血浆硫酸吲哚酚水平对不稳定型心绞痛有诊断价值且与冠状动脉斑块负荷存在相关性  

Plasma indoxyl sulfate levels have diagnostic value for unstable angina and are correlated with coronary atherosclerotic burden

作　　者：田雅楠 宋海玖 王思博 张文婧 张志宏 TIAN Ya-nan;SONG Hai-jiu;WANG Si-bo;ZHANG Wen-jing;ZHANG Zhi-hong(Department of Cardiology,The Traditional Chinese Hospital of Chengde,Hebei Chengde,067000,China;Department of Cardiology,Pingquan Hospital,Hebei Pingquan,067500,China)

机构地区：[1]承德市中医院心血管科,河北承德067000 [2]平泉市医院心内科,河北平泉067500

出　　处：《内科急危重症杂志》2024年第6期519-523,535,共6页Journal of Critical Care In Internal Medicine

基　　金：2023年河北省医学科学研究课题(20231376);2024年承德市科技计划自筹经费项目(202402A019)。

摘　　要：目的:探讨血浆硫酸吲哚酚(IS)水平对不稳定型心绞痛(UA)的诊断价值及其与冠状动脉斑块负荷的相关性。方法:收集接受冠状动脉造影的患者372例,其中UA患者177例(UA组)、冠状动脉粥样硬化(CAS)患者120例(CAS组)及冠状动脉造影未见异常者75例(对照组)。应用靶向快速分辨液相色谱质谱法检测血浆中IS水平。应用心脏外科与介入治疗狭窄冠状动脉研究(SYNTAX)评分量化冠状动脉斑块负荷。结果:UA组患者血浆IS水平高于CAS组及对照组(P均<0.05)。多因素Logistic回归分析显示IS是罹患UA的独立危险因素(OR=2.90,95%CI:1.89~4.44,P<0.001)。趋势性检验中,依据IS三分位数,将IS分为T1、T2、T3组,在校正混杂因素后,UA患病风险随血浆IS水平升高而逐渐增加[OR(95%CI):T2 vs.T1:1.99(1.13~3.50),P=0.018;T3 vs.T1:5.18(2.88~9.29),P<0.001;趋势性检验P<0.001]。IS预测UA的受试者工作特征(ROC)曲线下面积为0.69(95%CI:0.63~0.74,P<0.001)。IS水平与UA患者SYNTAX评分呈正相关(r=0.52,P<0.001)。多因素Logistic回归显示IS(OR=4.34,95%CI:2.27~8.31,P<0.001)是UA患者中/高SYNTAX评分的危险因素。结论:IS是诊断UA的独立预测因子,且与UA患者冠状动脉斑块负荷严重程度呈正相关。Objective:To evaluate the diagnostic value of indoxyl sulfate(IS)in unstable angina pectoris(UA)and its correlation with coronary atherosclerotic plaque burden.Methods:A total of 372 patients who underwent coronary angiography were selected consecutively.The selected patients were divided into three groups:UA group(177 cases),coronary atherosclerosis(CAS)group(120 cases)and control group(75 cases).The levels of plasma IS were determined by targeted liquid chromatography/mass spectrometry.Coronary atherosclerotic burden was quantified using the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score.Results:The plasma IS levels in the UA group were higher than those in CAS group and control group(P<0.05).Multivariate logistic regression analysis showed that IS(OR=2.90,95%CI:1.89-4.44,P=0.001)was a risk factor for UA.After adjusting for confounding factors in the linear trend test,the risk of UA increased gradually with rising plasma IS levels[OR(95%CI):T2 vs.T1:1.99(1.13-3.50),P=0.018;T3 vs.T1:5.18(2.88-9.29),P<0.001;P for trend<0.001].The area under the ROC curve predicted by IS for UA was 0.69(95%CI:0.63-0.74,P<0.001).The level of IS was positively correlated with the SYNTAX score of UA patients(r=0.52,P<0.001).Multivariate logistic regression showed IS(OR=4.34,95%CI:2.27-8.31,P<0.001)was a risk factor for the medium/high SYNTAX score of the patients with UA.Conclusions:IS is an independent predictor for diagnosing UA and is positively correlated with the severity of coronary atherosclerotic burden in UA patients.

关 键 词：不稳定型心绞痛 硫酸吲哚酚 诊断 心脏外科与介入治疗狭窄冠状动脉研究 冠状动脉斑块负荷 

分 类 号：R541.4[医药卫生—心血管疾病]