Correlation of plasma asprosin and secreted frizzled related protein 5 with the severity of coronary artery in patients with coronary heart disease
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摘要: 目的 探讨冠心病患者血浆白脂素和分泌型卷曲相关蛋白5(Sfrp5)与冠状动脉(冠脉)病变程度的相关性。方法 选择经冠脉造影检查明确诊断为冠心病的患者113例作为试验组，将冠心病患者分为稳定型心绞痛(SA)组27例，不稳定型心绞痛(UA)组43例，急性心肌梗死(AMI)组44例，另选择同期行冠脉造影检查无狭窄的患者34例为对照组。比较4组患者的一般资料和实验室化验指标。采用Gensini评分评估冠心病患者的冠脉病变程度，多因素logistic分析冠心病的影响因素。采用Spearman相关分析白脂素、Sfrp5与Gensini评分和冠心病临床分型之间的相关性。采用受试者工作特征(ROC)曲线评估白脂素、Sfrp5及两指标联合检测对冠心病的辅助诊断效能。结果 ① 与对照组比较，冠心病各亚组血浆白脂素水平均升高、Sfrp5水平均降低，其中UA组、AMI组差异有统计学意义(P< 0.05)。AMI组血浆白脂素水平高于其他3组，Sfrp5水平低于其他3组，差异有统计学意义(P< 0.05)。②多因素logistic分析结果示，年龄、白脂素为冠心病的影响因素(OR=1.088、1.801，P< 0.05)。③相关性分析结果示，白脂素与Gensini评分和冠心病临床分型呈正相关(rs=0.296、0.352，P< 0.05)，Sfrp5与Gensini评分和冠心病临床分型呈负相关(rs=-0.391、-0.338，P< 0.05)。④ROC曲线分析结果示，白脂素、Sfrp5、白脂素+Sfrp5诊断冠心病的曲线下面积分别为0.737、0.746、0.776，对应的最佳截断值分别为3.955 ng/mL、35.190 ng/mL、1.340，且联合检测的诊断特异度(88.2%)显著高于单独检测。结论 血浆白脂素与冠脉病变严重程度呈正相关，是冠心病的影响因素；Sfrp5与冠脉病变严重程度呈负相关。二者联合检测可用于辅助诊断冠心病，并评估冠脉病变程度，指导治疗。
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关键词:
- 白脂素 /
- 分泌型卷曲相关蛋白5 /
- 冠心病 /
- 冠状动脉病变程度
Abstract: Objective To investigate the correlation of plasma asprosin and secreted frizzled related protein 5 (Sfrp5) with the severity of coronary artery in patients with coronary heart disease (CHD).Methods A total of 113 patients were diagnosed with CHD by coronary angiography. The patients with CHD were divided into stable angina (SA) group(n=27), unstable angina(UA) group(n=43) and acute myocardial infarction(AMI) group(n=44). In addition, 34 patients without stenosis examined by coronary angiography were selected as the control group at the same time. Gensini score was used to evaluate the severity of coronary artery disease in patients with CHD. Multivariate logistic analysis was used to analyze the influencing factors of CHD. Spearman correlation analysis was used to analyze the correlation of asprosin and Sfrp5 with Gensini scores and clinical classification of CHD. The receiver operating characteristic (ROC) curve was used to evaluate the auxiliary diagnostic efficacy of asprosin, Sfrp5, and their combination in CHD.Results ① Compared with the control group, plasma asprosin levels in all CHD subgroups were increased and Sfrp5 levels were decreased, but only the UA group and AMI group had statistical significance. Plasma asprosin level in the AMI group was higher than that in the other three groups, and the Sfrp5 level was lower than that in the other three groups(P< 0.05). ②The results of multivariate logistic analysis showed that age and asprosin were the influencing factors of CHD(OR=1.088, 1.801,P< 0.05). ③Spearman correlation analysis showed that asprosin was positively correlated with Gensini scores and clinical classification of CHD(rs=0.225, 0.352,P< 0.05), while Sfrp5 were negatively correlated with Gensini scores and clinical classification of CHD (rs=-0.391, -0.338,P< 0.05). ④The results of ROC curve analysis showed that the areas under the curve of asprosin, Sfrp5, and the corresponding best cut-off values were 0.737, 0.746 and 0.776 respectively, and the corresponding best cut-off values were 3.955 ng/mL, 35.190 ng/mL and 1.340 respectively. The diagnostic specificity of combined detection (88.2%)was significantly higher than that of single detection.Conclusion Plasma asprosin is positively correlated with the severity of coronary artery and is an influencing factor of CHD. Sfrp5 is negatively correlated with the severity of CHD. The combination of the two tests can be used to assist in the diagnosis of CHD and evaluate the degree of coronary artery disease. -
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图 1 白脂素、Sfrp5及两指标联合诊断CHD的ROC曲线
Figure 1. ROC curve of asprosin, Sfrp5 and their combination in the diagnosis of CHD
表 1 4组患者一般资料和实验室检查指标比较
Table 1. General data and laboratory examination indexes
例(%), X±S, M(P25, P75) 指标 对照组
(34例)CHD组(113例) 统计值 P SA组(27例) UA组(43例) AMI组(44例) 男性 18(52.9) 12(44.4) 37(86.0)1)2) 35(79.5)1)2) 19.811 < 0.001 吸烟史 8(23.5) 6(22.2) 27(62.8)1)2) 22(50.0)1)2) 17.800 < 0.001 高血压病 6(17.6) 14(51.9)1) 18(41.9)1) 18(40.9)1) 8.620 0.035 糖尿病 6(17.6) 6(22.2) 5(11.6) 10(22.7) 2.150 0.542 年龄/岁 50.76±10.20 57.67±9.381) 60.37±9.431) 58.84±10.721) 6.554 < 0.001 BMI/(kg·m-2) 25.06±3.22 24.28±2.27 24.65±3.10 24.75±2.97 0.480 0.697 TC/(mmol·L-1) 4.15±1.03 4.29±1.05 4.60±1.30 4.18±1.06 1.289 0.281 TG/(mmol·L-1) 1.38(1.06，1.84) 1.56(1.09，1.92) 1.63(1.14，2.14) 1.54(1.12，2.08) 2.261 0.520 HDL-C/(mmol·L-1) 1.42±0.31 1.24±0.311) 1.20±0.271) 1.15±0.321) 5.883 0.001 LDL-C/(mmol·L-1) 2.36±0.83 2.47±0.75 2.44±0.83 2.54±0.81 0.310 0.818 HDL-C/TC 34.47±10.73 30.99±8.98 28.50±8.861) 24.81±8.721) 7.331 < 0.001 Cre/(μmol·L-1) 59.94±9.49 62.15±14.65 68.40±11.581)2) 69.27±12.721)2) 5.309 0.002 HbAlc/% 5.30(5.10，5.60) 5.50(5.30，5.90) 5.50(5.20，5.80) 5.90(5.33，6.93)1)2) 16.230 0.001 白脂素/(ng·mL-1) 3.63±0.89 3.98±0.93 4.44±1.281) 5.05±1.031)2)3) 12.654 < 0.001 Sfrp5/(ng·mL-1) 37.70±4.07 35.43±5.42 34.21±6.511) 30.43±4.831)2)3) 12.689 < 0.001 与对照组比较，1)P < 0.05；与SA组比较，2)P < 0.05；与UA组比较，3)P < 0.05。 
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表 2 多因素logistic回归分析CHD的影响因素
Table 2. Logistic regression analyzes the influencing factors of CHD
变量 β S.E. Wald OR(95%CI) P 男性 -0.508 0.810 0.392 0.602(0.123~2.947) 0.531 吸烟史 -0.501 0.707 0.502 0.606(0.152~2.423) 0.479 高血压病 -0.995 0.591 2.831 0.370(0.116~1.178) 0.092 年龄 0.084 0.031 7.620 1.088(1.025~1.155) 0.006 HDL-C -1.623 0.915 3.145 0.197(0.033~1.186) 0.076 HDL-C/TC -0.023 0.034 0.459 0.977(0.913~1.045) 0.498 Cre 0.033 0.026 1.577 1.033(0.982~1.087) 0.209 HbAlc 0.395 0.542 0.531 1.484(0.513~4.294) 0.466 白脂素 0.588 0.292 4.072 1.801(1.017~3.189) 0.044 Sfrp5 -0.056 0.055 1.054 0.945(0.849~1.052) 0.305
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表 3 白脂素、Sfrp5、白脂素+Sfrp5对CHD的预测价值
Table 3. Predictive value of asprosin, Sfrp5, asprosin +Sfrp5 for CHD
预测指标 约登指数 截断值 敏感度/% 特异度/% AUC(95%CI) P 白脂素 0.395 3.955 ng/mL 71.9 67.6 0.737(0.650~0.825) < 0.001 Sfrp5 0.461 35.190 ng/mL 79.4 66.7 0.746(0.664~0.828) < 0.001 白脂素+Sfrp5 0.531 1.340 64.9 88.2 0.776(0.700~0.520) < 0.001
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