稳定型心绞痛合并糖尿病患者膜联蛋白A5与颈动脉IMT及冠状动脉斑块形态的相关性  

Correlation of annexin A5 with carotid intima-media thickness and plaque morphology

作　　者：朱艳霞 王竹文 董希昌 张伟 王元元 ZHU Yanxia;WANG Zhuwen;DONG Xichang;ZHANG Wei;WANG Yuanyuan(Department of Cardiology,People＇s Hospital of Dongying,Dongying 257091,China)

机构地区：[1]山东省东营市人民医院心内科,257091

出　　处：《疑难病杂志》2018年第9期878-883,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：2014年度山东省自然科学基金面上项目(ZR201409160126)

摘　　要：目的 评价稳定型心绞痛合并2型糖尿病患者血膜联蛋白A5(anxA5)水平与颈动脉内膜中层厚度(IMT)、冠状动脉斑块形态的相关性。方法 纳入2015年3月-2017年8月于山东省东营市人民医院心内科接受冠状动脉造影,并随后对冠状动脉靶病变进行经皮冠状动脉介入治疗的稳定型心绞痛合并2型糖尿病患者203例。通过颈动脉超声检测患者IMT值,并根据IMT界值(0.80 mm)将患者分为IMT正常组(IMT<0.80 mm,n=93)与IMT增厚组(IMT≥0.80 mm,n=110),比较2组患者的临床资料。采用光学相干层析成像(OCT)对患者颈动脉进行检测,采用单变量与多变量分析患者IMT增厚的相关因素。根据受试者工作特性曲线(ROC)计算anxA5诊断IMT增厚的敏感度、特异度、阳性和阴性预测值及最佳临界值。根据最佳临界值将患者分为anxA5正常组(anxA5<1.907 ng/ml,n=99)与anxA5升高组(anxA5≥1.907 ng/ml,n=104),比较2组患者的OCT参数差异。结果 203例患者血清anxA5水平平均为(2.92±1.27)ng/ml,IMT平均为(0.89±0.21)mm。与IMT正常组患者比较,IMT增厚组患者anxA5水平更高(t=7.853,P<0.001)。单变量Logistic回归分析表明,anxA5与IMT增厚显著相关(OR=3.767,95%CI2.776～5.110,P<0.001)。ROC曲线分析表明,anxA5诊断价值为中等,AUC为0.710(0.593～0.809),anxA5的cut-off值为1.907 ng/ml,此时敏感度为72.4%,特异度为65.8%。anxA5正常组与anxA5升高组OCT参数包括斑块类型(钙化、纤维或脂质斑块)、薄帽纤维粥样斑块发生率、覆盖坏死脂质核的最小或平均纤维帽厚度等所占比例比较差异均无统计学意义(P均>0.05)。结论 稳定型心绞痛合并2型糖尿病患者血清anxA5水平与颈动脉IMT显著相关,血清anxA5与冠状动脉斑块形态无相关性。Objective To evaluate the correlation between the serum annexin A5（anxA5） and carotid intima-media thickness （IMT） in patients with stable angina pectoris complicated with type 2 diabetes mellitus who underwent the shape of coronary artery plaques by optical coherence tomography （OCT）. Methods From March 2015 to August 2017,203 patients with stable angina pectoris complicated with type 2 diabetes who underwent coronary angiography at the Department of Cardiology, Dongying People’s Hospital were enrolled, patients received percutaneous coronary intervention for stable target coronary artery lesions. Carotid ultrasound was used to measure IMT in all patients. According to the IMT boundary value （0.80 mm）, the patients were divided into normal IMT group （the normal group, n =93） and IMT thickening group （the thickening group, n =110）. The clinical data of the two groups of patients were compared. Univariate and multivariate analysis were used to analyze factors related to IMT thickening. The sensitivity, specificity, positive and negative predictive values, and the optimal cut-off value were calculated based on the receiver operating characteristic （ROC）. The value of anxA5 to predict the value of IMT thickening was evaluated. According to the cut-off value of anxA5, the patients were divided into anxA5 normal group （anxA5〈1.907 ng/ml, n =99） and anxA5 elevated group （anxA5≥1.907 ng/ml, n =104）. The OCT parameters between the two groups of patients was compared. Results The average anxA5 of all patients was （2.92±1.27） ng/ml,and the mean IMT was （0.89±0.21） mm. The patients with IMT thickening group had higher levels of anxA5 than the normal group （ t =7.853, P 〈0.001）. Univariate Logistic regression analysis showed that anxA5 was significantly associated with IMT thickening（ OR =3.767, 95% CI 2.776～5.110, P 〈0.001）. ROC curve analysis showed that the diagnostic value of anxA5 was moderate,the AUC was 0.710 （0.593～0.809）,and the cut-off value

关 键 词：膜联蛋白A5 冠状动脉斑块 内膜中层厚度 稳定型心绞痛 糖尿病 

分 类 号：R541.4[医药卫生—心血管疾病]