多种心脏标志物与冠状动脉钙化积分的关系及其诊断价值探讨

The diagnostic value of cardiac markers and their relathionship with coronary artery calcification score

目的探讨多种心脏标志物与冠状动脉钙化积分(CACS)的关系及其临床诊断价值。方法选取2013年10月至2014年4月在贵州省人民医院住院的冠心病(CHD)患者70例(疾病组)和体检健康者50例(对照组),检测其血清白细胞介素-10(IL-10)、妊娠相关血浆蛋白A(PAPP-A)、高迁移率族蛋白B1(HMGB1)、脂联素(APN)、1,25二羟基维生素D3[1,25(OH)2D3]、缺氧诱导因子-1α(HIF-1α)、白细胞介素-18(IL-18)、基质γ-羧基谷氨酸蛋白(MGP)及骨桥蛋白(OPN)9种标志物水平;使用双源CT对疾病组进行冠状动脉成像检查以计算患者CACS,并根据CACS将患者分为重度、中度、轻度患者;比较各组血清心脏标志物水平,分析其与CACS的关系,并评价其临床诊断价值。结果疾病组与对照组血清1,25(OH)2D3、HIF-1α、IL-18、MGP及OPN水平比较,差异均有统计学意义(P<0.05);不同CACS患者与对照组血清IL-10、PAPP-A、1,25(OH)2D3、HIF-1α、IL-18、MGP及OPN水平比较,差异均有统计学意义(P<0.05);CACS与1,25(OH)2D3呈负相关(P<0.05),与HIF-1α、IL-10、MGP呈正相关(P<0.05),且与1,25(OH)2D3、HIF-1α、IL-18、MGP及OPN存在明显的线性关系(P<0.05);绘制受试者工作特征(ROC)曲线显示,HIF-1α、MGP、1,25(OH)2D3对CHD的诊断价值较高,其ROC曲线下面积分别为0.826、0.667和0.616,灵敏度分别为73.30%、58.80%、48.50%,特异度分别为73.50%、83.70%和95.80%,3项标志物联合检测的AUC为0.845,灵敏度和特异度分别达到90.0%和70.0%。结论多项心脏标志物对CHD具有较高的诊断价值,加强心脏标志物与动脉粥样硬化及钙化的相关性研究,有利于促进心脏标志物的临床应用。

Objective To explore thd correlations between various cardiac markers and coronary artery calcification score （CACS）and clinical diagnostic values of these makers. Methods A total of 70 cases of patients with coronary heart disease（CHD, disease group） and 50 cases of healthy individuals（control group） in Guizhou Provincial People＇s Hospital from October 2013 to April 2014 were selected. The serum levels of 9 kinds of markers, including IL-10, PAPP-A, HMGB1, APN, 1,25 （OH） 2 D3, HIF-1 , IL-18, MGP and OPN, were detected. The CACS of patients in the disease group was calculated by coronary angiography with dual source CT. Patients were grouped according to CACS,including mild,moderate and severe group. The serum levels of cardiac markers were compared among these groups, and their correlations to the CACS and clinical diagnosis values were analysed and assessed. Results There were statistically significant differences in serum levels of 1,25 （OH）2 D3, HIF-1α, IL-18, MGP and OPN between the disease group and the control group（P〈0.05）, And statistically significant differences were found in serum levels of IL-10, PAPP-A, 1,25 （OH）2 D3, HIF-1α, IL-18, MGP and OPN between disease groups with different CACS and the control group. The CACS was negatively correlated with serum level of 1,25 （OH）2 D3 （P〈0.05）, positively correlated with serum level of HIF-la, IL- l0 and MGP（P〈0.05） ; there was linear relationship between CACS and 1,25 （OH）2D3, HIF-1α, IL-18, MGP and OPN（P〈 0.05）. ROC curves showed HIF-1α,MGP and 1,25（OH）zD3 had relatively high value in diagnosis of CHD,the area under the curve （AUC） was 0. 826,0. 667 and 0. 616 ,respectively;the sensitivity was 73.30% ,58.80% and 48.50% ,respectively;the specific was 73.50% ,83.70% and 95.80% ,respectively. The AUC of joint detection of HIF-1α,MGP and 1,25（OH）2D3 was 0. 845,and the sensitivity and specific was reached to 90.0% and 70.0%, respectively. Conclusion The diagnostic values of a variety of cardiac markers are relatively high. To strengthen the correlation study between cardiac markers and atherosclerosis and coronary calcification might be benifical for promoting the clinical application of cardiac markers.