血浆ANGPTL3、ANGPTL8与ACS合并T2DM患者冠状动脉病变程度及PCI术后主要不良心血管事件的关系  

Study on the relationship between plasma ANGPTL3,ANGPTL8,coronary artery lesions,and major adverse cardiovascular events after PCI in patients with ACS complicated by T2DM

作　　者：杨彦杰 李聪 段丽军[1] 张敬[1] Yang Yanjie;Li Cong;Duan Lijun;Zhang Jing(Department of Emergency,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院急诊科,北京100176

出　　处：《疑难病杂志》2025年第3期257-262,273,共7页Chinese Journal of Difficult and Complicated Cases

基　　金：国家卫生健康委医药卫生科技发展研究中心课题(W2021ZT073)。

摘　　要：目的探讨血浆血管生成素样蛋白(ANGPTL)3、ANGPTL8与急性冠状动脉综合征(ACS)合并2型糖尿病(T2DM)患者冠状动脉病变程度及经皮冠状动脉介入(PCI)术后主要不良心血管事件(MACE)的关系。方法选取2021年1月—2023年6月首都医科大学附属北京同仁医院急诊科收治的ACS合并T2DM患者200例(合并症组)和100例单纯ACS患者100例(单纯ACS组),另选取同期体检健康志愿者100例作为健康对照组。ACS合并T2DM患者根据冠状动脉病变程度分为轻度亚组62例、中度亚组80例、重度亚组58例,根据PCI术1年后是否发生MACE分为MACE亚组71例和非MACE亚组129例。采用酶联免疫吸附法检测血浆ANGPTL3、ANGPTL8水平;多因素Logistic回归分析ACS合并T2DM患者PCI术后发生MACE的影响因素;受试者工作特征(ROC)曲线分析血浆ANGPTL3、ANGPTL8水平对PCI术后发生MACE的预测价值。结果血浆ANGPTL3、ANGPTL8水平合并症组>单纯ACS组>健康对照组(F/P=225.251/<0.001、166.309/<0.001);轻度亚组、中度亚组、重度亚组血浆ANGPTL3、ANGPTL8水平依次升高(F/P=410.079/<0.001、390.246/<0.001)。ACS合并T2DM患者血浆ANGPTL3、ANGPTL8水平与Gensini评分呈正相关(r s/P=0.803/<0.001、0.814/<0.001);与非MACE亚组比较,MACE亚组cTnI、CK-MB、HbA 1c、ANGPTL3、ANGPTL8水平及Gensini评分升高(t/P=2.720/0.007、3.005/0.003、3.790/<0.001、7.914/<0.001、8.249/<0.001、7.048/<0.001);多因素Logistic回归分析发现Gensini评分升高、ANGPTL3升高、ANGPTL8升高为ACS合并T2DM患者PCI术后MACE的独立危险因素[OR(95%CI)=1.053(1.030~1.077)、1.244(1.120~1.381)、1.017(1.010~1.024)];血浆ANGPTL3、ANGPTL8水平及二者联合预测ACS合并T2DM患者PCI术后MACE的AUC分别为0.780、0.790、0.886,二者联合优于各自单独预测效能(Z/P=3.638/<0.001、3.756/<0.001)。结论ACS合并T2DM患者血浆ANGPTL3、ANGPTL8水平升高,与冠状动脉病变加重和PCI术后MACE发生有关,血浆ANGPTL3联合ANGPTL8对PCI术后MACE具有Objective To explore the relationship between plasma angiopoietin-like(ANGPTL)3,ANGPTL8,coronary artery lesions,and major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS)complicated by type 2 diabetes mellitus(T2DM).Methods A total of 200 patients with ACS complicated by T2DM(comorbidity group)and 100 patients with pure ACS(pure ACS group)were selected from the Emergency Department of Beijing Tongren Hospital,Capital Medical University,from January 2021 to June 2023.Additionally,100 healthy volunteers were selected as the healthy control group.According to the severity of coronary artery lesions,the ACS complicated by T2DM patients were divided into mild(62 cases),moderate(80 cases),and severe(58 cases)subgroups.Based on whether MACE occurred one year after PCI,the patients were divided into the MACE subgroup(71 cases)and the non-MACE subgroup(129 cases).The levels of plasma ANGPTL3 and ANGPTL8 were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression analysis was used to analyze the influencing factors of MACE in ACS complicated by T2DM after PCI.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of plasma ANGPTL3 and ANGPTL8 levels for MACE after PCI.Results Plasma levels of ANGPTL3 and ANGPTL8 in the comorbidity group were higher than those in the pure ACS group,which were higher than those in the healthy control group(F/P=225.251/<0.001,166.309/<0.001).Plasma levels of ANGPTL3 and ANGPTL8 increased sequentially from mild to moderate to severe subgroups(F/P=410.079/<0.001,390.246/<0.001).Plasma ANGPTL3 and ANGPTL8 levels in ACS complicated by T2DM were positively correlated with the Gensini score(r s/P=0.803/<0.001,0.814/<0.001).Compared with non-MACE subgroup,cTnI,CK-MB,HbA 1c,ANGPTL3,ANGPTL8 and Gensini score were increased in MACE subgroup(t/P=2.720/0.007,3.005/0.003,3.790/<0.001,7.914/<0.001,8.249/<0.001,7.048/<0.001).Multivariable Logistic regression analysis showed

关 键 词：急性冠状动脉综合征 2型糖尿病 血管生成素样蛋白3 血管生成素样蛋白8 冠状动脉病变 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]