摘要
目的探讨补体C1q/肿瘤坏死因子相关蛋白3(CTRP3)联合N末端B型利钠肽前体(NT-proBNP)对冠状动脉(冠脉)多支病变(MVD)患者发生高同型半胱氨酸血症(HHcy)的预测价值。方法回顾性分析200例MVD患者的临床资料,根据血浆同型半胱氨酸(Hcy)水平是否>15μmol/L分为高Hcy组(111例)和正常Hcy组(89例)。比较两组基线资料[年龄、性别、冠心病病程、吸烟史、糖尿病病史、高血压病史、体质量指数(BMI)],生化指标(NT-proBNP、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、Hcy、CTRP3),采用二元Logistic回归分析法分析影响MVD患者发生HHcy危险因素,绘制受试者工作特征(ROC)曲线分析CTRP3联合NT-proBNP对MVD患者发生HHcy的预测效能。结果两组年龄、高血压病史、BMI、UA、TG、TC、HDL-C比较均无统计学差异(P>0.05);高Hcy组男性患者数量70例、冠心病病程(6.66±4.49)年、吸烟史55例、糖尿病病史60例,均大于正常Hcy组的36例、(3.67±2.31)年、28例、17例,NT-proBNP(5234.95±7476.76)pg/ml、LDL-C(3.55±0.95)mmol/L、Hcy(44.75±12.48)μmol/L均高于正常Hcy组的(1296.94±3864.78)pg/ml、(2.95±0.88)mmol/L、(10.58±2.80)μmol/L,CTRP3(65.20±13.61)μg/L低于正常Hcy组的(88.69±14.94)μg/L,两组间比较差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示:男性[OR=3.745,95%CI=(1.398,10.030)]、糖尿病病史[OR=3.262,95%CI=(1.264,8.417)]、冠心病病程[OR=1.194,95%CI=(1.022,1.394)]、LDL-C[OR=2.254,95%CI=(1.337,3.800)]为导致MVD患者发生HHcy的独立危险因素,而CTRP3[OR=0.902,95%CI=(0.873,0.933)]为其独立保护因素(P<0.05)。ROC曲线结果显示:CTRP3联合NT-proBNP预测MVD患者发生HHcy的AUC为0.901,敏感度为83.8%,特异度为86.5%,优于LDL-C、NT-proBNP或CTRP3单独预测(P<0.05)。结论性别、糖尿病病史、冠心病病程、LDL-C为导致MVD患者发生HHcy的独立危险因素,而CTRP3为其独立保护因素。血清CTRP3联合NT-proBNP可提高MVD患者发生HHcy的预测价值。
Objective To investigate the predictive value of complement-C1q/tumor necrosis factor related protein-3(CTRP3)combined with N-terminal pro-B-type natriuretic peptide(NT-proBNP)for hyperhomocysteinemia(HHcy)in patients with coronary multi-vessel disease(MVD).Methods A retrospective analysis was performed on clinical data of 200 patients with coronary MVD.Patients were divided into high Hcy group(111 cases)and normal Hcy group(89 cases)according to whether plasma homocysteine(Hcy)level>15μmol/L or not.Both groups were compared in terms of baseline data[age,sex,duration of coronary heart disease,smoking history,history of diabetes mellitus,history of hypertension,and body mass index(BMI)]and biochemical indicators[NT-proBNP,uric acid(UA),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),Hcy,CTRP3].Binary Logistic regression analysis was used to analyze the risk factors affecting HHcy in MVD patients,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of CTRP3 combined with NT-proBNP on HHcy in MVD patients.Results There were no significant differences in age,history of hypertension,BMI,UA,TG,TC and HDL-C between the two groups(P>0.05).The number of male patients in the high Hcy group was 70 cases,the duration of coronary heart disease was(6.66±4.49)years,55 cases had a smoking history and 60 cases had a history of diabetes mellitus,which were higher than 36 cases,(3.67±2.31)years,28 cases and 17 cases in the normal Hcy group;NT-proBNP in the high Hcy group was(5234.95±7476.76)pg/ml,LDL-C was(3.55±0.95)mmol/L and Hcy was(44.75±12.48)μmol/L,which were higher than(1296.94±3864.78)pg/ml and(2.95±0.88)mmol/L L,(10.58±2.80)μmol/L in normal Hcy group;CTRP3 of(65.20±13.61)μg/L in the high Hcy group was lower than(88.69±14.94)μg/L in normal Hcy group;the difference between the two groups was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that male[OR=3.745,95%CI=(1.398,10.030)],history of diabetes mellitus[OR=3.262,95%CI=(1.264,8.417)],duration of coronary heart disease[OR=1.194,95%CI=(1.022,1.394)]and LDL-C[OR=2.254,95%CI=(1.337,3.800)]were independent risk factors for HHcy in MVD patients,while CTRP3[OR=0.902,95%CI=(0.873,0.933)]was an independent protective factor(P<0.05).Conclusion Sex,history of diabetes mellitus,duration of coronary heart disease and LDLC are independent risk factors for HHcy in MVD patients;while CTRP3 is an independent protective factor.Serum CTRP3 combined with NT-proBNP can improve the predictive value of HHcy in MVD patients.
作者
李欣
张明亮
曲超
邢丽婷
王嵬民
LI Xin;ZHANG Ming-liang;QU Chao(Department of Cardiology,Heilongjiang Provincial Hospital,Harbin 150036,China)
出处
《中国实用医药》
2024年第3期68-71,共4页
China Practical Medicine
基金
2022年黑龙江省卫生健康委科研课题立项(项目编号:20220303010661),项目名称:同型半胱氨酸对冠脉多支病变患者心脏功能的影响。
