急性冠脉综合征患者血清CRTP5水平与冠状动脉病变程度及心肌纤维化的相关性研究

李勇, 李占虎, 靳博伟, 等. 急性冠脉综合征患者血清CRTP5水平与冠状动脉病变程度及心肌纤维化的相关性研究[J]. 临床心血管病杂志, 2024, 40(9): 742-748. doi: 10.13201/j.issn.1001-1439.2024.09.010
引用本文: 李勇, 李占虎, 靳博伟, 等. 急性冠脉综合征患者血清CRTP5水平与冠状动脉病变程度及心肌纤维化的相关性研究[J]. 临床心血管病杂志, 2024, 40(9): 742-748. doi: 10.13201/j.issn.1001-1439.2024.09.010
LI Yong, LI Zhanhu, JIN Bowei, et al. The correlation between serum CTRP5 level and the degree of coronary artery lesion and myocardial fibrosis in patients with acute coronary syndrome[J]. J Clin Cardiol, 2024, 40(9): 742-748. doi: 10.13201/j.issn.1001-1439.2024.09.010
Citation: LI Yong, LI Zhanhu, JIN Bowei, et al. The correlation between serum CTRP5 level and the degree of coronary artery lesion and myocardial fibrosis in patients with acute coronary syndrome[J]. J Clin Cardiol, 2024, 40(9): 742-748. doi: 10.13201/j.issn.1001-1439.2024.09.010

急性冠脉综合征患者血清CRTP5水平与冠状动脉病变程度及心肌纤维化的相关性研究

  • 基金项目:
    河北省医学科学研究课题(No:20220456)
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The correlation between serum CTRP5 level and the degree of coronary artery lesion and myocardial fibrosis in patients with acute coronary syndrome

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  • 目的 检测急性冠脉综合征(ACS)患者血清补体C1q/肿瘤坏死因子相关蛋白-5(CTRP5)水平,并分析其与冠状动脉病变程度和心肌纤维化的关系。方法 选择2022年10月—2023年10月在衡水市人民医院心血管内科住院的ACS患者210例,根据临床诊断标准分为不稳定型心绞痛(UA)亚组、非ST段抬高型心肌梗死(NSTEMI)亚组和ST段抬高型心肌梗死(STEMI)亚组;根据冠状动脉造影血管病变支数分为单支病变亚组、双支病变亚组和3支病变亚组;根据Gensini评分分为高评分亚组(>60分)、中评分亚组(31~60分)和低评分亚组(0~30分)。其中的60例ACS患者术后1个月行心脏磁共振检查,根据心血管磁共振-延迟钆增强(CMR-LGE)分为LGE阳性组和LGE阴性组。另选择同期行冠状动脉造影无明显阻塞性狭窄病变的100例患者作为对照组。比较各组全身免疫炎症指数(SII)和血清CTRP5水平。采用logistic回归分析影响冠状动脉病变程度的因素。绘制受试者工作特征(ROC)曲线,分析血清CTRP5水平对冠状动脉病变程度与心肌纤维化的预测价值。结果 与对照组患者比较,UA亚组、NSTEMI亚组和STEMI亚组患者血清CTRP5和SII水平明显升高(均P < 0.05),但NSTEMI亚组与STEMI亚组上述指标差异无统计学意义。随着冠状动脉病变支数和Gensini评分的增加,CTRP5与SII水平呈升高趋势(均P < 0.05)。LGE阳性组患者入院后CTRP5与SII水平均高于LGE阴性组(均P < 0.05)。Logistic回归分析显示,空腹血糖(FBG,OR=1.267,95%CI:1.041~1.544,P=0.019)、SII(OR=1.001,95%CI:1.000~1002,P=0.044)和CTRP5(OR=1.127,95%CI:1.036~1.226,P=0.005)是冠状动脉多支病变的危险因素。ROC曲线显示,血清CTRP5预测冠状动脉多支病变的曲线下面积(AUC)为0.708,灵敏度为81.4%,特异度为78.9%,截断值为10.31 ng/mL;预测心肌纤维化的AUC为0.775,灵敏度为64.7%,特异度为92.3%,截断值为11.10 ng/mL。结论 ACS患者血清CTRP5水平升高,其水平对冠状动脉病变程度尤其是多支病变及心肌纤维化均具有较好的预测价值。
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  • 图 1  FBG、SII和CTRP5预测冠脉多支病变的ROC曲线

    Figure 1.  ROC curves for predicting the multi-vessel coronary artery disease using FBG, SII, and CTRP5

    图 2  CTRP5和SII预测心肌纤维化ROC曲线

    Figure 2.  ROC curves for predicting myocardial fibrosis using CTRP5 and SII

    表 1  对照组、UA亚组、NSTEMI亚组和STEMI亚组一般临床资料比较

    Table 1.  Comparison of baseline data among control group, UA subgroup, NSTEMI subgroup, and STEMI subgroup 例(%), X ± S, M(P25, P75)

    项目 对照组(100例) UA亚组(79例) NSTEMI亚组(54例) STEMI亚组(77例) F/χ/H2 P
    年龄/岁 58.04±9.85 59.48±10.13 60.81±9.22 59.86±11.29 0.980 0.398
    男性 61(61.00) 56(67.09) 43(79.63) 58(75.32) 7.341 0.062
    吸烟 35(35.00) 38(48.10) 33(61.11) 38(49.35) 6.582 0.086
    BMI/(kg/m2) 26.22±3.08 26.22±3.02 26.16±2.85 26.00±3.61 0.086 0.968
    高血压 56(56.00) 55(69.62) 41(75.93) 52(67.53) 7.344 0.062
    糖尿病 13(13.00) 9(11.39) 11(20.37) 14(18.18) 2.921 0.404
    TC/(mmol/L) 4.64±1.08 4.71±1.11 4.78±1.09 4.96±1.07 1.320 0.268
    TG/(mmol/L) 1.58(1.09,2.42) 1.78(1.11,2.40) 1.72(1.11,2.45) 1.70(1.15,2.57) 2.797 0.424
    LDL-C/(mmol/L) 2.56±0.95 2.68±0.96 2.72±0.88 2.74±0.74 0.732 0.534
    FBG/(mmol/L) 6.13±2.21 6.31±2.41 6.96±2.22 8.27±3.84 10.189 < 0.001
    HbA1c/% 5.2(4.4,5.7) 5.2(4.6,5.9) 5.1(4.6,6.1) 5.3(4.7,5.9) 0.945 0.815
    BUN/(mmol/L) 5.65(4.90,6.61) 5.50(4.86,6.27) 6.19(4.71,6.70) 5.90(4.82,7.36) 3.551 0.314
    SCr/(μmol/L) 69.02±12.11 69.49±13.47 70.29±17.22 73.54±17.51 1.532 0.206
    NC/(×109/L) 3.58(2.73,4.66) 3.83(3.14,5.06) 5.47(3.91,7.03) 5.92(3.87,7.88) 53.371 < 0.001
    LC/(×109/L) 1.57(1.32,1.93) 1.69(1.32,2.20) 1.60(1.10,1.95) 1.54(1.23,2.26) 1.854 0.603
    PLT/(×109/L) 236.00(195.00,282.75) 230.00(193.00,266.00) 235.00(192.00,288.50) 246.50(189.50,289.75) 4.999 0.172
    SII 494.64(367.50,749.50) 533.25(358.40,802.02) 789.84(552.21,1 164.45) 767.34(454.27,1 520.03) 28.218 < 0.001
    hs-cTnI/(ng/mL) 0.03(0.02,0.23) 0.03(0.02,0.04) 1.55(0.52,6.88) 5.26(0.63,26.92) 205.882 < 0.001
    CK-MB/(ng/mL) 4.24(1.36,8.60) 1.64(0.88,4.24) 35.68(14.85,80.25) 79.75(10.24,162.92) 169.539 < 0.001
    NT-proBNP/(ng/L) 75.20(38.90,224.60) 131.50(58.60,217.50) 343.65(121.35,1233.60) 257.20(71.58,1261.05) 69.887 < 0.001
    CTRP5/(ng/mL) 8.34±3.66 10.95±4.32 12.65±5.03 12.91±5.30 18.424 < 0.001
    下载: 导出CSV

    表 2  单支病变亚组、双支病变亚组与3支病变亚组患者CTRP5与SII水平比较

    Table 2.  Comparison of CTRP5 and SII levels among the single-vessel, double-vessel, and three-vessel disease groups X ± S, M(P25, P75)

    组别 CTRP5/(ng/mL) SII
    单支病变亚组(57例) 9.67±4.17 620.10(440.59,935.34)
    双支病变亚组(75例) 11.32±4.741) 790.28(523.16,1 254.28)1)
    3支病变亚组(78例) 15.22±7.451)2) 894.24(694.88,1 318.40)1)2)
    F/H 16.990 24.678
    P < 0.001 < 0.001
    与单支病变亚组比较,1)P < 0.05;与双支病变亚组比较,2)P < 0.05。
    下载: 导出CSV

    表 3  低评分亚组、中评分亚组与高评分亚组患者CTRP5和SII水平比较

    Table 3.  Comparison of CTRP5 and SII levels among the low, middle, and high-score groups X ± S, M(P25, P75)

    组别 CTRP5/(ng/mL) SII
    低评分亚组(74例) 10.22±4.32 559.24(393.60,986.23)
    中评分亚组(86例) 12.47±6.89 699.85(524.38,1 141.81)
    高评分亚组(50例) 13.97±8.921)2) 967.87(715.69,1 685.10)1)2)
    F/H 4.989 19.902
    P 0.008 < 0.001
    与低评分亚组比较,1)P < 0.05;与中评分亚组比较,2)P < 0.05。
    下载: 导出CSV

    表 4  LGE阳性组与LGE阴性组CTRP5和SII水平比较

    Table 4.  Comparison of CTRP5 and SII levels between LGE positive group and negative group X ± S, M(P25, P75)

    组别 CTRP5/(ng/mL) SII FBG/(mmol/L)
    LGE阴性组(26例) 9.19±2.25 641.83(438.39,945.72) 6.79±2.54
    LGE阳性组(34例) 14.99±7.18 915.78(693.47,1 195.21) 7.53±2.25
    t/Z 3.964 -2.193 0.988
    P < 0.001 0.028 0.327
    下载: 导出CSV

    表 5  冠脉多支病变影响因素的logistic回归分析结果

    Table 5.  Multivariate logistic regression analysis for influencing factors of coronary artery multi-vessel disease

    参数 B SE Wald χ2 P OR(95%CI)
    FBG 0.237 0.101 5.545 0.019 1.267(1.041~1.544)
    NC 0.061 0.108 0.326 0.568 1.063(0.861~1.313)
    hs-cTnI 0.015 0.011 1.844 0.175 0.985(0.963~1.007)
    CK-MB 0.002 0.003 0.588 0.443 1.002(0.997~1.008)
    NT-proBNP < 0.001 < 0.001 0.008 0.927 1.000(0.998~1.014)
    SII 0.001 0.001 4.041 0.044 1.001(1.000~1.002)
    CTRP5 0.119 0.043 7.716 0.005 1.127(1.036~1.226)
    常数项 -3.228 0.862 14.015 < 0.001
    下载: 导出CSV

    表 6  FBG、SII和CTRP5预测冠脉多支病变的ROC分析结果

    Table 6.  ROC results for predicting multi-vessel coronary artery disease using FBG, SII, and CTRP5

    指标 AUC 95%CI 截断值 灵敏度/% 特异度/% P
    FBG 0.627 0.546~0.708 6.28 mmol/L 55.6 68.4 < 0.001
    SII 0.695 0.619~0.772 632.14 77.1 52.6 < 0.001
    CTRP5 0.708 0.628~0.788 10.31 ng/mL 81.4 78.9 < 0.001
    下载: 导出CSV

    表 7  SII和CTRP5预测心肌纤维化的ROC分析结果

    Table 7.  ROC results for predicting myocardial fibrosis using SII and CTRP5

    指标 AUC 95%CI 截断值 灵敏度/% 特异度/% P
    SII 0.655 0.514~0.796 673.05 76.5 53.8 0.041
    CTRP5 0.775 0.656~0.895 11.10 ng/mL 64.7 92.3 < 0.001
    下载: 导出CSV
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收稿日期:  2024-06-01
刊出日期:  2024-09-13

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