急性心肌梗死患者血清LTB4、TN-C水平与冠状动脉易损斑块不稳定性的相关性分析  

Correlation analysis between serum LTB4, TN-C levels and coronary vulnerable plaque instability in patients with acute myocardial infarction

作　　者：王亚荣 王媛媛 任旭爱 刘懿[4] WANG Yarong;WANG Yuanyuan;REN Xu'ai;LIU Yi(Laboratory Department,Jingyang County Hospital,Xianyang 713700;Laboratory Department,the First People's Hospital of Xianyang,Xianyang 712000;Cardiology Department,the First People's Hospital of Xianyang,Xianyang 712000;Laboratory Department,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]咸阳市泾阳县医院检验科,陕西咸阳713700 [2]咸阳市第一人民医院检验科,陕西咸阳712000 [3]咸阳市第一人民医院心内科,陕西咸阳712000 [4]西安交通大学第一附属医院检验科,陕西西安710061

出　　处：《临床医学研究与实践》2023年第33期14-17,22,共5页Clinical Research and Practice

基　　金：陕西省创新能力支撑计划项目(No.2020PT-007)。

摘　　要：目的分析急性心肌梗死(AMI)患者血清白三烯B4(LTB4)、腱糖蛋白C(TN-C)水平与冠状动脉易损斑块不稳定性的相关性。方法选择2018年2月至2020年2月住院治疗的117例冠状动脉造影(CAG)易损斑块阳性患者作为研究对象,依据是否发生AMI将其分为AMI组(22例)和非AMI组(95例)。检测LTB4、TN-C、心肌肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)水平及冠状动脉粥样斑块纤维帽厚度。分析冠状动脉斑块破裂诱发AMI的影响因素、血清LTB4及TN-C水平与其他指标的相关性、LTB4及TN-C水平对AMI的诊断价值。结果AMI组的LTB4、TN-C、cTnI及hs-CRP水平高于非AMI组,斑块纤维帽厚度低于非AMI组(P<0.01)。多因素Logistic回归分析结果显示,高水平LTB4、TN-C、cTnI、hs-CRP及斑块纤维帽厚度<65μm是冠状动脉斑块破裂诱发AMI的独立危险因素(P<0.05)。易损斑块阳性患者的LTB4水平与TN-C、hs-CRP、cTnI水平呈正相关,与斑块纤维帽厚度呈负相关(P<0.05);TN-C水平与斑块纤维帽厚度呈负相关,与hs-CRP、cTnI水平呈正相关(P<0.05)。LTB4、TN-C诊断AMI的曲线下面积(AUC)分别为0.855、0.818,诊断灵敏度分别为72.70%、81.80%,诊断特异度分别为91.60%、84.20%。结论LTB4、TN-C可能参与冠状动脉易损斑块破裂的病理过程,检测血清LTB4、TN-C水平可对冠状动脉易损斑块的不稳定性进行评估,进而预测AMI的发生。Objective To analyze the correlation between serum leukotriene B4(LTB4),tenascin-C(TN-C)levels and coronary vulnerable plaque instability in patients with acute myocardial infarction(AMI).Methods A total of 117 patients with positive coronary angiography(CAG)vulnerable plaques who were hospitalized from February 2018 to February 2020 were selected as the research objects.According to whether AMI occurred,the patients were divided into AMI group(22 cases)and non-AMI group(95 cases).The levels of LTB4,TN-C,cardiac troponin I(cTnI),high sensitivity C-reactive protein(hs-CRP)and the thickness of fibrous cap of coronary atherosclerotic plaque were detected.The influencing factors of AMI induced by coronary plaque rupture,the correlation between serum LTB4 and TN-C levels and other indexes and the diagnostic value of LTB4 and TN-C levels for AMI were analyzed.Results The levels of LTB4,TN-C,cTnI and hs-CRP in the AMI group were higher than those in the non-AMI group,and the plaque fibrous cap thickness was lower than that in the non-AMI group(P<0.01).Multivariate Logistic regression analysis results showed that high levels of LTB4,TN-C,cTnI,hs-CRP and plaque fibrous cap thickness<65μm were independent risk factors for AMI induced by coronary plaque rupture(P<0.05).The level of LTB4 in patients with positive vulnerable plaques was positively correlated with the levels of TN-C,hs-CRP and cTnI,and negatively correlated with the plaque fibrous cap thickness(P<0.05);the level of TN-C was negatively correlated with the plaque fibrous cap thickness,and positively correlated with the levels of hs-CRP and cTnI(P<0.05).The areas under curve(AUC)of LTB4 and TN-C in the diagnosis of AMI was 0.855 and 0.818 respectively,the diagnostic sensitivity was 72.70%and 81.80%respectively,and the diagnostic specificity was 91.60%and 84.20%respectively.Conclusion LTB4 and TN-C may be involved in the pathological process of coronary vulnerable plaque rupture.Detection of serum LTB4 and TN-C levels can evaluate the instability of coronary vuln

关 键 词：急性心肌梗死 冠状动脉易损斑块 不稳定性 白三烯B4 腱糖蛋白C 冠状动脉造影 

分 类 号：R542.22[医药卫生—心血管疾病]