南方医科大学学报

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (3): 550-558.doi: 10.12122/j.issn.1673-4254.2026.03.09

• 临床研究 • 上一篇    

急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后30天主要不良心血管事件的列线图预测模型：基于血清GSDMD蛋白表达水平

胡欣怡1,2,4(), 王圩健4(), 李慧3,4, 陈宗正4,5, 周忻6, 袁俊菲6, 陈亮1,4,5()   

  1. 1.安徽医科大学无锡临床学院，江苏 无锡 214044
    2.安徽医科大学第五临床医学院，安徽 合肥 230032
    3.安徽医科大学第二临床医学院，安徽 合肥 230032
    4.中国人民解放军联勤保障部队第904医院心血管内科，江苏 无锡 214044
    5.江南大学无锡医学院，江苏 无锡 214122
    6.中国人民解放军联勤保障部队第904医院检验科，江苏 无锡 214044
  • 收稿日期:2025-09-08 出版日期:2026-03-20 发布日期:2026-03-26
  • 通讯作者: 陈亮 E-mail:huxydoct@163.com;wangweijian904@163.com;chenliangsmmu@163.com
  • 作者简介:胡欣怡，在读硕士研究生，E-mail: huxydoct@163.com
    王圩健，硕士，主治医师，E-mail: wangweijian904@163.com
    第一联系人：本文共同第一作者。
  • 基金资助:
    国家自然科学基金(82000420);江苏省自然科学基金(BK20211043);无锡市科技发展资金“太湖之光”科技攻关项目(Y20232010);无锡市“双百”中青年医疗卫生拔尖人才项目(HB2023128)

A nomogram model for predicting MACE risk following primary percutaneous coronary intervention in STEMI patients: an exploratory study based on serum GSDMD

Xinyi HU1,2,4(), Weijian WANG4(), Hui LI3,4, Zongzheng CHEN4,5, Xin ZHOU6, Junfei YUAN6, Liang CHEN1,4,5()   

  1. 1.Wuxi Clinical College of Anhui Medical University, Wuxi 214044, China
    2.Fifth Clinical School of Anhui Medical University, Hefei 230032, China
    3.Second Clinical School of Anhui Medical University, Hefei 230032, China
    4.Department of Cardiovascular Medicine
    6.Department of Laboratory, 904th Hospital of the PLA Joint Logistic Support Force, Wuxi 214044, China
    5.Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China
  • Received:2025-09-08 Online:2026-03-20 Published:2026-03-26
  • Contact: Liang CHEN E-mail:huxydoct@163.com;wangweijian904@163.com;chenliangsmmu@163.com
  • Supported by:
    National Natural Science Foundation of China(82000420)

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摘要：

目的 通过检测急性ST段抬高型心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PPCI）术前及术后血清GSDMD蛋白表达水平，评估其对30 d主要不良心血管事件（MACE）的预测效能，并结合临床指标构建列线图预测模型。 方法 选取2024年6月~2025年5月在我院接受PPCI的100例STEMI患者进行前瞻性分析。用酶联免疫吸附试验（ELISA）检测患者术前和术后第2天清晨血清中GSDMD蛋白表达水平，并同步收集患者基线临床资料和实验室指标。采用Wilcoxon符号秩检验比较患者术前与术后血清GSDMD的水平变化。根据术后GSDMD水平通过约登指数确定最佳截断值，将患者分为高GSDMD组和低GSDMD组，随访30 d，记录两组患者术后30 d内MACE的发生情况。MACE定义包括再发心肌梗死，新发心力衰竭或心力衰竭加重再入院，恶性心律失常，通过临床症状和头颅CT或MRI诊断的缺血性卒中，全因死亡，以及非计划的血运重建。根据是否发生MACE分为MACE组（n=26）与非MACE组（n=74）。采用单因素Logistic回归初步筛选差异变量，继而通过LASSO回归进行变量降维，最终通过多因素Logistic回归确定独立预测因子，基于回归系数建立列线图模型，并通过ROC曲线、Bootstrap验证、Hosmer-Lemeshow拟合优度检验、校准曲线和决策分析曲线（DCA）评价预测模型的预测效能、拟合度和临床应用价值。 结果 STEMI患者术后GSDMD水平较术前升高（Z=-4.848，P<0.001）。PPCI术后血清GSDMD表达高的STEMI患者发生短期MACE事件的风险增加（P=0.01）。经过单因素Logistic分析、多重共线性诊断、LASSO回归、多因素Logistic校正后确定PPCI术后血清GSDMD水平是STEMI患者30 dMACE的独立危险因素。通过多因素Logistic回归分析筛选出关键参数建立列线图预测模型，最后将Killip分级、支架个数、白蛋白、GSDMD纳入模型，ROC曲线分析结果显示，模型预测STEMI患者30 d内MACE的AUC为0.847（P<0.001，95% CI=0.759-0.936），灵敏度为84.6%，特异度为79.7%。Bootstrap校正、Hosmer-Lemeshow拟合优度检验、校准曲线和DCA均证实了模型的预测效能。 结论 PPCI术后血清GSDMD升高是STEMI患者30 d内MACE的独立危险因素，以此构建的预测模型对STEMI患者30 d内MACE的发生具有较好的预测价值。

关键词: Gasdermin D, 细胞焦亡, ST段抬高急性心肌梗死, 主要不良心血管事件, 经皮冠状动脉介入治疗

Abstract:

Objective To investigate the value of serum gasdermin D (GSDMD) level for predicting 30-day major adverse cardiovascular events (MACE) in patients following primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI) and construct a predictive nomogram. Methods A total of 100 STEMI patients undergoing PPCI were prospectively enrolled. Serum GSDMD levels of the patients were measured by ELISA before and on the second morning after PPCI and compared using Wilcoxon signed-rank test. The patients were divided into high-GSDMD and low-GSDMD groups based on the optimal cut-off value of postoperative GSDMD levels determined by the Youden index. During the 30-day follow-up, the patients were categorized into MACE group (n=26) and non-MACE group (n=74). The key predictors were selected using univariable and LASSO regression, followed by multivariable logistic regression to identify the independent risk factors. A nomogram was constructed and evaluated by ROC curve analysis, Bootstrap internal validation, Hosmer-Lemeshow test, calibration plots and decision curve analysis (DCA). Results Post-PPCI serum GSDMD levels were significantly elevated relative to the pre-PPCI levels (Z=-4.848, P<0.001). The incidence of 30-day MACE was significantly higher in the high GSDMD group (P=0.01). Post-PPCI GSDMD level was identified as an independent risk factor for short-term MACE. The final nomogram incorporated Killip classification, number of stents, albumin, and post-PPCI GSDMD and demonstrated good predictive performance with an AUC of 0.847 (P<0.001, 95% CI: 0.759-0.936), a sensitivity of 84.6% and a specificity of 79.7%. All the validation analyses confirmed good predictive efficacy and clinical utility of the model. Conclusion Elevated post-PPCI serum GSDMD level is an independent risk factor for 30-day MACE in STEMI patients. The nomogram model based on this biomarker provides a reliable tool for short-term risk stratification of these patients.

Key words: gasdermin D, pyroptosis, ST-segment elevation acute myocardial infarction, major adverse cardiovascular events, primary percutaneous coronary intervention