趋化因子CCL21对急性冠状动脉综合征的临床预测价值

Clinical prediction value of chemokine CCL21 level for acute coronary syndrome

目的探讨趋化因子CCL21与急性冠状动脉综合征之间的关系。方法连续选取接受冠状动脉造影检查的患者212例，其中急性心肌梗死患者72例（AMI组），不稳定型心绞痛患者76例（UAP组），稳定型心绞痛患者64例（sAP组）。采用双抗体夹心酶联免疫吸附法（ELISA法）测定血清趋化因子CCL21的水平，应用Gensini积分系统衡量冠状动脉病变程度。对所有患者随访6个月，记录心血管不良事件发生情况。结果血清CCL21水平在AMI组、UAP组、sAP组分别为（169．72±14．64）ng／L、（154．42±16．50）ng／L、（143．87±9．80）ng／L，差异有统计学意义（F=99．818，P=0．000）；ACS组、SAP组血清CCL21浓度与Gensini积分呈正相关（r=0．474、0．350，P=0．000、0，049）；二分类Logistic回归分析结果显示，趋化因子CCL21是预测ACS的独立危险因素（OR=1．049，P=0．022）；应用CCL21水平判断ACS患者的受试者工作特征（R0c）曲线下面积为0．887±0．028（P=0．000），诊断界点为159．15ng／L，敏感度为0．635，特异度为0．981；发生心血管不良事件组血清CCL21水平较无心血管不良事件组高，且差异有统计学意义[（168．57±7．24）ng／L比（156．92±6．53）ng／L，t=16．100、P=0．0003。结论血清趋化因子CCL21水平反映了冠状动脉粥样硬化的病变程度，是一种独立的、有效预测ACS的生物标记物。

Objective To investigate the clinical prediction value of chemokine CCL21 level for acute coronary syndrome. Methods Totally 212 patients receiving coronary arteriography were divided into acute myocardial infarction group（AMI, n=72）, unstable angina pectoris group（UAP, n= 76） ,and stable angina pectoris group（SAP,n=64）. The serum＇level of chemokine CCL21 was detected by double-antibody sandwich enzyme-linked immunosorbent assay （ELISA）and the pathological changes of coronary artery were measured by Gensini scoring system. All patients were followed up for six months and the cardiovascular adverse events were recorded. Results The serum level of CCL21 was（169.72±14.64）ng/L in AMI group,（154.42±16.50）ng/L in UAP group,and（143.87±9.80） ng/L in SAP group, with statistically significant differences （F= 99. 818, P = 0. 000）. Serum levels of CCL21 in ACS group and SAP group were positively correlated with Gensini score（r=0. 474, P = 0. 000;r= 0. 350, P = 0. 049）. Binary Logistic regression analysis revealed that chemokine CCL21 was an independent risk factor for predicting acute coronary syndrome（OR = 1. 049, P = 0. 022）. The CCL21-judged area under the ROC curve in acute coronary syndrome group was 0. 887 ±0. 028 （ P = 0. 000） ,with diagnostic point of serum level of chemokine CCL21 at 159.15 ng/L, sensitivity of 0. 635, specificity of 0. 981. Serum level of CCL21 was higher in the patients with cardiovascular adverse events than in the patients without cardiovascular adverse events[（168.57± 7.24）ng/L vs. （156.92± 6.53）ng/L], with statistically significant difference （t = 16. 100, P = 0. 000）. Conclusions Serum level of chemokine CCL21 reflects the severity degree of coronary artery disease. The chemokine CCL21,as an independent and effective marker,can predict acute coronary syndrome.