摘要
目的探讨急性心肌梗死(AMI)患者冠状动脉病变程度与血清血管内皮生长因子(VEGF)、脂蛋白(a)[LP(a)]、总胆红素(TBIL)的关系。方法选取2019年8月至2022年8月中国人民解放军陆军第七十三集团军医院收治的AMI患者112例(AMI组)和同期健康体检者98例(对照组)为研究对象,根据Gensini评分将AMI组患者分为冠状动脉轻度狭窄组(≤36分)40例和重度狭窄组(>36分)72例。比较各组一般临床资料及VEGF、LP(a)、TBIL水平,并分析不同病变血管支数患者VEGF、LP(a)、TBIL水平。采用多因素Logistic回归分析评价VEGF、LP(a)、TBIL是否为重度冠状动脉狭窄发生的危险因素,ROC评价上述指标对重度冠状动脉狭窄的预测效能。结果AMI组VEGF、LP(a)高于对照组(P<0.05),TBIL低于对照组(P<0.05)。冠状动脉轻度狭窄组白细胞计数、D-二聚体及VEGF、LP(a)低于重度狭窄组(P<0.05),TBIL高于重度狭窄组(P<0.05)。单支病变患者VEGF、LP(a)低于双支和三支病变患者(P<0.05),TBIL高于双支和三支病变患者(P<0.05);双支病变患者VEGF、LP(a)低于三支病变患者(P<0.05),TBIL高于三支病变患者(P<0.05)。多因素Logistic回归分析显示,VEGF、LP(a)、TBIL是AMI患者冠状动脉重度狭窄的危险因素[OR(95%CI)=2.012(1.218~3.324)、1.011(1.004~1.018)、2.684(1.331~5.412),P<0.05]。ROC曲线分析显示,VEGF、LP(a)、TBIL对AMI患者冠状动脉重度狭窄均有一定预测效能,曲线下面积分别为0.784、0.707和0.717;三项指标联合预测冠状动脉重度狭窄的曲线下面积为0.928。结论VEGF、LP(a)、TBIL与AMI患者冠状动脉病变程度密切相关,均为冠状动脉重度狭窄的危险因素,联合应用可作为冠状动脉重度狭窄早期筛查的指标。
Objective To investigate the relationship between the severity of coronary artery disease and serum levels of vascular endothelial growth factor(VEGF),lipoprotein(a)[LP(a)],and total bilirubin(TBIL)in patients with acute myocardial infarction(AMI).Methods A total of 112 AMI patients admitted to the 73rd Group Military Hospital of the Chinese People's Liberation Army from August 2019 to August 2022(AMI group)and 98 healthy individuals underwent routine health examinations during the same period(control group)were selected as the research objects.According to the Gensini score,AMI group was further divided into the mild coronary artery stenosis group(≤36 points,40 cases)and the severe coronary artery stenosis group(>36 points,72 cases).General clinical data and the levels of VEGF,LP(a)and TBIL were compared among the groups,and the levels of VEGF,LP(a)and TBIL in patients with different numbers of diseased vessels were analyzed.Multivariate logistic regression analysis was used to evaluate whether VEGF,LP(a)and TBIL were risk factors for severe coronary artery stenosis.ROC analysis was performed to evaluate the predictive efficacy of the above indexes for severe coronary artery stenosis.Results The levels of VEGF and LP(a)in the AMI group were higher than those in the control group(P<0.05),while TBIL level was lower than that in the control group(P<0.05).The white blood cell count,D-dimer,VEGF and LP(a)levels in the mild coronary artery stenosis group were lower than those in the severe coronary artery stenosis group(P<0.05),while TBIL level was higher(P<0.05).VEGF and LP(a)levels in patients with single-vessel disease were lower than those in patients with double-and triple-vessel disease(P<0.05),while TBIL level was higher(P<0.05).VEGF and LP(a)levels in patients with double-vessel disease were lower than those in patients with triple-vessel disease(P<0.05),while TBIL level was higher(P<0.05).Multivariate logistic regression analysis showed that VEGF,LP(a)and TBIL were risk factors for severe coronary artery stenosis in AMI patients[OR(95%CI)=2.012(1.218-3.324),1.011(1.004-1.018),2.684(1.331-5.412);P<0.05].ROC curve analysis showed that VEGF,LP(a)and TBIL had certain predictive efficacy for severe coronary artery stenosis in AMI patients,and the areas under the curve(AUC)were 0.784,0.707 and 0.717,respectively.The AUC of combined prediction of the 3 indexes for severe coronary artery stenosis was 0.928.Conclusion VEGF,LP(a)and TBIL are closely related to the severity of coronary artery disease in AMI patients,and are independent risk factors for severe coronary artery stenosis.The combined application can serve as a sensitivity index for early screening of severe coronary artery stenosis.
作者
赖增华
窦学凯
陈瑞娟
陈晓茹
贾春文
Lai Zenghua;Dou Xuekai;Chen Ruijuan;Chen Xiaoru;Jia Chunwen(Department of Cardiovascular Medicine,the 73rd Group Military Hospital of the Chinese People's Liberation Army,Xiamen 361001,China;Department of Cardiovascular Medicine,Zhongshan Hospital,Xiamen University,Xiamen 361003,China)
出处
《心脑血管病防治》
2023年第10期25-29,共5页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
关键词
急性心肌梗死
冠状动脉病变程度
血管内皮生长因子
脂蛋白(a)
总胆红素
Acute myocardial infarction
Severity of coronary artery disease
Vascular endothelial growth factor
Lipoprotein(a)
Total bilirubin
