基于胆汁酸谱的不稳定型心绞痛与急性心肌梗死诊断模型研究  

Research on a diagnostic model for differentiating acute myocardial infarction from unstable angina based on bile acid profile

作　　者：于倩 赵福荣 贾兴旺 王爽 李莹 刘馨 YU Qian;ZHAO Furong;JIA Xingwang;WANG Shuang;LI Ying;LIU Xin(Post Graduate School of Jinzhou Medical University,Jinzhou,Liaoning 121001,P.R.China;Huludao Central Hospital Teaching Base of Jinzhou Medical University,Huludao,Liaoning 125001,P.R.China;Dalian Boyuan Medical Technology Co.,Ltd.,Dalian,Liaoning 116000,P.R.China;Liaoning Provincial Key Laboratory of Clinical Metabolomics for Oncology,Jinzhou Medical University,Jinzhou,Liaoning 121001,P.R.China)

机构地区：[1]锦州医科大学研究生院,辽宁锦州121001 [2]锦州医科大学葫芦岛市中心医院教学基地,辽宁葫芦岛125001 [3]大连博源医学科技有限公司,辽宁大连116000 [4]锦州医科大学辽宁省肿瘤临床代谢组学重点实验室,辽宁锦州121001

出　　处：《华西医学》2024年第9期1406-1412,共7页West China Medical Journal

基　　金：辽宁省科学技术计划项目(2022-MS-460)。

摘　　要：目的基于液相色谱串联质谱技术检测血清中的胆汁酸谱,建立区分不稳定型心绞痛(unstable angina,UA)与急性心肌梗死(acute myocardial infarction,AMI)的生物标志物联合诊断模型。方法连续随机选取2023年8月—2024年2月在葫芦岛市中心医院就诊的180例急性冠脉综合征患者作为研究对象,其中UA组117例,AMI组63例。应用液相色谱串联质谱技术检测血清中15种胆汁酸亚型,采用正交最小二乘判别分析比较受试者的血清胆汁酸代谢轮廓,结合P<0.05且变量投影重要性(variable importance in projection,VIP)>1作为筛选差异代谢物的标准,并通过多因素二分类logistic回归分析建立诊断模型,最后通过受试者操作特征曲线等统计分析方法对模型区分UA与AMI的鉴别诊断效能进行评判。结果经过筛选,胆汁酸差异代谢物有甘氨脱氧胆酸、甘氨鹅脱氧胆酸、脱氧胆酸、甘氨胆酸、牛磺脱氧胆酸(VIP>1且P<0.05)。将上述胆汁酸生物标志物联合临床资料进行二分类logistic逐步回归分析,最终确定3种胆汁酸指标(甘氨鹅脱氧胆酸、脱氧胆酸和牛磺脱氧胆酸)与3种临床常用生化指标(天冬氨酸转氨酶、肌酸激酶和总胆汁酸)可用于区分UA和AMI(P<0.05)。模型的受试者操作特征曲线下面积为0.986[95%置信区间(0.973,0.999),P<0.001],显示出较好的诊断能力。结论甘氨鹅脱氧胆酸、脱氧胆酸和牛磺脱氧胆酸可作为区分UA和AMI患者疾病状态的潜在生物标志物,3种胆汁酸联合天冬氨酸转氨酶、肌酸激酶和总胆汁酸构建的模型可以有效识别AMI。Objective To detect the bile acid profile in serum based on liquid chromatography-tandem mass spectrometry,and construct a combined biomarker diagnostic model for differentiating acute myocardial infarction(AMI)from unstable angina(UA).Methods A total of 180 patients with acute coronary syndrome who visited Huludao Central Hospital between August 2023 and February 2024 were randomly selected,and there were 117 patients with UA and 63 patients with AMI.Using liquid chromatography-tandem mass spectrometry,15 bile acid subtypes in serum were detected.Orthogonal partial least squares discriminant analysis was used to compare the serum bile acid metabolic profiles of the subjects.Differences in metabolites were screened based on a significance level of P<0.05 and variable importance in projection(VIP)>1.Multiple logistic regression analysis was performed to construct a diagnostic model for differentiating AMI from UA,and the diagnostic performance of the model was evaluated using receiver operating characteristic(ROC)curve and other statistical methods.Results The differential bile acid biomarkers in the serum of UA and AMI patients included glycodeoxycholic acid,glycochenodeoxycholic acid(GCDCA),deoxycholic acid(DCA),glycocholic acid,and aurodeoxycholic acid(TDCA)(P<0.05,VIP>1).A binary logistic stepwise regression analysis showed that three bile acid biomarkers(GCDCA,DCA,and TDCA)and three common biochemical indicators(aspartate aminotransferase,creatine kinase,and total bile acid)were factors differentiating AMI from UA(P<0.05).The area under the ROC curve of the model was 0.986[95%confidence interval(0.973,0.999),P<0.001],demonstrating a good diagnostic performance.Conclusions GCDCA,DCA,and TDCA can serve as potential biomarkers for distinguishing AMI from UA.The model combining these three bile acids with aspartate aminotransferase,creatine kinase,and total bile acid can effectively identify AMI.

关 键 词：胆汁酸谱 不稳定型心绞痛 急性心肌梗死 诊断模型 

分 类 号：R541.4[医药卫生—心血管疾病] R542.22[医药卫生—内科学]