摘要
目的探讨冠状动脉粥样硬化性心脏病(CHD)患者血清补体C1q与补体C1q/肿瘤坏死因子相关蛋白1(CTRP1)的水平及两者相关性。方法病例对照研究。选取2018年1至11月于宁夏医科大学总医院心脏内科住院治疗的CHD患者115例作为病例组,其中男72例,女43例,年龄35~82岁,平均(59.96±9.49)岁。分为稳定型心绞痛亚组(SAP,n=12)、不稳定型心绞痛亚组(UA,n=69)、急性心肌梗死亚组(AMI,n=34)3个亚组。对照组选自同期43名健康体检者,其中男21名,女22名,年龄23~71岁,平均(45.00±10.66)岁。分别采用免疫透射比浊法和ELISA法测定血清C1q、CTRP1水平,同时检测甘油三酯(TG)、总胆固醇(CHOL)等生化指标。使用多元线性回归分析各因素对C1q水平影响。ROC曲线及曲线下面积(AUC)探讨C1q与CTRP1诊断价值。结果CHD组(184.06±31.05)mg/L C1q水平高于对照组(122.22±28.18)mg/L(t=-11.405,P<0.001)。AMI组(192.80±34.08)mg/L显著高于SAP组(169.17±27.13)mg/L(t=-2.328,P=0.021)。CHD组[241.85(79.38)]ng/ml CTRP1水平低于对照组[292.7(67.64)]ng/ml(Z=-3.64,P<0.001)。Gensini评分较高的两个组(t=3.672,P<0.001)、(t=2.529,P=0.013)C1q水平均高于低分组。校正了年龄、性别及其他指标的影响后,C1q水平与HDL-C(β=-0.582,P<0.001)、CHOL(β=0.384,P<0.001)、收缩压(β=0.142,P=0.038)有关。ROC曲线显示诊断CHD时,C1q水平>150.82 mg/L的敏感度为87.0%,特异度为88.4%,AUC为0.942。CTRP1水平<281.80 ng/ml对应敏感度、特异度分别为76.5%和60.5%,AUC为0.688。C1q与CTRP1联合诊断CHD时,AUC为0.944,敏感度、特异度分别为89.6%和86.0%。诊断AMI时,C1q水平>178.3 mg/L,对应敏感度、特异度为70.6%和66.1%,AUC为0.726,而CTRP1无诊断价值。结论CHD患者血清C1q水平升高,且AMI患者高于SAP患者;C1q可能成为反映冠状动脉病变严重程度的潜在标志物;CHD患者血清C1q与CTRP1两者之间无明显相关性。
Objective To explore the relationship between serum complement 1q(C1q)and C1q/tumor necrosis factor-related protein 1(CTRP1)levels in patients with coronary atherosclerotic heart disease(CHD)and their clinical value.Methods Case-control study.115 patients with CHD who were hospitalized in the Department of Cardiology of Ningxia Medical University General Hospital from January 2018 to November 2018 were selected as the case group,including 72 males and 43 females,aged 35-82 years,average(59.96±9.49)years old.There were three subgroups:stable angina group(SAP,n=12),unstable angina group(UA,n=69),and acute myocardial infarction group(AMI,n=34).The control group was selected from 43 healthy subjects in the same period,including 21 males and 22 females,aged 23-71 years,with an average of(45.00±10.66)years old.Serum C1q and CTRP1 levels were tested by immunoturbidimetry and ELISA,and other biochemical indicators such as triglyceride(TG)and total cholesterol(CHOL)were detected.Multiple linear regression was used to analyze the influence of various factors on C1q level.ROC curve and area under the curve(AUC)to explore the diagnostic value of C1q and CTRP1.Results The C1q level in the CHD group(184.06±31.05)mg/L was higher than that in the control group(122.22±28.18)mg/L(t=-11.405,P<0.001).The AMI group(192.80±34.08)mg/L was significantly higher than the SAP group(169.17±27.13)mg/L(t=-2.328,P=0.021).The CTRP1 level in the CHD group[241.85(79.38)]ng/ml was lower than that in healthy control group[292.7(67.64)]ng/ml(Z=-3.64,P<0.001).Group B with higher Gensini score(t=3.672,P<0.001)and group C(t=2.529,P=0.013)had higher C1q levels than group A.After adjusting for the effects of age,sex and other indicators,C1q levels were correlated with HDL-C(β=-0.582,P<0.001),CHOL(β=0.384,P<0.001)and systolic blood pressure(β=0.142,P=0.038).The ROC curve shows that when the CHD is diagnosed,the sensitivity of C1q level>150.82 mg/L is 87%,the specificity is 88.4%,and the AUC is 0.942.The corresponding sensitivity and specificity of CTRP1<281.80 ng/ml are 76.5%and 60.5%respectively,and the AUC is 0.688.The AUC obtained by combined predictors was 0.944,and the sensitivity and specificity were 89.6%and 86.0%respectively.When AMI is diagnosed,C1q level>178.3 mg/L,corresponding sensitivity and specificity are 70.6%and 66.1%,the AUC is 0.726,CTRP1 has no diagnostic value.Conclusions Serum C1q levels in patients with CHD are elevated,and AMI patients are higher than SAP patients;C1q may be a potential marker reflecting the severity of coronary artery disease;there is no significant correlation between serum C1q and CTRP1 in CHD patients.
作者
牛潇晗
买丹
邱霜
沈梦园
孔奥冉
王利新
Niu Xiaohan;Mai Dan;Qiu Shuang;Shen Mengyuan;Kong Aoran;Wang Lixin(Department of Clinical Laboratory,the General Hospital of Ningxia Medical University,Yinchuan 750004,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2019年第10期864-868,共5页
Chinese Journal of Laboratory Medicine
