测定急性冠脉综合征患者小动脉弹性指数的临床意义

Significance of detecting small artery elasticity index in patients with acute coronary syndrome

目的探讨急性冠脉综合征(Acute coronary syndrome,ACS)患者监测小动脉弹性指数(C2)水平的临床价值。方法前瞻性、连续性纳入我院心血管内科于2011年1月至2013年7月期间所收治新发病的ACS患者,并以同样方式纳入同期入院的稳定型心绞痛(Stable angina,SA)患者作为对照组。收集两组患者的临床资料,比较各项危险因素之间的差异性,采用多因素Logistic模型建立回归分析,进一步筛查其中独立、敏感的影响指标。经由一元线性回归分析测定各项敏感指标与C2水平之间的关联性。结果两组患者基线资料比较显示,共有C2等11项危险因素存在显著差异。经多因素Logistic回归分析验证,低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、血清脂联素(APN)、血浆纤维蛋白原(FIB)、超敏肌钙蛋白I(c-TNI)及C2是ACS患者的独立敏感因素。单因素方差分析显示不同C2水平时FIB及HDL-C的组间资料比较差异均无统计学意义(P>0.05),而c-TNI、LDL-C、APN的组间资料比较则差异均有统计学意义(P<0.05)。对上述三项指标进行一元线性回归分析,LDL-C与C2呈显著负相关(回归系数=-1.566,Pearson相关系数=0.591,P=0.018),APN与C2呈显著正相关(回归系数=0.075,Pearson相关系数=0.507,P=0.043),c-TNI与C2呈非线性相关(P>0.05)。结论 C2水平可作为ACS患者的高危风险因子用于指导临床诊疗,亦可动态评估ACS的病情进展,建议临床推广。

Objective To investigate the clinical significance of determining small artery elasticity index（C2） in patients with acute coronary syndrome（ACS）. Methods Hospitalized ACS patients in the Department of Cardiovascular Medicine from January 2011 to July 2013 were included（the study group）, and the stable angina patients were included as the control group. The independent and sensitive indicators were screened by multivariable Logistic regression analysis. The correlation between different C2 levels and the associated sensitive indicators was analyzed by simple linear regression model. Results Comparison on baseline data showed that there were significant differences in a total of 11 risk factors between the two groups, including C2. Multivariate Logistic regression analysis and validation revealed that low density lipoprotein（LDL-C）, high density lipoprotein（HDL-C）, serum adiponectin（APN）, plasma fibrinogen（FIB）, high sensitive troponin I（c-TNI） and C2 were the independent sensitive factors of patients with ACS. Single factor analysis showed that at different levels of C2 there was no significant differences in FIB and HDL-C data between the two groups（P〉0.05）, while differences in c-TNI, LDL-C, APN was statistically significant（P〈0.05）. The above three indicators were further included for linear regression analysis. A significant negative correlation was found between LDL-C and C2（regression coefficient=-1.566, Pearson correlation coefficient=0.591, P=0.018）, with a significant positive correlation between APN and C2（regression coefficient=0.075, Pearson correlation coefficient=0.507, P=0.043）, and a nonlinear correlation between c-TNI and C2（P〉0.05）. Conclusion C2 level could serve as a risk factor of ACS patients to guide clinical intervention, and it is recommended to be popularized in clinic.