关键词: 急性心肌梗死, 糖原合成酶激酶-3, 细胞间黏附分子1, 心功能, 主要不良心血管事件

Abstract: Objective To analyze the relationship between levels of glycogen synthase kinase-3(GSK-3),intercellular adhesion molecule-1(ICAM-1),and the progression of acute ST segment elevation myocardial infarction(STEMI),as well as their predictive value for major adverse cardiovascular events(MACE)after emergency percutaneous coronary intervention(PCI).Methods A total of 102 STEMI patients who underwent emergency PCI at Liangjiang New District People’s Hospital in Chongqing from April 2022 to March 2023 were selected as the study subjects,with 40 patients in the severe group and 62 patients in the moderate to mild group.After 2-year follow-up,the patients were divided into two groups according to the occurrence of MACE:MACE group(n=32)and non-MACE group(n=70).The biochemical indicators,cardiac function,and the incidence of MACE in STEMI patients with different conditions were compared and the correlation between patient’s condition,cardiac function,biochemical indicators and levels of GSK-3β,ICAM-1 were analyzed.The clinical data between the MACE and non-MACE groups were compared and the factors influencing the occurrence of MACE were analyzed by logistic regression analysis.The receiver operating characteristic(ROC)curves were drown to analyze the efficacy of GSK-3β and ICAM-1 in predicting MACE occurrence.Results The levels of GSK-3β,ICAM-1,TNF-α,NT proBNP,HMGB1,the values of LVESD,LVEDD,and the incidence of MACE were higher in the severe group than in the moderate to mild group,while LVEF value was lower in the moderate to mild group(P<0.05).The levels of GSK-3β and ICAM-1 in STEMI patients were positively correlated with Killip grading and values of LVESD and LVEDD,respectively,and negatively correlated with LVEF value(P<0.05).Logistic regression analysis showed that GSK-3β(OR=1.962),ICAM-1(OR=1.702),LVESD(OR=1.621),LVEDD(OR=1.606),TNF-α(OR=1.388),NT-proBNP(OR=1.443)and HMGB1(OR=1.425)were independent risk factors for MACE after emergency PCI in STEMI patients(P<0.05),while LVEF(OR=0.581)was a protective factor(P<0.05).The ROC curve showed that the sensitivity and specificity of combining GSK-3β and ICAM-1 in predicting MACE after emergency PCI in STEMI patients were 83.45% and 81.27 %,respectively.The area under the curve of combining GSK-3β and ICAM-1 was 0.832,which was higher than that of the single indicators of GSK-3β(Z=2.643)and ICAM-1(Z=2.872)(P<0.05).Conclusion GSK-3β and ICAM-1 are highly expressed in the serum of STEMI patients,and their expression levels are closely related to the patient’s cardiac function.Both can be used to evaluate the occurrence of MACE after emergency PCI in STEMI patients,and their combined predictive power is greater.

Key words: acute myocardial infarction, glycogen synthase kinase-3, intercellular cell adhesion molecule-1, cardiac function, major adverse cardiovascular events