急性冠脉综合征患者血清补体C1q/肿瘤坏死因子相关蛋白5水平与冠状动脉病变程度及心肌纤维化蛋白指标的相关性研究  

Correlation between Serum Complement C1q/Tumor Necrosis Factor-related Protein 5 Levels and the Severity of Coronary Artery Lesions and Myocardial Fibrosis Markers in Patients with Acute Coronary Syndrome

作　　者：李勇 李占虎 靳博伟 李原 张宏博 苏亚坤 闫小菊 LI Yong;LI Zhanhu;JIN Bowei;LI Yuan;ZHANG Hongbo;SU Yakun;YAN Xiaoju(Department of Cardiology,Hengshui People's Hospital,Hengshui 053000,China)

机构地区：[1]河北省衡水市人民医院心血管内科,053000

出　　处：《中国全科医学》2024年第27期3365-3371,共7页Chinese General Practice

基　　金：河北省医学科学研究课题(20220456)。

摘　　要：背景急性冠脉综合征(ACS)是威胁人类健康的常见心血管疾病,严重的冠状动脉病变及心肌纤维化影响患者预后。应用无创血清学指标评估冠状动脉病变程度和心肌纤维化有助于ACS患者早期危险分层及治疗管理。目的探讨ACS患者血清补体C1q/肿瘤坏死因子相关蛋白5(CTRP5)水平与冠状动脉病变程度、心肌纤维化相关蛋白指标的关系,为临床判断冠状动脉病变程度和心肌纤维化提供指导。方法选取2021年2月—2022年2月在衡水市人民医院心血管内科住院阻塞性狭窄的ACS患者184例,另选取同期行冠状动脉造影未见明显阻塞性狭窄的100例ACS患者作为对照。收集患者一般资料,行多普勒超声心动图检查,测定血清CTRP5、Ⅰ型前胶原(PCⅠ)、Ⅲ型前胶原(PCⅢ)。将阻塞性狭窄的ACS患者按照临床诊断标准分为不稳定型心绞痛(UA)组(n=67)、ST段抬高型心肌梗死(STEMI)组(n=57)和非ST段抬高型心肌梗死(NSTEMI)组(n=61);根据冠状动脉造影病变支数分为单支病变组(n=42)、双支病变组(n=69)和三支病变组(n=73)。根据SYNTAXⅡ评分标准分为低危组(n=77)、中危组(n=73)和高危组(n=34)。根据PCⅠ中位数分为低PCⅠ水平组(n=95)和高PCⅠ水平组(n=89),依据PCⅢ中位数分为低PCⅢ水平组(n=93)、高PCⅢ水平组(n=91)。采用多因素Logistic回归分析探究冠状动脉病变程度的影响因素。绘制受试者工作特征(ROC)曲线分析血清CTRP5对冠状动脉病变程度的诊断价值。结果ACS患者白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比值、空腹血糖(FBG)、超敏肌钙蛋白I、血清CTRP5、超敏C反应蛋白(hs-CRP)、PCⅠ、PCⅢ水平高于对照患者(P<0.05)。NSTEMI组、STEMI组患者血清CTRP5、hs-CRP高于UA组(P<0.05)。三支病变组患者血清CTRP5、PCⅠ、PCⅢ、hs-CRP水平高于单支病变组、双支病变组(P<0.05)。高危组患者血清CTRP5、PCⅠ、PCⅢ、hs-CRP水平高于低危组Background Acute coronary syndrome(ACS)represents a common cardiovascular disease that poses a significant threat to human health,with severe coronary artery lesions and myocardial fibrosis affecting patient prognosis.The use of non-invasive serological markers to assess the severity of coronary artery lesions and myocardial fibrosis can aid in the early risk stratification and management of ACS patients.Objective This study aimed to explore the relationship between serum levels of complement C1q/tumor necrosis factor-related protein-5(CTRP5)and the severity of coronary artery lesions,as well as myocardial fibrosis markers in ACS patients,to provide guidance for the clinical assessment of coronary artery lesion severity and myocardial fibrosis.Methods A total of 184 patients with obstructive stenosis admitted to the Department of Cardiology,Hengshui People's Hospital from February 2021 to February 2022 were selected,along with 100 ACS patients without significant obstructive stenosis undergoing coronary angiography in the same period as controls.General patient data were collected,Doppler echocardiograms were performed,and serum levels of CTRP5,procollagen type Ⅰ (PCⅠ),and procollagen type Ⅲ(PCⅢ)were measured.The patients with obstructive stenosis were divided into unstable angina(UA)group(n=67),ST-segment elevation myocardial infarction(STEMI)group(n=57),and non-ST-segment elevation myocardial infarction(NSTEMI)group(n=61);based on the number of coronary artery lesions,they were categorized into single-vessel disease group(n=42),double-vessel disease group(n=69),and triple-vessel disease group(n=73).According to the SYNTAXⅡscore,they were classified into low-risk(n=77),intermediate-risk(n=73),and high-risk(n=34)groups.Based on the median levels of PCⅠ,patients were divided into low PCⅠlevel group(n=95)and high PC I level group(n=89);similarly,based on PCⅢmedian levels,into low PCⅢlevel group(n=93)and high PCⅢlevel group(n=91).Multiuariate Logistic regression analysis was used to explore the i

关 键 词：冠心病 急性冠脉综合征 心内膜心肌纤维化症 补体C1q/肿瘤坏死因子相关蛋白5 

分 类 号：R541.4[医药卫生—心血管疾病]