Background. Acute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease that poses a great threat to the life and health of patients. Therefore, early diagnosis is important for STEMI patient treatment and prognosis. The purpose of this study was to investigate the value of serum YKL-40 and TNF-α in the diagnosis of STEMI. Methods. From October 2020 to February 2022, 120 patients with STEMI were admitted to the Chest Pain Center of the Second People’s Hospital of Hefei, and 81 patients with negative coronary angiography were selected as the control group. Serum YKL-40 and TNF-α concentrations were measured by sandwich ELISA. Pearson correlation was used to analyze the correlation between serum YKL-40, TNF-α, and serum troponin I (cTnI) in STEMI patients; multivariate logistic regression analysis was used to screen independent risk factors for STEMI. Three diagnostic models were constructed: cTnI univariate model (model A), combined serum YKL-40 and TNF-α model other than cTnI (model B), and combined cTnI and serum YKL-40 and TNF-α model (model C). We assessed the clinical usefulness of the diagnostic model by comparing AUC with decision curve analysis (DCA). Results. Serum YKL-40 and TNF-α in the STEMI group were significantly higher than those in the control group (). On Pearson correlation analysis, there was a significant positive correlation between serum YKL-40, TNF-α, and cTnI levels in STEMI patients. Multivariate logistic regression analysis showed that serum YKL-40 and TNF-α were independent risk factors for the development of STEMI. The results of ROC analysis showed that the area under the curve (AUC) of serum YKL-40 for predicting the occurrence of STEMI was 0.704. The AUC of serum TNF-α for predicting the occurrence of STEMI was 0.852. The AUC of cTnI as a traditional model, model A, for predicting the occurrence of STEMI was 0.875. Model B predicted STEMI with an AUC of 0.851. The addition of serum YKL-40 and serum TNF-α to the traditional diagnostic model composed of cTnI constituted a new diagnostic model; that is, the AUC of model C for predicting the occurrence of STEMI was 0.930. Model C had a better net benefit between a threshold probability of 70–95% for DCA. Conclusion. In this study, we demonstrate the utility of serum YKL-40 and TNF-α as diagnostic markers for STEMI and the clinical utility of diagnostic models by combining serum YKL-40 and TNF-α with cTnI.

中文翻译：

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血清YKL-40和TNF-α在急性ST段抬高型心肌梗死诊断中的价值

背景。急性ST段抬高型心肌梗死(STEMI)是一种严重的心血管疾病，对患者的生命和健康构成极大威胁。因此，早期诊断对 STEMI 患者的治疗和预后具有重要意义。本研究旨在探讨血清 YKL-40 和 TNF- α在 STEMI 诊断中的价值。方法。2020年10月至2022年2月，合肥市第二人民医院胸痛中心收治STEMI患者120例，选择冠状动脉造影阴性患者81例作为对照组。通过夹心ELISA测量血清YKL-40和TNF- α浓度。采用 Pearson 相关性分析血清 YKL-40、TNF-α和 STEMI 患者的血清肌钙蛋白 I (cTnI)；多变量逻辑回归分析用于筛选 STEMI 的独立危险因素。构建了三个诊断模型：cTnI单变量模型（模型A）、血清YKL-40和除cTnI之外的TNF-α联合模型（模型B）和cTnI联合血清YKL-40和TNF- α模型（模型C）。我们通过将 AUC 与决策曲线分析 (DCA) 进行比较来评估诊断模型的临床实用性。结果。STEMI组血清YKL-40和TNF- α显着高于对照组（）。在 Pearson 相关分析中，STEMI 患者血清 YKL-40、TNF- α和 cTnI 水平呈显着正相关多因素logistic回归分析显示，血清YKL-40和TNF- α是STEMI发生的独立危险因素。ROC分析结果显示，血清YKL-40预测STEMI发生的曲线下面积（AUC）为0.704。血清TNF -α预测STEMI发生的AUC为0.852。cTnI 作为传统模型模型A预测 STEMI 发生的 AUC 为 0.875。模型B预测 STEMI 的 AUC 为 0.851。添加血清 YKL-40 和血清 TNF- α对由cTnI组成的传统诊断模型构成了新的诊断模型；即模型C预测STEMI发生的AUC为0.930。对于 DCA，模型C在 70-95% 的阈值概率之间具有更好的净收益。结论。在这项研究中，我们证明了血清 YKL-40 和 TNF- α作为 STEMI 诊断标志物的效用以及通过将血清 YKL-40 和 TNF- α与 cTnI 相结合的诊断模型的临床效用。