SDMA、PGAM2水平。分析血清SDMA、PGAM2与Killip分级的相关性及其与预后不良的关联，并评估其对预后不良的预测效能。结果 病例组血清SDMA、PGAM2均高于对照组［（2.08±0.34）μmol/L比（1.52±0.29）μmol/L、（86±14）ng/L比（42±12）ng/L］（均P＜0.05）。Ⅲ级和Ⅳ级患者血清SDMA、PGAM2均高于Ⅱ级患者，且Ⅳ级患者高于Ⅲ级患者（均P＜0.05）。血清SDMA、PGAM2与Killip分级呈正相关性（rs=0.461、P=0.012，rs=0.533，P=0.004）。与预后良好组比较，预后不良组Killip分级更高、左心室射血分数（LVEF）更低、SDMA和PGAM2更高（均P＜0.05）。Killip分级Ⅳ级、SDMA升高、PGAM2升高是预后不良危险因素，LVEF升高是保护因素（均P＜0.05）。血清SDMA、PGAM2及指标联合预测预后不良的曲线下面积分别为0.808、0.840、0.905，指标联合预测价值大于单一指标（Z=2.102、P=0.007，Z=1.522，P=0.026）。结论 血清SDMA、PGAM2在AMI合并射血分数降低型心力衰竭患者中表达上调，并与心功能分级及预后密切相关，早期联合检测可辅助临床评估心功能及预测预后不良风险。

• Objective To investigate the expression levels and clinical significance of serum symmetric dimethylarginine (SDMA) and phosphoglyceromutase 2 (PGAM2) in patients with acute myocardial infarction (AMI) complicated with heart failure with reduced ejection fraction. Methods A total of 129 patients with AMI complicated with heart failure with reduced ejection fraction admitted to Yan′an University Affiliated Hospital from February 2021 to February 2025 were enrolled as the case group. The patients were divided into Killip class Ⅱ (51 cases), class Ⅲ (46 cases) and class Ⅳ (32 cases). According to the 6-month post-discharge follow-up results, the patients were divided into good prognosis group (80 cases) and poor prognosis group (49 cases); meanwhile, 129 healthy subjects undergoing physical examination were randomly selected as the control group. Enzyme-linked immunosorbent assay was used to detect serum SDMA and PGAM2 levels. The correlations of serum SDMA and PGAM2 with Killip classification and their associations with poor prognosis were analyzed, and their predictive efficacy for poor prognosis was evaluated. Results Serum SDMA and PGAM2 in the case group were higher than those in the control group ［(2.08±0.34)μmol/L vs (1.52±0.29)μmol/L, (86±14)ng/L vs (42±12)ng/L］(both P＜0.05).Serum SDMA and PGAM2 in patients of class Ⅲ and class Ⅳ were higher than those in patients of class Ⅱ, and the levels in class Ⅳ patients were higher than those in class Ⅲ patients (all P＜0.05). Serum SDMA and PGAM2 were positively correlated with Killip classification (rs=0.461, P=0.012; rs=0.533, P=0.004).Compared with the good prognosis group, the poor prognosis group had higher Killip classification, lower left ventricular ejection fraction (LVEF), and higher SDMA and PGAM2 (all P＜0.05).Killip class Ⅳ, elevated SDMA and elevated PGAM2 were risk factors for poor prognosis, while increased LVEF was a protective factor (all P＜0.05).The areas under the curve of serum SDMA, PGAM2 and their combination for predicting poor prognosis were 0.808, 0.840 and 0.905, respectively; the combined detection had higher predictive value than single indicator (Z=2.102, P=0.007; Z=1.522, P=0.026).Conclusion Serum SDMA and PGAM2 are upregulated in patients with AMI complicated with heart failure with reduced ejection fraction, and are closely correlated with cardiac function classification and prognosis. Early combined detection can assist clinicians in evaluating cardiac function and predicting the risk of poor prognosis.