Correlation between the serum Gla rich protein level and the degree of coronary artery calcification in patients with unstable angina
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摘要: 目的 探讨不稳定型心绞痛(UA)患者血清富含Gla蛋白水平(GRP)与冠状动脉(冠脉)钙化程度的关系，为冠脉钙化的诊断和评估提供依据。方法 选取衡水市人民医院心血管内科诊断的UA患者304例为研究对象。行冠脉双源CT扫描，采用Agatston修正法计算冠脉钙化积分(CACS)。根据CACS，将患者分为无钙化组(CACS=0，78例)、少量钙化组(1≤CACS≤10，48例)、轻度钙化组(11≤CACS≤100，60例)、中度钙化组(101≤CACS≤399，68例)和重度钙化组(400≤CACS，50例)。比较各组患者血清GRP水平。采用logistic回归分析筛选冠脉钙化的影响因素，采用Spearman相关性分析探讨血清GRP水平与冠脉钙化的相关性，采用ROC分析评估GRP水平诊断冠脉钙化的价值。结果 总体来看，随着冠脉钙化程度的加重，GRP水平有逐渐降低趋势(均P<0.05)。多因素logistic回归分析结果显示，血清GRP水平是冠脉钙化的独立保护因素(OR=0.156，95%CI：0.113~0.217，P<0.05)。Spearman相关性分析显示，血清GRP水平与冠脉钙化程度呈负相关性(r=-0.858，P<0.05)。ROC分析显示，GRP预测冠脉钙化的曲线下面积为0.893(95%CI：0.857~0.928)，截点值为22.68 ng/mL，灵敏度为72.6%，特异度为94.9%。结论 UA患者血清GRP水平与冠脉钙化程度呈负相关性，是冠脉钙化的独立保护因素，且对冠脉钙化有一定的诊断价值。Abstract: Objective To investigate the relationship between serum Gla-rich protein level (GRP) and the degree of coronary artery calcification in patients with unstable angina (UA), and to provide evidence for the diagnosis and evaluation of coronary artery calcification.Methods A total of 304 patients diagnosed with UA in the Department of Cardiology at Hengshui People's Hospital were selected as subjects. Coronary double-source CT scan was performed, and coronary vascular calcification scores (CACS) were calculated using Agatston correction method. According to CACS, all patients were divided into the non-calcification group (CACS=0, n=78), small-calcification group (1≤CACS≤10, n=48), mild-calcification group (11≤CACS≤100, n=60), moderate-calcification group (101≤CACS≤399, n=68), and severe-calcification group (400≤CACS, n=50). GRP levels in each group were compared. Logistic regression analysis was used to screen the influencing factors of coronary artery calcification, Spearman correlation analysis was used to explore the correlation between serum GRP levels and coronary artery calcification, ROC analysis was used to evaluate the diagnostic value of GRP levels in coronary artery calcification.Results Generally, the levels of serum GRP decreased gradually with the increase of coronary calcification degree (all P<0.05). Multivariate logistic regression analysis showed that serum GRP level was an independent protective factor for coronary artery calcification (OR=0.156, 95%CI: 0.113-0.217, P<0.05). Spearman correlation analysis showed that serum GRP level was negatively correlated with the degree of coronary artery calcification (r=-0.858, P<0.05). ROC analysis showed that the area under the curve for predicting coronary artery calcification using GRP was 0.893 (95%CI: 0.857-0.928), with a cutoff value of 22.68 ng/mL, sensitivity of 72.6%, and specificity of 94.9%.Conclusion Serum GRP level in UA patients is negatively correlated with the degree of coronary artery calcification. GRP is an independent protective factor for coronary artery calcification and has significant diagnostic value.
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Key words:
- Gla rich protein /
- coronary artery calcification /
- unstable angina
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图 1 GRP预测冠脉钙化的ROC曲线
Figure 1. The ROC curve for coronary artery calcification predicting by GRP
表 1 不同钙化组患者临床资料比较
Table 1. Clinical data
例(%), X±S 项目 无钙化组(78例) 少量钙化组(48例) 轻度钙化组(60例) 中度钙化组(68例) 重度钙化组(50例) 男性 49(62.82) 32(66.67) 31(51.67) 36(52.94) 40(80.00) 吸烟 36(46.15) 26(54.17) 22(36.67) 25(36.76) 33(66.00) 高血压 30(38.46) 24(50.00) 35(58.33) 46(67.65) 30(60.00)1) 糖尿病 23(29.49) 30(62.50) 41(68.33) 51(75.00) 42(84.00)1) 年龄/岁 61.55±8.87 61.31±9.34 62.35±9.26 62.51±7.67 65.48±7.25 TG/(mmol/L) 1.34±0.36 1.35±0.48 1.36±0.42 1.40±0.38 1.42±0.401) TC/(mmol/L) 3.66±0.78 3.72±0.85 5.23±0.95 5.67±0.82 6.03±0.881) HDL-C/(mmol/L) 1.32±0.42 1.18±0.46 1.07±0.45 1.03±0.33 0.92±0.37 LDL-C/(mmol/L) 2.75±0.89 3.17±0.76 3.37±0.88 3.74±0.96 3.86±0.84 Lp(a)/(mg/dL) 12.65±2.66 12.81±2.75 12.79±2.68 13.18±2.64 14.44±2.55 hs-CRP/(mg/L) 3.55±1.26 6.08±3.26 6.03±3.17 6.25±2.66 8.27±3.67 CREA/(μmol/L) 59.84±2.67 57.98±2.74 58.66±2.82 61.68±2.62 61.97±2.85 Ca/(mmol/L) 2.32±0.74 2.15±0.85 2.13±0.68 2.25±0.92 2.26±0.72 GRP/(ng/mL) 23.82±0.77 23.57±0.65 22.07±0.681)2) 21.86±0.651)2) 18.26±0.681)2)3)4) 与无钙化组比较，1)P<0.05；与少量钙化组比较，2)P<0.05；与轻度钙化组比较，3)P<0.05；与中度钙化组比较，4)P<0.05。 
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表 2 冠脉钙化的影响因素
Table 2. The influencing factors of coronary artery calcification
因素 β SE Wald P OR 95%CI TC 0.991 0.152 42.348 <0.05 2.694 1.998~3.630 HDL-C -1.108 0.336 10.867 <0.05 0.330 0.171~0.638 LDL-C 0.399 0.155 6.607 <0.05 1.490 1.099~2.020 hs-CRP 0.193 0.051 14.584 <0.05 1.213 1.098~1.339 GRP -1.856 0.167 123.030 <0.05 0.156 0.113~0.217 CREA 0.163 0.049 10.875 <0.05 1.177 1.068~1.296 Lp(a) 0.131 0.052 6.196 <0.05 1.140 1.028~1.263 高血压(无) -0.778 0.279 7.759 <0.05 0.459 0.265~0.794 糖尿病(无) -1.205 0.289 17.406 <0.05 0.300 0.170~0.528
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表 3 血清GRP水平与生化指标及冠脉钙化程度的相关性分析
Table 3. The correlation between serum GRP levels, biochemical indicators, and degree of coronary artery calcification
指标 TG TC LDL-C HDL-C CREA Lp(a) hs-CRP Ca 冠脉钙化程度 GRP r -0.078 -0.580 -0.365 0.259 -0.285 -0.182 -0.412 -0.043 -0.858 P >0.05 <0.05 <0.05 <0.05 <0.05 <0.05 <0.05 >0.05 <0.05
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