γ-谷氨酰转移酶与冠心病的相关性研究  

Correlation between Gamma-glutamyl Transferase and Coronary Heart Disease

作　　者：蒋元英 史玲 刘瑶 JIANG Yuanying;SHI Ling;LIU Yao(Changfeng Community Health Service Center of Putuo District,Shanghai 200062,China;Putuo District Community Management Center,Shanghai 200333,China;Department of General Practice,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市普陀区长风街道长风社区卫生服务中心,200062 [2]上海市普陀区社区管理中心,200333 [3]复旦大学附属中山医院全科医学科,上海市200032

出　　处：《中国全科医学》2021年第2期176-182,共7页Chinese General Practice

摘　　要：背景近年来研究认为γ-谷氨酰转移酶(GGT)水平与冠心病的发生相关,由于GGT存在于人体多种组织器官,GGT水平是否能预测冠心病仍未明确。目的分析血清GGT水平与冠心病相关性。方法选取2016年9月-2018年1月在复旦大学附属华山医院行冠状动脉造影的患者481例,根据冠状动脉造影结果分为冠心病组351例,非冠心病组130例。回顾性分析研究对象一般资料、实验室检查指标、左心室射血分数(LVEF),冠状动脉狭窄程度采用Gensini积分,根据Gensini积分将研究对象分为低危组(<20分)(n=260)、中危组(20~50分)(n=121)、高危组(>50分)(n=100)。冠心病发生的影响因素采用多因素Logistic回归分析,绘制受试者工作特征(ROC)曲线评价GGT水平诊断冠心病的价值。结果非冠心病组与冠心病组性别、年龄、糖尿病发生率、脑梗死发生率、吸烟率、糖化血红蛋白(HbA1c)、GGT、高密度脂蛋白胆固醇(HDL-C)、脂蛋白(a)〔LP(a)〕、清蛋白、尿酸、肌酐、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血小板/淋巴细胞比值(PLR)、LVEF比较,差异均有统计学意义(P<0.05)。低危组、中危组、高危组GGT、中性粒细胞/淋巴细胞比值(NLR)比较,差异均有统计学意义(P<0.05)。冠心病组患者中,<65岁者GGT水平高于≥65岁者(P<0.05);<65岁与≥65岁者Gensini积分比较,差异无统计学意义(P>0.05)。非冠心病组患者中,<65岁与≥65岁者GGT水平、Gensini积分比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,HbA1c〔OR=1.403,95%CI(1.022,1.912)〕、GGT〔OR=1.049,95%CI(1.011,1.089)〕、ALT〔OR=1.062,95%CI(1.017,1.110)〕、AST〔OR=0.892,95%CI(0.816,0.974)〕和Gensini积分〔OR=1.534,95%CI(1.374,1.712)〕与冠心病发生有回归关系(P<0.05)。HbA1c诊断冠心病的ROC曲线下面积(AUC)为0.572〔95%CI(0.527,0.617)〕,GGT诊断冠心病的AUC为0.679〔95%CI(0.635,0.720)〕,Gensini积分诊断冠心病的AUC�Background In recent years,studies have suggested that the gamma-glutamyl transferase(GGT)is related to coronary heart disease(CHD).As GGT exists in a variety of human tissues and organs,it is still unclear whether GGT level can predict CHD.Objective This paper aimed to study the correlation between GGT level and CHD.Methods We selected 481 patients who underwent coronary angiography in Huashan Hospital,Fudan University from September 2016 to January 2018,including 351 with coronary angiography-detected CHD(CHD group)and 130 without(non-CHD group).We analyzed their general condition,laboratory results,left ventricular ejection fraction(LVEF),and severity of the coronary lesion determined by the Gensini score[stratified into low risk(<20 points)(n=260),medium risk(20-50 points)(n=121),and high risk(>50 points)(n=100),respectively].We used multivariate Logistic regression analysis to identify the associated factors for CHD,and used ROC curve analysis to evaluate the diagnostic value of GGT in CHD.Results CHD and non-CHD groups showed significant differences in sex ratio,average age,prevalence of history of diabetes and cerebral infarction,smoking rate,average HbA1c,GGT,high-density lipoprotein cholesterol,lipoprotein(a),albumin,uric acid,creatinine,ALT,AST,platelet-to-lymphocyte ratio(PLR),LVEF(P<0.05).Low,medium and high risk groups had significant differences in average GGT and NLR(P<0.05).In CHD group,those aged less than 65 years old had higher average GGT than those aged 65 or over(P<0.05),but they showed similar average Gensini score(P>0.05).However,in non-CHD group,those aged less than 65 and those aged 65 or over had no significant differences in average GGT level and Gensini score(P>0.05).Multivariate Logistic regression analysis showed that HbA1c〔OR=1.403,95%C(I 1.022,1.912)〕,GGT〔OR=1.049,95%CI(1.011,1.089)〕,ALT〔OR=1.062,95%CI(1.017,1.110)〕,AST〔OR=0.892,95%CI(0.816,0.974)〕and Gensini score〔OR=1.534,95%CI(1.374,1.712)〕were associated with CHD(P<0.05).In diagnosing CHD,the AUC of Gensini

关 键 词：冠心病 Γ-谷氨酰转移酶 影响因素分析 

分 类 号：R541.4[医药卫生—心血管疾病]