血清血小板活化因子、活化T细胞核因子c1水平与冠心病、冠状动脉病变严重程度及冠心病类型的关系研究

Relations of Serum Levels of PAF and NFATc1 to Coronary Heart Disease,Severity of Coronary Artery Lesion and Types of Coronary Heart Disease

背景血清血小板活化因子(PAF)、活化T细胞核因子c1(NFATc1)水平与冠心病(CHD)患者不稳定斑块有关,但其与冠状动脉病变严重程度、CHD类型的关系尚不明确。目的探讨血清PAF、NFATc1水平与CHD、冠状动脉病变严重程度及CHD类型的关系。方法选取2015年12月—2017年12月在内蒙古医科大学附属医院住院并行冠状动脉造影(CAG)检查的患者195例,根据CAG检查结果分为非CHD组51例和CHD组144例。根据冠状动脉病变严重程度将CHD患者分为轻度组36例、中度组68例、重度组40例;根据CHD类型将CHD患者分为稳定型心绞痛(SAP)组69例和急性冠脉综合征(ACS)组75例。比较CHD组与非CHD组患者一般资料、血脂指标及血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、PAF、NFATc1水平,并分别比较非CHD组、轻度组、中度组、重度组及非CHD组、SAP组、ACS组患者血清CK、CK-MB、PAF、NFATc1水平;绘制ROC曲线以评价血清PAF、NFATc1、PAF+NFATc1水平对CHD的诊断价值及血清PAF、NFATc1、PAF+NFATc1、CK、CK-MB水平对ACS的诊断价值。结果 (1)CHD组与非CHD组患者年龄≥65岁者所占比例、心率、收缩压、舒张压比较,差异无统计学意义(P>0.05);CHD组患者男性比例,有吸烟史、饮酒史、糖尿病病史、高血压病史、高脂血症病史、脑血管疾病病史者所占比例及血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、CK、CKMB、PAF、NFATc1水平高于非CHD组,血清高密度脂蛋白胆固醇(HDL-C)水平低于非CHD组(P<0.05)。(2)轻度组、中度组、重度组患者血清CK、CK-MB、PAF、NFATc1水平高于非CHD组,中度组、重度组患者血清CK、CK-MB、PAF、NFATc1水平高于轻度组,重度组患者血清CK、CK-MB、PAF、NFATc1水平高于中度组(P<0.05)。(3)SAP组、ACS组患者血清CK、CK-MB、PAF、NFATc1水平高于非CHD组,ACS组患者血清CK、CK-MB、PAF、NFATc1水平高于SAP组(P<0.05)。(4)绘制ROC曲线发现,血清PAF、NFATc1、PAF+NFATc1水平诊断CHD的曲线下面积(AUC)分别为0.821、0.755、0.871,血清PAF+NFATc1水平诊断CHD的AUC大于血清PAF、NFATc1水平(P<0.05);血清PAF、NFATc1、PAF+NFATc1、CK、CK-MB水平诊断ACS的AUC分别为0.936、0.834、0.979、0.753、0.760,血清PAF、NFATc1水平诊断ACS的AUC大于血清CK、CK-MB水平,血清PAF+NFATc1水平诊断ACS的AUC大于血清PAF、NFATc1水平(P<0.05)。结论血清PAF、NFATc1水平与CHD、冠状动脉病变严重程度及CHD类型有关;血清PAF、NFATc1水平对CHD及ACS均具有一定诊断价值,且二者联合对CHD及ACS的诊断价值较高。

Background Serum levels of PAF and NFATc1 are significantly correlated with unstable plaques in patients with coronary heart disease(CHD),but their relations to severity of coronary artery lesion and types of CHD are not yet clear.Objective To investigate the relations of serum levels of PAF and NFATc1 to CHD,severity of coronary artery lesion and types of CHD.Methods A total of 195 inpatients undergoing coronary artery angiography(CAG)were selected in the Affiliated Hospital of Inner Mongolia Medical University from December 2015 to December 2017,and they were divided into non-CHD group(n=51)and CHD(n=144).Patients in CHD group were divided into mild group(n=36),moderate group(n=68)and severe group(n=40)according to the severity of coronary artery lesion,into SAP group(n=69)and ACS group(n=75)according to the types of CHD.General information,blood lipid parameter,serum levels of CK,CK-MB,PAF and NFATc1 were compared between CHD group and non-CHD group,moreover serum levels of CK,CK-MB,PAF and NFATc1 were compared in non-CHD group,mild group,moderate group and severe group,in non-CHD group,SAP group and ACS group;ROC was drawn to evaluate the diagnostic value of serum levels of PAF,NFATc1 and PAF+NFATc1 on CHD,and diagnostic value of serum level of PAF,NFATc1,PAF+NFATc1,CK and CK-MB on ACS.Results(1)No statistically significant difference of proportion of patients≥65 years old,heart rate,SBP or DBP was found between CHD group and non-CHD group(P>0.05);male ratio,proportion of patients with history of smoking,drinking,diabetes,hypertension,hyperlipidemia and cerebrovascular disease,serum levels of TC,TG,LDL-C,CK,CK-MB,PAF and NFATc1 in CHD group were statistically significantly higher than those in non-CHD group,while serum HDL-C level in CHD group was statistically significantly lower than that in non-CHD group(P<0.05).(2)Serum levels of CK,CK-MB,PAF and NFATc1 in mild group,moderate group and severe group were statistically significantly higher than those in non-CHD group,serum levels of CK,CK-MB,PAF and NFATc1 in moderate group and severe group were statistically significantly higher than those in mild group,meanwhile serum levels of CK,CK-MB,PAF and NFATc1 in severe group were statistically significantly higher than those in moderate group(P<0.05).(3)Serum levels of CK,CK-MB,PAF and NFATc1 in SAP group and ACS group were statistically significantly higher than those in non-CHD group,meanwhile serum levels of CK,CKMB,PAF and NFATc1 in ACS group were statistically significantly higher than those in SAP group(P<0.05).(4)ROC curve showed that,AUC of serum levels of PAF,NFATc1 and PAF+NFATc1 was 0.821,0.755 and 0.871,respectively,and AUC of serum PAF+NFATc1 level in diagnosing CHD was statistically significantly larger than that of serum levels of PAF and NFATc1,respectively(P<0.05);AUC of serum levels of PAF,NFATc1,PAF+NFATc1,CK and CK-MB in diagnosing ACS was 0.936,0.834,0.979,0.753 and 0.760,respectively,and AUC of serum levels of PAF and NFATc1 in diagnosing ACS was statistically significantly higher than that of serum levels of CK and CK-MB,respectively,meanwhile AUC of serum PAF+NFATc1 level in diagnosing ACS was statistically significantly higher than that of serum levels of PAF and NFATc1,respectively(P<0.05).Conclusion Serum levels of PAF and NFATc1 are significantly related to CHD,severity of coronary artery lesion and types of CHD;serum levels of PAF,NFATc1 have diagnostic value on CHD and ACS to some extent,moreover the combination of the above two has relatively high diagnostic value on CHD and ACS.