急性冠状动脉综合征患者外周血血清肌红蛋白、白介素-6、PCT水平与冠状病变程度的关系

Relationship between serum myoglobin, interleukin-6, PCT levels and severity of coronary lesions in patients with acute coronary syndrome

【目的】检测急性冠状动脉综合征患者外周血血清肌红蛋白(myoglobin,Mb)、白介素-6(interleukin-6,IL-6)、降钙素原(procalcitonin,PCT)水平,并探讨三者与冠状病变程度的关系。【方法】选取2016年9月至2019年9月于本院就诊的急性冠状动脉综合征(Acute coronary syndrome,ACS)患者102例作为观察组,其中AMI患者71例,不稳定型心绞痛(UAP)患者31例,选取同期门诊体检的健康人60例作为对照组。采用酶联免疫吸附(ELISA)法检测血清中Mb、IL-6、PCT水平,比较不同冠脉病变支数患者血清中Mb、IL-6、PCT表达水平;同时比较不同冠脉狭窄程度患者血清Mb、IL-6、PCT水平,分析血清Mb、IL-6、PCT水平与Gensini积分的相关性;ROC曲线分析血清Mb、IL-6、PCT水平对AUC的诊断价值。【结果】与对照组相比,UAP组、AMI组患者血清Mb、IL-6、PCT水平、Gensini积分显著升高(P<0.05),AMI组患者血清Mb、IL-6、PCT水平、Gensini积分显著高于UAP组(P<0.05)。与一支病变组相比,两支病变组、多支病变组患者血清Mb、IL-6、PCT水平显著升高(P<0.05),与两支病变组相比,多支病变组患者血清Mb、IL-6、PCT水平显著升高(P<0.05)。不同冠脉狭窄程度患者血清Mb、IL-6、PCT水平比较,随TIMI分级的增大,血清Mb、IL-6、PCT水平逐渐降低,组间差异具有统计学意义(P<0.05)。血清Mb、IL-6、PCT水平与Gensini积分均呈正相关(r=0.517、0.591、0.598,P<0.05)。ROC结果显示,Mb诊断ACS的AUC为0.912,敏感度为76.5%,特异性为88.3%;IL-6诊断ACS的AUC为0.887,敏感度为79.4%,特异性为85.0%;PCT诊断ACS的AUC为0.907,敏感度为82.4%,特异性为81.7%;三者联合诊断的AUC为0.958,敏感度、特异性均较高(P<0.05)。【结论】ACS患者血清Mb、IL-6、PCT水平呈高表达,且血清Mb、IL-6、PCT水平随病变支数的增多而升高,随冠脉狭窄程度增加而升高,与冠状动脉病变程度呈正相关。

【Objective】To detect the levels of serum myoglobin(MB),interleukin-6(IL-6)and procalcitonin(PCT)in patients with acute coronary syndrome(ACS),and to explore the relationship between them and the severity of coronary lesions.9【Methods】A total of 102 patients with acute coronary syndrome(ACS)in our hospital from September 2016 to September 2019 were selected as the observation group,including 71 patients with AMI,31 patients with unstable angina pectoris(UAP),and 60 healthy people in the same period as the control group.The levels of Mb,IL-6 and PCT in serum were detected by enzyme-linked immunosorbent assay(ELISA),the expression levels of Mb,IL-6 and PCT in serum of patients with different coronary artery disease branches were compared;at the same time,the levels of Mb,IL-6 and PCT in patients with different degree of coronary stenosis were compared,the correlation between serum Mb,IL-6,PCT levels and Gensini score was analyzed;in addition,ROC curve was used to analyze the diagnostic value of serum Mb,IL-6 and PCT levels for AUC.【Results】Compared with those in the control group,the levels of serum Mb,IL-6,PCT,and Gensini score in UAP group and AMI group were significantly higher(P<0.05),and the levels of serum Mb,IL-6,PCT,and Gensini score in AMI group were significantly higher than those in UAP group(P<0.05).Compared with those in single vessel disease group,the levels of Mb,IL-6 and PCT in two vessel disease group and multiple vessel disease group were significantly higher(P<0.05),and compared with those in two vessel lesion group,the levels of Mb,IL-6 and PCT in multiple vessel disease group were significantly higher(P<0.05).Among patients with different degree of coronary stenosis,with the increase of TIMI grade,the levels of serum Mb,IL-6 and PCT gradually decreased,the difference between groups was statistically significant(P<0.05).Serum Mb,IL-6,PCT levels were positively correlated with Gensini score(r=0.517,0.591,0.598,P<0.05).ROC results showed that the AUC of Mb in the diagnosis of ACS was 0.912,the sensitivity was 76.5%,and the specificity was 88.3%;the AUC of IL-6 in the diagnosis of ACS was 0.887,the sensitivity was 79.4%,and the specificity was 85.0%;the AUC of PCT in the diagnosis of ACS was 0.907,the sensitivity was 82.4%,and the specificity was 81.7%;moreover,the AUC of combined diagnosis was0.958,with high sensitivity and specificity.【Conclusion】The levels of serum Mb,IL-6 and PCT in patients with ACS are high,and the levels of serum Mb,IL-6 and PCT increase with the increase of the number of diseased branches and the degree of coronary artery stenosis,which are positively correlated with the severity of coronary artery disease.