冠心病患者血清抵抗素水平诊断价值的临床研究

Value of Serum Resistin Level in Diagnosis of Patients with Coronary Artery Diseases

目的探讨血清抵抗素水平在冠心病患者中的诊断价值。方法采用病例-对照研究,48例冠心病患者入院时测定血清抵抗素水平,观察24个月时发生不良心血管事件(心原性死亡、非致死性心肌梗死)的情况。Cox比例风险回归分析血清抵抗素水平对研究对象的预后影响,应用受试者工作特征曲线(ROC曲线)确定抵抗素水平界值,根据该值将患者危险分层,分为高危组和低危组。结果冠心病患者血清抵抗素水平较对照组明显升高[(96±23)vs(16±5)μg/L,P<0.001],而且不同临床类型的冠心病患者间差异显著(均P<0.01);Cox比例风险回归分析显示,血清抵抗素(RR1.216,95%CI:1.203～1.229)和糖尿病(RR2.083,95%CI:1.301～3.334)对估测预后有价值;ROC曲线确定血清抵抗素水平危险分层的最佳界值取93μg/L,其敏感性75%,特异性81.8%,高危组中发生不良心血管事件3例(27.3%),而无事件者为8例(72.7%);低危组中依次分别为1例(8.3%)和36例(91.7%),高危组预后情况较低危组更差(27.3%vs8.3%,P=0.033;RR13.5,95%CI:1.238～147.232)。结论根据血清抵抗素水平可评估冠心病患者的预后,而对其危险分层的最佳界值取值93μg/L可能是较有意义的生化指标。

Objective To explore the value of serum resistin in diagnosis of patients with coronary artery disease.Methods Serum resistin levels in baseline were measured in 48 patients with coronary artery disease.To observe major adverse cardiovascular events（MACE） including non-fatal myocardial infarction and death from cardiovascular causes in follow-up for 24 months.Predictors of MACE were analyzed by Cox regression analysis.The cutoff point of the resistin level was determined by receiver operator characteristic curve （ROC）. 48 patients were divided into two groups, high risk andlow risk group, according to the cutoff point. Results The serum resistin level in the CAD was higher than that of the control group [ （96 ± 23 ） vs （16 ± 5 ）μg/L, P 〈 0. 0011. As revealed by Cox regression analysis, predictors of MACE were diabetes and serum resistin level. The optimal value of resistin for predicting MACE was 93μg/L and its sensitivity and specificity was respectively 75% and 81.8%. The adverse outcome patients accounted for 27.3% , whereas the no adverse outcome ones 72.7% in the high risk group. In contrast,8.3% and 91.7% in the low risk group,respectively. Adverse outcome emerge of the high risk group was more frequent than that of the low risk group（27.3% vs 8.3% , P = 0. 033 ; RR 13.5,95% CI ： 1. 238 - 147. 232）. Conclusion A baseline serum resistin is independently predictive of MACE. The best cutoff point of serum resistin level for risk stratification in patients with CAD is 93 μg/L, which is reliable biochemistry marker.