Association between Plasma Thiol Parameters and Troponin Levels in Patients with Acute Coronary Syndrome and Prediction of In-Hospital Ventricular Arrhythmia

Abstract Background Ventricular arrhythmias (VAs) are the main cause of in-hospital mortality and morbidity in acute coronary syndrome (ACS) patients and its relationship with thiol is not known. Objective To investigate the relationship between plasma thiol levels and troponin levels in patients with ACS and to estimate in-hospital VA development during hospital stay. Method The study included 231 consecutive ST-segment elevation ACS (STE-ACS) and non-ST-segment elevation ACS (NSTE-ACS) patients. After application of exclusion criteria, 191 patients were included in the statistical analysis. Patients were classified into two groups: STE-ACS group (n=94) and NSTE-ACS group (n=97). Plasma thiol, disulphide and troponin levels were measured and troponin-to-native thiol ratio (TNTR) was calculated. A two-sided p value of less than 0.05 was considered to be statistically significant. Results Plasma native thiol, total thiol, disulphide and their ratios were similar between the groups. TNTR was significantly higher in the STE-ACS group compared to the NSTE-ACS group. Troponin and thiol levels correlated negatively and significantly. Native thiol was found to be an independent predictor of VA development in STE-ACS patients and in all ACS patients. TNTR was found to be an independent predictor of VA development in NSTE-ACS patients and in all ACS patients. Conclusion Plasma thiol levels can be used to identify ACS patients at high risk for in-hospital VA development. Correlation between troponin and thiol levels may suggest that thiols may be an important marker for diagnosis and prognosis of ACS with the help of future studies.

摘要 研究背景：室性心律失常（Ventricular arrhythmias, VAs）是急性冠状动脉综合征（Acute Coronary Syndrome, ACS）患者住院期间死亡与不良预后的主要诱因，目前其与巯基的关联尚不明晰。
研究目的：本研究旨在探讨急性冠状动脉综合征患者血浆巯基水平与肌钙蛋白水平的关联，并评估住院期间室性心律失常的发生风险。
研究方法：本研究连续纳入231例ST段抬高型急性冠状动脉综合征（ST-segment elevation ACS, STE-ACS）与非ST段抬高型急性冠状动脉综合征（non-ST-segment elevation ACS, NSTE-ACS）患者。经排除标准筛选后，最终191例患者纳入统计分析。将受试者分为两组：ST段抬高型ACS组（n=94）与非ST段抬高型ACS组（n=97）。检测受试者血浆巯基、二硫键与肌钙蛋白水平，并计算肌钙蛋白/天然巯基比值（troponin-to-native thiol ratio, TNTR）。采用双侧检验，以P<0.05为差异具有统计学意义。
研究结果：两组患者的血浆天然巯基、总巯基、二硫键水平及其相关比值均无显著差异。ST段抬高型ACS组的肌钙蛋白/天然巯基比值显著高于非ST段抬高型ACS组。肌钙蛋白水平与巯基水平呈显著负相关。在ST段抬高型ACS患者及全部急性冠状动脉综合征患者中，天然巯基是住院期间室性心律失常发生的独立预测因子；在非ST段抬高型ACS患者及全部急性冠状动脉综合征患者中，肌钙蛋白/天然巯基比值是住院期间室性心律失常发生的独立预测因子。
研究结论：血浆巯基水平可用于识别住院期间室性心律失常高风险的急性冠状动脉综合征患者。肌钙蛋白与巯基水平的相关性提示，未来通过进一步研究，巯基或可成为急性冠状动脉综合征诊断与预后评估的重要生物标志物。