The value of systemic inflammatory factors in predicting major adverse cardiac cerebrovascular events after PCI in elderly patients with coronary heart disease
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摘要: 目的 探讨系统炎症因子预测老年冠心病经皮冠状动脉介入术(PCI)术后主要不良心脑血管事件(MACCE)的价值。方法 选取2017年2月—2020年2月我院老年冠心病并行PCI治疗的患者85例(观察组)及同期健康体检者85例(对照组)进行回顾性研究。比较2组超敏C反应蛋白(hs-CRP)、脂联素(APN)、单核细胞与高密度脂蛋白胆固醇比值(MHR)水平及不同Gensini积分老年冠心病患者hs-CRP、APN、MHR水平，分析老年冠心病患者hs-CRP、APN、MHR水平与Gensini积分的相关性，Cox回归分析老年冠心病PCI术后MACCE的影响因素，受试者工作特征(ROC)曲线分析hs-CRP、APN、MHR预测PCI术后MACCE的价值。结果 观察组hs-CRP、MHR水平高于对照组，APN水平低于对照组(P< 0.05)；Gensini积分高分患者hs-CRP、MHR水平高于中分、低分患者，APN水平低于中分、低分患者，中分患者hs-CRP、MHR水平高于低分患者，APN水平低于低分患者(P< 0.05)；老年冠心病患者hs-CRP、MHR水平与Gensini积分呈正相关，APN水平与Gensini积分呈负相关(P< 0.05)；Cox回归分析显示，将年龄、吸烟控制后，冠脉病变、Gensini积分、hs-CRP、APN、MHR水平仍与老年冠心病患者PCI术后MACCE相关(P< 0.05)；hs-CRP、APN、MHR联合预测老年冠心病患者PCI术后MACCE的AUC值(0.890)最大，对应灵敏度为93.75%，特异度为70.19%。结论 老年冠心病患者hs-CRP、APN、MHR水平与冠脉病变程度有关，且可预测患者PCI术后MACCE发生风险，为临床防治提供理论参考。
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关键词:
- 冠心病 /
- 老年 /
- 经皮冠状动脉介入术 /
- 超敏C反应蛋白 /
- 脂联素 /
- 单核细胞与高密度脂蛋白胆固醇比值 /
- 主要不良心脑血管事件
Abstract: Objective To explore the value of systemic inflammatory factors in predicting major adverse cardiac cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease.Methods From February 2017 to February 2020, 85 elderly patients with coronary heart disease undergoing PCI treatment in our hospital (observation group) and 85 healthy patients (control group) during the same period were selected for retrospective study. We compared the two groups of high-sensitivity C-reactive protein (hs-CRP), adiponectin (APN), monocyte-to-high density lipoprotein cholesterol ratio (MHR) levels, and the hs-CRP, APN, MHR level of different Gensini scores in elderly patients. Then we analyzed the correlation between the hs-CRP, APN, MHR level, and Gensini scores in elderly patients with coronary heart disease. Cox regression analysis of influencing factors of MACCE and receiver operating characteristic (ROC) curve were analyzed.Results The hs-CRP and MHR levels were higher while the APN level was lower in the observation group than in the control group (P< 0.05). Patients have higher hs-CRP, MHR levels and lower APN levels in high-score than middle- and low-score. The levels of hs-CRP and MHR in elderly patients with coronary heart disease were positively correlated with Gensini scores, while APN levels were negatively correlated with Gensini scores (P< 0.05); Cox regression analysis showed that after controlling age and smoking, the levels of coronary artery disease, Gensini score, hs-CRP, APN, and MHR were still correlated with MACCE (P< 0.05). The highest AUC was 0.890 in the combined prediction of hs-CRP, APN, and MHR. It's sensitivity was 93.75% and specificity was 70.19%.Conclusion The levels of hs-CRP, APN and MHR in elderly patients with coronary heart disease are related to the degree of coronary artery disease, and can predict the risk of MACCE in patients after PCI. -
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图 1 老年冠心病患者hs-CRP、APN、MHR水平与Gensini积分的相关性
Figure 1. Correlation between hs-CRP, APN, MHR levels and Gensini scores in elderly patients with coronary heart disease
表 1 2组hs-CRP、APN、MHR水平比较
Table 1. Comparison of hs-CRP, APN, MHR levels in the two groups
X±S 组别 例数 hs-CRP/(mg·L-1) APN/(mg·L-1) MHR 观察组 85 12.09±3.15 3.68±1.09 0.59±0.22 对照组 85 0.85±0.39 8.10±2.14 0.26±0.09 t 32.648 16.968 12.800 P < 0.001 < 0.001 < 0.001 
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表 2 不同Gensini积分老年冠心病患者hs-CRP、APN、MHR水平
Table 2. The levels of hs-CRP, APN and MHR in elderly patients with coronary heart disease with different Gensini points
X±S Gensini积分 例数 hs-CRP/
(mg·L-1)APN/
(mg·L-1)MHR 低分 19 8.74±2.55 5.64±1.25 0.38±0.17 中分 54 11.93±3.07 3.75±0.94 0.60±0.18 高分 12 14.92±3.28 2.05±0.86 0.74±0.21 F 25.892 78.749 22.678 P < 0.001 < 0.001 < 0.001
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表 3 老年冠心病患者PCI术后MACCE的单因素分析
Table 3. Univariate analysis of MACCE in elderly patients with coronary heart disease after PCI
例(%) 指标 例数 MACCE (21例) χ2 P 性别 0.042 0.837 男 51 13(25.49) 女 34 8(23.53) 年龄/岁 4.852 0.028 60~70 46 7(15.22) >70 39 14(35.90) 吸烟 17.651 < 0.001 有 32 16(50.00) 无 53 5(9.43) TG 0.192 0.661 高水平 41 11(26.83) 低水平 44 10(22.73) TC 0.317 0.573 高水平 40 11(27.50) 低水平 45 10(22.22) HDL-C 0.335 0.563 高水平 37 8(21.62) 低水平 48 13(27.08) LDL-C 0.103 0.749 高水平 46 12(26.09) 低水平 39 9(23.08) 冠脉病变 8.249 0.016 单支 31 3(9.68) 2支 34 9(26.47) 3支 20 9(45.00) Gensini积分 4.852 0.028 高水平 39 14(35.90) 低水平 46 7(15.22) hs-CRP 6.649 0.010 高水平 40 15(37.50) 低水平 45 6(13.33) APN 17.651 < 0.001 高水平 53 5(9.43) 低水平 32 16(50.00) MHR 6.664 0.010 高水平 44 16(36.36) 低水平 41 5(12.20) 注：观察组TG为(1.82±0.53) mmol/L，TC为(4.61±0.92) mmol/L，HDL-C为(0.95±0.18) mmol/L，LDL-C为(3.15±0.74) mmol/L，Gensini积分为(41.38±6.71)分，hs-CRP为(12.09±3.15) mg/L，APN为(3.68±1.09) mg/L，MHR为(0.59±0.22)，≥均值为高水平，<均值为低水平。
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表 4 PCI术后MACCE的Cox回归分析
Table 4. Cox regression analysis of MACCE after PCI
因素 β SE Wald χ2 P HR 95%CI 冠脉病变 1.402 0.402 12.162 < 0.001 4.063 2.056~8.029 Gensini积分 1.302 0.357 13.298 < 0.001 3.676 1.863~7.254 hs-CRP 1.332 0.402 10.977 < 0.001 3.788 2.197~6.532 APN -1.080 0.513 4.429 0.037 0.340 0.163~0.708 MHR 1.325 0.368 12.965 < 0.001 3.762 1.764~8.025
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表 5 hs-CRP、APN、MHR预测PCI术后MACCE的价值
Table 5. hs-CRP, APN, MHR predict the value of MACCE after PCI
指标 AUC 95%CI χ2 P cut-off值 灵敏度/% 特异度/% hs-CRP 0.861 0.763~0.921 8.796 < 0.001 >8.80 88.19 72.43 APN 0.812 0.686~0.905 6.135 < 0.001 ≤4.82 89.62 71.43 MHR 0.849 0.778~0.932 9.227 < 0.001 >0.51 68.75 95.25 联合 0.890 0.792~0.941 7.516 < 0.001 93.75 70.19
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[1] Timmis A, Townsend N, Gale C, et al. European Society of Cardiology: Cardiovascular Disease Statistics 2017[J]. Eur Heart J, 2018, 39(7): 508-579. doi: 10.1093/eurheartj/ehx628
[2] Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association[J]. Circulation, 2019, 139(10): e56-e528.
[3] 陈思宇, 邓肃, 易春艳, 等. 老年冠心病患者经皮冠状动脉介入治疗术后焦虑抑郁对不良心血管事件发生率的影响[J]. 中华老年多器官疾病杂志, 2017, 16(5): 370-373. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG201705013.htm
[4] 张增磊, 郑颖颖, 唐俊楠, 等. 术前单核细胞与高密度脂蛋白胆固醇比值对冠心病PCI术后患者预后的预测[J]. 郑州大学学报(医学版), 2020, 55(3): 305-308. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYK202003003.htm
[5] 艾民, 颜昌福, 夏福纯, 等. 血清hs-CRP及VEGF水平对急性心肌梗死经皮冠状动脉介入治疗术后心血管事件的影响[J]. 山东医药, 2018, 58(1): 16-18. doi: 10.3969/j.issn.1002-266X.2018.01.005
[6] 陈万义, 张庆民. Hcy、CRP、SAA、APN检测在冠状动脉病变严重程度评估中的价值[J]. 检验医学与临床, 2019, 16(12): 1687-1691. doi: 10.3969/j.issn.1672-9455.2019.12.017
[7] Yayla KG, Canpolat U, Yayla Ç, et al. A Novel Marker of Impaired Aortic Elasticity in Never Treated Hypertensive Patients: Monocyte/High-Density Lipoprotein Cholesterol Ratio[J]. Acta Cardiol Sin, 2017, 33(1): 41-49.
[8] 余云华, 于亚梅, 李茂巍, 等. 高龄冠心病患者PCI术后主要心脑血管不良事件风险评估模型验证与分析研究[J]. 介入放射学杂志, 2018, 27(10): 953-958. doi: 10.3969/j.issn.1008-794X.2018.10.011
[9] 武金娥, 霍建华, 蒋永荣, 等. 老年冠心病患者PCI术后不良心脑血管事件的随访研究[J]. 西安交通大学学报(医学版), 2019, 40(4): 579-582. https://www.cnki.com.cn/Article/CJFDTOTAL-XAYX201904019.htm
[10] Peikert A, Kaier K, Merz J, et al. Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort[J]. Clin Res Cardiol, 2020, 109(3): 315-323. doi: 10.1007/s00392-019-01511-0
[11] 黄乐, 林德智, 倪卫, 等. 冠心病患者血清RBP4、hs-CRP、IL-6水平检测的临床意义[J]. 中国循证心血管医学杂志, 2019, 11(6): 691-693, 697. doi: 10.3969/j.issn.1674-4055.2019.06.11
[12] 娜尔给扎·艾尔肯, 胡力哈尔·拜合提亚尔, 布娃加·吾守尔. 脂联素、血管紧张素Ⅱ血液水平及其基因多态性与新疆维吾尔族原发性高血压的相关性研究[J]. 临床心血管病杂志, 2020, 36(12): 1110-1114. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202012009.htm
[13] Ghazouani L, Elmufti A, Baaziz I, et al. Contribution of adiponectin polymorphisms to the risk of coronary artery disease in a North-African Tunisian population[J]. J Clin Lab Anal, 2018, 32(7): e22446. doi: 10.1002/jcla.22446
[14] 彭宏超, 阮春雨. 冠心病患者血清中hs-CRP、APN和BNP的表达及意义研究[J]. 标记免疫分析与临床, 2018, 25(5): 669-672. https://www.cnki.com.cn/Article/CJFDTOTAL-BJMY201805021.htm
[15] 徐慧, 刘芳. 单核细胞计数/高密度脂蛋白胆固醇比值与早发冠心病的相关性分析[J]. 临床心血管病杂志, 2020, 36(8): 709-713. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202008007.htm
[16] Zhao Q, Li J, Yang J, et al. Association of total cholesterol and HDL-C levels and outcome in coronary heart disease patients with heart failure[J]. Medicine(Baltimore), 2017, 96(9): e6094.
[17] 段运霞, 周荣, 贺杰. 冠心病患者MHR与冠脉狭窄程度的相关性及其临床意义[J]. 心脏杂志, 2019, 31(3): 282-285. https://www.cnki.com.cn/Article/CJFDTOTAL-XGNZ201903009.htm
[18] 李莉, 李阳, 樊泽元, 等. 外周血MHR与冠状动脉粥样硬化易损斑块的关系[J]. 山东医药, 2020, 60(7): 26-29. doi: 10.3969/j.issn.1002-266X.2020.07.006
[19] 杨小英, 邓晓剑, 常荣. 单核细胞/高密度脂蛋白胆固醇比值与冠心病SYN-TAX积分的关系[J]. 岭南心血管病杂志, 2018, 24(3): 266-271. doi: 10.3969/j.issn.1007-9688.2018.03.05
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