摘要
背景急性冠脉综合征(ACS)是威胁人类健康的常见心血管疾病,严重的冠状动脉病变及心肌纤维化影响患者预后。应用无创血清学指标评估冠状动脉病变程度和心肌纤维化有助于ACS患者早期危险分层及治疗管理。目的探讨ACS患者血清补体C1q/肿瘤坏死因子相关蛋白5(CTRP5)水平与冠状动脉病变程度、心肌纤维化相关蛋白指标的关系,为临床判断冠状动脉病变程度和心肌纤维化提供指导。方法选取2021年2月—2022年2月在衡水市人民医院心血管内科住院阻塞性狭窄的ACS患者184例,另选取同期行冠状动脉造影未见明显阻塞性狭窄的100例ACS患者作为对照。收集患者一般资料,行多普勒超声心动图检查,测定血清CTRP5、Ⅰ型前胶原(PCⅠ)、Ⅲ型前胶原(PCⅢ)。将阻塞性狭窄的ACS患者按照临床诊断标准分为不稳定型心绞痛(UA)组(n=67)、ST段抬高型心肌梗死(STEMI)组(n=57)和非ST段抬高型心肌梗死(NSTEMI)组(n=61);根据冠状动脉造影病变支数分为单支病变组(n=42)、双支病变组(n=69)和三支病变组(n=73)。根据SYNTAXⅡ评分标准分为低危组(n=77)、中危组(n=73)和高危组(n=34)。根据PCⅠ中位数分为低PCⅠ水平组(n=95)和高PCⅠ水平组(n=89),依据PCⅢ中位数分为低PCⅢ水平组(n=93)、高PCⅢ水平组(n=91)。采用多因素Logistic回归分析探究冠状动脉病变程度的影响因素。绘制受试者工作特征(ROC)曲线分析血清CTRP5对冠状动脉病变程度的诊断价值。结果ACS患者白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比值、空腹血糖(FBG)、超敏肌钙蛋白I、血清CTRP5、超敏C反应蛋白(hs-CRP)、PCⅠ、PCⅢ水平高于对照患者(P<0.05)。NSTEMI组、STEMI组患者血清CTRP5、hs-CRP高于UA组(P<0.05)。三支病变组患者血清CTRP5、PCⅠ、PCⅢ、hs-CRP水平高于单支病变组、双支病变组(P<0.05)。高危组患者血清CTRP5、PCⅠ、PCⅢ、hs-CRP水平高于低危组、中危组(P<0.05)。高PCⅠ水平组血清CTRP、hs-CRP水平高于低PCⅠ水平组(P<0.05)。高PCⅢ水平组血清CTRP、hs-CRP水平高于低PCⅢ水平组(P<0.05)。多因素Logistic回归分析结果显示,FBG、hs-CRP和CTRP5升高是冠状动脉多支病变的危险因素(P<0.05)。血清CTRP5、hs-CRP、FBG预测冠状动脉多支病变的ROC曲线下面积(AUC)分别为0.736(95%CI=0.678~0.794)、0.687(95%CI=0.625~0.748)、0.649(95%CI=0.585~0.713)。结论血清CTRP5水平对ACS患者冠状动脉病变程度具有较好的预测价值,且CTRP5水平升高与心肌纤维化的发生可能存在关联。
Background Acute coronary syndrome(ACS)represents a common cardiovascular disease that poses a significant threat to human health,with severe coronary artery lesions and myocardial fibrosis affecting patient prognosis.The use of non-invasive serological markers to assess the severity of coronary artery lesions and myocardial fibrosis can aid in the early risk stratification and management of ACS patients.Objective This study aimed to explore the relationship between serum levels of complement C1q/tumor necrosis factor-related protein-5(CTRP5)and the severity of coronary artery lesions,as well as myocardial fibrosis markers in ACS patients,to provide guidance for the clinical assessment of coronary artery lesion severity and myocardial fibrosis.Methods A total of 184 patients with obstructive stenosis admitted to the Department of Cardiology,Hengshui People's Hospital from February 2021 to February 2022 were selected,along with 100 ACS patients without significant obstructive stenosis undergoing coronary angiography in the same period as controls.General patient data were collected,Doppler echocardiograms were performed,and serum levels of CTRP5,procollagen type Ⅰ (PCⅠ),and procollagen type Ⅲ(PCⅢ)were measured.The patients with obstructive stenosis were divided into unstable angina(UA)group(n=67),ST-segment elevation myocardial infarction(STEMI)group(n=57),and non-ST-segment elevation myocardial infarction(NSTEMI)group(n=61);based on the number of coronary artery lesions,they were categorized into single-vessel disease group(n=42),double-vessel disease group(n=69),and triple-vessel disease group(n=73).According to the SYNTAXⅡscore,they were classified into low-risk(n=77),intermediate-risk(n=73),and high-risk(n=34)groups.Based on the median levels of PCⅠ,patients were divided into low PCⅠlevel group(n=95)and high PC I level group(n=89);similarly,based on PCⅢmedian levels,into low PCⅢlevel group(n=93)and high PCⅢlevel group(n=91).Multiuariate Logistic regression analysis was used to explore the influencing factors of coronary artery lesion severity.Receiver operating characteristic(ROC)curves were drawn to analyze the diagnostic value of serum CTRP5 for coronary artery lesion severity.Results In ACS patients,white blood cell count,neutrophil count,neutrophil-to-lymphocyte ratio,fasting blood glucose(FBG),high-sensitivity cardiac troponinⅠ,serum CTRP5,hypersensitive C-reactive protein(hs-CRP),PCⅠ,and PCⅢ levels were higher than in control patients(P<0.05).Serum CTRP5 and hs-CRP levels in the NSTEMI and STEMI groups were higher than in the UA group(P<0.05).The triple-vessel disease group had higher serum CTRP5,PCⅠ,PCⅢ,and hs-CRP levels than the single-vessel and double-vessel disease groups(P<0.05).High-risk group patients had higher serum CTRP5,PCⅠ,PCⅢ,and hs-CRP levels compared to low-risk and intermediate-risk groups(P<0.05).The high PCⅠ level group had higher serum CTRP5 and hs-CRP levels compared to the low PCⅠ level group(P<0.05).The high PCⅢ level group had higher serum CTRP5 and hs-CRP levels compared to the low PCⅢ level group(P<0.05).Multivariate Logistic regression analysis showed that increased levels of FBG,hs-CRP,and CTRP5 were risk factors for multivessel coronary artery disease(P<0.05).The areas under the ROC curve(AUC)for predicting multivessel coronary artery disease by serum CTRP5,hs-CRP,and FBG were 0.736(95%CI=0.678-0.794),0.687(95%CI=0.625-0.748),and 0.649(95%CI=0.585-0.713),respectively.Conclusion Serum CTRP5 levels have good predictive value for the severity of coronary artery lesions in ACS patients,and elevated levels of CTRP5 are potentially associated with the occurrence of myocardial fibrosis.
作者
李勇
李占虎
靳博伟
李原
张宏博
苏亚坤
闫小菊
LI Yong;LI Zhanhu;JIN Bowei;LI Yuan;ZHANG Hongbo;SU Yakun;YAN Xiaoju(Department of Cardiology,Hengshui People's Hospital,Hengshui 053000,China)
出处
《中国全科医学》
CAS
北大核心
2024年第27期3365-3371,共7页
Chinese General Practice
基金
河北省医学科学研究课题(20220456)。
