血清CysC、hs-CRP、Lp(a)在急性冠脉综合征患者中的表达及临床意义
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摘要
目的探讨血清胱抑素C(CysC)、高敏C反应蛋白(hs-CRP)、脂蛋白a[Lp(a)]在急性冠脉综合征患者中的表达及临床意义。方法选取2016年10月~2018年5月鄂东医疗集团黄石市中心医院106例急性冠脉综合征患者设为研究组,另选取同期健康体检者106名设为对照组。入院后第2天晨起时抽取所有受检者空腹静脉血4 mL,以免疫透射比浊法测定血清Lp(a)水平,以酶联免疫吸附法测定血清CysC、hs-CRP水平。统计研究组与对照组、不同病理类型急性冠脉综合征患者、不同病变支数急性冠脉综合征患者、不同病情程度急性冠脉综合征患者血清CysC、hs-CRP、Lp(a)水平,分析血清CysC、hs-CRP、Lp(a)水平与急性冠脉综合征病情程度相关性,并比较血清CysC、hs-CRP、Lp(a)单独及联合诊断急性冠脉综合征效能。结果研究组血清CysC、hs-CRP、Lp(a)水平高于对照组,差异有高度统计学意义(P <0.01)。不同病理类型急性冠脉综合征患者血清CysC、hs-CRP、Lp(a)水平间差异有高度统计学意义(P <0.01),且不稳定型心绞痛患者血清CysC、hs-CRP、Lp(a)水平高于稳定型心绞痛,急性心肌梗死患者血清CysC、hs-CRP、Lp(a)水平高于不稳定型心绞痛,差异有高度统计学意义(P <0.01)。不同病变支数急性冠脉综合征患者血清CysC、hs-CRP、Lp(a)水平间差异有高度统计学意义(P <0.01),且双支病变患者血清CysC、hs-CRP、Lp(a)水平高于单支病变,三支病变患者血清CysC、hs-CRP、Lp(a)水平高于双支病变,差异有统计学意义(P <0.05)。不同病情程度急性冠脉综合征患者血清CysC、hs-CRP、Lp(a)水平间差异有高度统计学意义(P <0.01),且中度患者血清CysC、hs-CRP、Lp(a)水平高于轻度,重度患者血清CysC、hs-CRP、Lp(a)水平高于中度,差异有统计学意义(P <0.05)。Pearson检验结果显示:血清CysC、hs-CRP、Lp(a)水平均与急性冠脉综合征病情程度呈明显正相关(r=0.663、0.691、0.652,P <0.05)。联合诊断敏感度(95.28%)与准确度(95.28%)高于血清CysC(79.25%、88.68%)、hs-CRP(80.19%、87.74%)、Lp(a)(78.30%、87.26%)单独诊断,差异有统计学意义(P <0.05);联合诊断特异度(95.28%)与血清CysC(98.11%)、hs-CRP(95.28%)、Lp(a)(96.23%)单独诊断间差异无统计学意义(P> 0.05)。结论急性冠脉综合征患者血清CysC、hs-CRP、Lp(a)水平异常增高,在不同病理类型中存在显著差异,且随病变支数增多、病情程度加剧,其血清含量呈增高趋势,通过联合检测上述指标水平,可对疾病予以有效鉴别诊断及病情评估。
Objective To explore the expression and clinical significance of serum Cystatin C(Cys C), high sensitivity C reactive protein(hs-CRP), lipoprotein a [Lp(a)] in patients with acute coronary syndrome. Methods From October2016 to May 2018, in Huangshi Central Hospital, Edong Healthcare Group, 106 patients with acute coronary syndrome were selected as the study group, at the same time, 106 healthy persons were selected as the control group. At the sec-ond morning, 4 m L fasting venous blood was taken from all subjects. Serum Lp(a) levels were measured by immunoturbidimetry and serum Cys C and hs-CRP levels were measured by enzyme-linked immunosorbent assay. The levels of serum Cys C, hs-CRP and Lp(a) in the study group and control group, patients with differ-ent pathological types of acute coronary syndrome, patients with different pathological changes of acute coronary syndrome, and patients with different severity of acute coronary syndromes were observed. The correlation between serum Cys C, hs-CRP, Lp(a) and the severity of acute coronary syndrome was analyzed. And the efficacy of serum Cys C, hs-CRP and Lp(a) alone and combined in the diagnosis of acute coronary syndrome were compared. Results The levels of serum Cys C, hs-CRP and Lp(a) in the study group were higher than those in the control group, the differences were statistically significant(P < 0.01). There were statistically significant differences in serum levels of Cys C, hs-CRP and Lp(a) in patients with different pathological types of acute coronary syndrome(P < 0.01). The serum levels of Cys C, hs-CRP and Lp(a) in patients with unstable angina pectoris were higher than patients with stable angina, the levels of serum Cys C,hs-CRP and Lp(a) in patients with acute myocardial infarction were higher than patients with unstable angina pectoris,the differences were statistically significant(P < 0.01). There were statistically significant differences in serum levels of Cys C, hs-CRP and Lp(a) in patients with different coronary artery lesions(P < 0.05). The levels of serum Cys C, hsCRP and Lp(a) in patients with double vessel disease were higher than those in single vessel disease, and the levels of serum Cys C, hs-CRP and Lp(a) were higher in three vessel lesions than double vessel lesions, the differences were statistically significant(P < 0.01). There were statistically significant differences in serum levels of Cys C, hs-CRP and Lp(a) in patients with different severity of acute coronary syndrome(P < 0.05). The serum levels of Cys C, hs-CRP and Lp(a) in moderate patients were higher than those in mild patients, the levels of serum Cys C, hs-CRP and Lp(a) in severe patients were higher than those in moderate patients, the differences were statistically significant(P < 0.05).Pearson test showed that the level of serum Cys C, hs-CRP, Lp(a) and the degree of acute coronary syndrome were positively correlated with the degree of acute coronary syndrome(r = 0.663, 0.691, 0.652, P < 0.05). Combined diagnostic sensitivity(95.28%) and accuracy(95.28%) were higher than serum Cys C(79.25%, 88.68%), hs-CRP(80.19%,87.74%), Lp(a)(78.30%, 87.26%) alone, the differences were statistically significant(P < 0.05). There was no significant difference between the combined diagnostic specificity(95.28%) and serum Cys C(98.11%), hs-CRP(95.28%), Lp(a)(96.23%) alone(P > 0.05). Conclusion The serum levels of Cys C, hs-CRP and Lp(a) in patients with acute coronary syndromes are very high, and there are significant differences in different pathological types. With the increase of the number of diseases and the severity of the disease, the serum levels are increasing. The diagnosis and evaluation of the disease can be effectively identified by the combined detection of the above indexes.
Objective To explore the expression and clinical significance of serum Cystatin C(Cys C), high sensitivity C reactive protein(hs-CRP), lipoprotein a [Lp(a)] in patients with acute coronary syndrome. Methods From October2016 to May 2018, in Huangshi Central Hospital, Edong Healthcare Group, 106 patients with acute coronary syndrome were selected as the study group, at the same time, 106 healthy persons were selected as the control group. At the sec-ond morning, 4 m L fasting venous blood was taken from all subjects. Serum Lp(a) levels were measured by immunoturbidimetry and serum Cys C and hs-CRP levels were measured by enzyme-linked immunosorbent assay. The levels of serum Cys C, hs-CRP and Lp(a) in the study group and control group, patients with differ-ent pathological types of acute coronary syndrome, patients with different pathological changes of acute coronary syndrome, and patients with different severity of acute coronary syndromes were observed. The correlation between serum Cys C, hs-CRP, Lp(a) and the severity of acute coronary syndrome was analyzed. And the efficacy of serum Cys C, hs-CRP and Lp(a) alone and combined in the diagnosis of acute coronary syndrome were compared. Results The levels of serum Cys C, hs-CRP and Lp(a) in the study group were higher than those in the control group, the differences were statistically significant(P < 0.01). There were statistically significant differences in serum levels of Cys C, hs-CRP and Lp(a) in patients with different pathological types of acute coronary syndrome(P < 0.01). The serum levels of Cys C, hs-CRP and Lp(a) in patients with unstable angina pectoris were higher than patients with stable angina, the levels of serum Cys C,hs-CRP and Lp(a) in patients with acute myocardial infarction were higher than patients with unstable angina pectoris,the differences were statistically significant(P < 0.01). There were statistically significant differences in serum levels of Cys C, hs-CRP and Lp(a) in patients with different coronary artery lesions(P < 0.05). The levels of serum Cys C, hsCRP and Lp(a) in patients with double vessel disease were higher than those in single vessel disease, and the levels of serum Cys C, hs-CRP and Lp(a) were higher in three vessel lesions than double vessel lesions, the differences were statistically significant(P < 0.01). There were statistically significant differences in serum levels of Cys C, hs-CRP and Lp(a) in patients with different severity of acute coronary syndrome(P < 0.05). The serum levels of Cys C, hs-CRP and Lp(a) in moderate patients were higher than those in mild patients, the levels of serum Cys C, hs-CRP and Lp(a) in severe patients were higher than those in moderate patients, the differences were statistically significant(P < 0.05).Pearson test showed that the level of serum Cys C, hs-CRP, Lp(a) and the degree of acute coronary syndrome were positively correlated with the degree of acute coronary syndrome(r = 0.663, 0.691, 0.652, P < 0.05). Combined diagnostic sensitivity(95.28%) and accuracy(95.28%) were higher than serum Cys C(79.25%, 88.68%), hs-CRP(80.19%,87.74%), Lp(a)(78.30%, 87.26%) alone, the differences were statistically significant(P < 0.05). There was no significant difference between the combined diagnostic specificity(95.28%) and serum Cys C(98.11%), hs-CRP(95.28%), Lp(a)(96.23%) alone(P > 0.05). Conclusion The serum levels of Cys C, hs-CRP and Lp(a) in patients with acute coronary syndromes are very high, and there are significant differences in different pathological types. With the increase of the number of diseases and the severity of the disease, the serum levels are increasing. The diagnosis and evaluation of the disease can be effectively identified by the combined detection of the above indexes.
引文
[1]张章国,汪官富,陈雅,等.血清Cys C水平在急性冠脉综合征危险评估中的应用[J].中国卫生检验杂志,2015,25(13):2154-2156.
[2]章春艳,章爽.急性冠脉综合征患者炎症因子IL-6、IL-8、IL-1β、TNF-α及hs-CRP水平检测[J].心脑血管病防治,2014,14(6):488-489.
[3]Guler E,Gecmen C,Guler G B,et al.Adding lipoprotein(a)levels to the GRACE score to predict prognosis in patients with non-ST elevation acute coronary syndrome[J].Kardiol Pol,2013,71(7):695-701.
[4]刘洪军,杨猛,张开忠.NT-pro BNP、Cys C和PCT对急性冠脉综合征患者预后评估的应用价值[J].广西医科大学学报,2017,34(8):1145-1149.
[5]王琼,戴晓燕.P-选择素、hs CRP在急性冠脉综合征中作用的研究新进展[J].心血管康复医学杂志,2015,24(1):108-110.
[6]Mommersteeg PM,Meeuwis SH,Denollet J,et al.C-reactive protein and fibrinogen in non-obstructive coronary artery disease as related to depressive symptoms and anxiety:findings from the Twee Steden Mild Stenosis Study(TWIST)[J].J Psychosom Res,2014,77(5):426-429.
[7]徐海燕,陈雨,蒙涛,等.胱抑素C和N末端B型利钠肽原评估非ST段抬高型急性冠脉综合征预后的价值[J].心血管康复医学杂志,2016,25(1):88-93.
[8]莫海泉,赵建萍,黄自明,等.hs-CRP、LP(a)在急性冠脉综合征患者临床危险分层中的应用[J].广东医学院学报,2015,33(3):283-284.
[9]Jabor B,Choi H,Ruel I,et al.Lipoprotein-associated phospholipase A(2)(Lp-PLA(2))in acute coronary syndrome:relationship with low-density lipoprotein cholesterol[J].Can J Cardiol,2013,29(12):1679-1686.
[10]卢剑华,谭健锋,胡允兆,等.急性冠脉综合征患者LpPLA2水平和心血管事件的相关性及他汀的干预效果[J].广东医学,2016,37(16):2428-2430.
[11]Akerblom A,Wallentin L,Larsson A,et al.Cystatin C-and creatinine-based estimates of renal function and their value for risk prediction in patients with acute coronary syndrome:results from the PLATelet Inhibition and Patient Outcomes(PLATO)study[J].Clin Chem,2013,59(9):1369-1375.
[12]石一夫,夏芳,梁洁,等.血清MCP-1、RANTES及Cys C联合检测对急性冠状动脉综合征的诊断价值[J].现代生物医学进展,2016,16(12):2312-2315.
[13]Lópezcuenca魣,Manzanofernández S,Marín F,et al.Beta-trace protein and cystatin c as predictors of major bleeding in non-ST-segment elevation acute coronary syndrome[J].Circ J,2013,77(8):2088-2096.
[14]王纬.Cys C、hs-CRP水平在急性冠状动脉综合征PCI术后心血管不良事件发生中的预测价值[J].医学综述,2016,22(3):614-617.
[15]胡江乔,皮林,宋丽芬,等.hs CRP、Cys C水平对老年急性冠脉综合征诊断和病情预测的价值[J].心血管康复医学杂志,2017,26(2):165-167.
[16]袁启明.急性冠脉综合征患者血浆胱抑素C和超敏C反应蛋白检测的临床意义[J].国际检验医学杂志,2012,33(10):1181-1182.
[17]夏剑,罗珲.急性冠脉综合征患者血清hs-CRP、c Tn I、BNP及D-二聚体水平变化[J].海南医学院学报,2014,20(3):331-333.
[18]罗厚龙,刘行超,谭秋培,等.急性冠状动脉综合征患者Cys C、hs-CRP及Mb水平及相关性研究[J].检验医学与临床,2016,13(9):1156-1157.
[19]Cheng JM,Oemrawsingh RM,Garciagarcia HM,et al.Relation of C-reactive protein to coronary plaque characteristics on grayscale,radiofrequency intravascular ultrasound,and cardiovascular outcome in patients with acute coronary syndrome or stable angina pectoris(from the ATHEROREMO-IVUS study)[J].Am J Cardiol,2014,114(10):1497-1503.
[20]徐慧,龚开政,张昕,等.非ST段抬高性急性冠脉综合征患者C反应蛋白、胱抑素C、载脂蛋白A、脂蛋白a与GRACE评分的相关研究[J].南京医科大学学报:自然科学版,2014,34(6):761-765.
[21]Aditya GP,Bari MA.Apolipoprotein B versus non-high density lipoprotein cholesterol as a discriminating factor for acute coronary syndrome in young people[J].Mymensingh Med J,2016,25(3):458-464.
[22]王猛,曾莉容,张弢.非ST段抬高型急性冠状动脉综合征hs-CRP、Lp(a)、Cys C及Apo A与GRACE评分相关性研究[J].蚌埠医学院学报,2017,42(6):728-731.
[2]章春艳,章爽.急性冠脉综合征患者炎症因子IL-6、IL-8、IL-1β、TNF-α及hs-CRP水平检测[J].心脑血管病防治,2014,14(6):488-489.
[3]Guler E,Gecmen C,Guler G B,et al.Adding lipoprotein(a)levels to the GRACE score to predict prognosis in patients with non-ST elevation acute coronary syndrome[J].Kardiol Pol,2013,71(7):695-701.
[4]刘洪军,杨猛,张开忠.NT-pro BNP、Cys C和PCT对急性冠脉综合征患者预后评估的应用价值[J].广西医科大学学报,2017,34(8):1145-1149.
[5]王琼,戴晓燕.P-选择素、hs CRP在急性冠脉综合征中作用的研究新进展[J].心血管康复医学杂志,2015,24(1):108-110.
[6]Mommersteeg PM,Meeuwis SH,Denollet J,et al.C-reactive protein and fibrinogen in non-obstructive coronary artery disease as related to depressive symptoms and anxiety:findings from the Twee Steden Mild Stenosis Study(TWIST)[J].J Psychosom Res,2014,77(5):426-429.
[7]徐海燕,陈雨,蒙涛,等.胱抑素C和N末端B型利钠肽原评估非ST段抬高型急性冠脉综合征预后的价值[J].心血管康复医学杂志,2016,25(1):88-93.
[8]莫海泉,赵建萍,黄自明,等.hs-CRP、LP(a)在急性冠脉综合征患者临床危险分层中的应用[J].广东医学院学报,2015,33(3):283-284.
[9]Jabor B,Choi H,Ruel I,et al.Lipoprotein-associated phospholipase A(2)(Lp-PLA(2))in acute coronary syndrome:relationship with low-density lipoprotein cholesterol[J].Can J Cardiol,2013,29(12):1679-1686.
[10]卢剑华,谭健锋,胡允兆,等.急性冠脉综合征患者LpPLA2水平和心血管事件的相关性及他汀的干预效果[J].广东医学,2016,37(16):2428-2430.
[11]Akerblom A,Wallentin L,Larsson A,et al.Cystatin C-and creatinine-based estimates of renal function and their value for risk prediction in patients with acute coronary syndrome:results from the PLATelet Inhibition and Patient Outcomes(PLATO)study[J].Clin Chem,2013,59(9):1369-1375.
[12]石一夫,夏芳,梁洁,等.血清MCP-1、RANTES及Cys C联合检测对急性冠状动脉综合征的诊断价值[J].现代生物医学进展,2016,16(12):2312-2315.
[13]Lópezcuenca魣,Manzanofernández S,Marín F,et al.Beta-trace protein and cystatin c as predictors of major bleeding in non-ST-segment elevation acute coronary syndrome[J].Circ J,2013,77(8):2088-2096.
[14]王纬.Cys C、hs-CRP水平在急性冠状动脉综合征PCI术后心血管不良事件发生中的预测价值[J].医学综述,2016,22(3):614-617.
[15]胡江乔,皮林,宋丽芬,等.hs CRP、Cys C水平对老年急性冠脉综合征诊断和病情预测的价值[J].心血管康复医学杂志,2017,26(2):165-167.
[16]袁启明.急性冠脉综合征患者血浆胱抑素C和超敏C反应蛋白检测的临床意义[J].国际检验医学杂志,2012,33(10):1181-1182.
[17]夏剑,罗珲.急性冠脉综合征患者血清hs-CRP、c Tn I、BNP及D-二聚体水平变化[J].海南医学院学报,2014,20(3):331-333.
[18]罗厚龙,刘行超,谭秋培,等.急性冠状动脉综合征患者Cys C、hs-CRP及Mb水平及相关性研究[J].检验医学与临床,2016,13(9):1156-1157.
[19]Cheng JM,Oemrawsingh RM,Garciagarcia HM,et al.Relation of C-reactive protein to coronary plaque characteristics on grayscale,radiofrequency intravascular ultrasound,and cardiovascular outcome in patients with acute coronary syndrome or stable angina pectoris(from the ATHEROREMO-IVUS study)[J].Am J Cardiol,2014,114(10):1497-1503.
[20]徐慧,龚开政,张昕,等.非ST段抬高性急性冠脉综合征患者C反应蛋白、胱抑素C、载脂蛋白A、脂蛋白a与GRACE评分的相关研究[J].南京医科大学学报:自然科学版,2014,34(6):761-765.
[21]Aditya GP,Bari MA.Apolipoprotein B versus non-high density lipoprotein cholesterol as a discriminating factor for acute coronary syndrome in young people[J].Mymensingh Med J,2016,25(3):458-464.
[22]王猛,曾莉容,张弢.非ST段抬高型急性冠状动脉综合征hs-CRP、Lp(a)、Cys C及Apo A与GRACE评分相关性研究[J].蚌埠医学院学报,2017,42(6):728-731.