非ST段抬高型急性冠状动脉综合征hs-CRP、Lp(a)、CysC及ApoA与GRACE评分相关性研究

Relationship between the levels of hs-CRP,CysC,ApoA,Lp(a) and GRACE score in NEST-ACS patients

目的:探讨非ST段抬高型急性冠状动脉综合征(NSTE-ACS)病人血清高敏C反应蛋白(hs-CRP)、胱抑素C(Cys C)、载脂蛋白A(ApoA)、脂蛋白a[Lp(a)]与全球急性冠状动脉事件注册评分(GRACE评分)相关性。方法:选取130例NSTE-ACS病人(NSTE-ACS组)及同期80例非冠心病病人(对照组),入院后收集2组的临床资料,同时第2天清晨空腹采集肘静脉血检测hs-CRP、CysC、ApoA、Lp(a)水平,并进行GRACE危险评分,根据GRACE危险评分将病人分为3组,低危组≤99分,中危组>99~140分,高危组>140分。结果:NSTE-ACS组年龄、性别、肌酐、高血压病史、糖尿病病史、hs-CRP、Lp(a)、CysC和GRACE评分值均高于对照组(P<0.05~P<0.01),ApoA显著低于对照组(P<0.01);不同GRACE评分病人冠状动脉病变支数构成差异无统计学意义(P>0.05),而3组冠状动脉狭窄程度构成差异有统计学意义(P<0.05);中危组和高危组病人血浆hs-CRP和Lp(a)水平均明显高于低危组(P<0.01),而血浆ApoA水平均明显低于低危组(P<0.01)。高危组血浆Lp(a)和CysC水平均明显高于中危组(P<0.01),ApoA水平显著低于中危组(P<0.01),且血清CysC水平明显高于低危组(P<0.01);不同冠状动脉病变支数及不同冠状动脉狭窄程度病人血浆hs-CRP、Apo A、Lp(a)和CysC差异均有统计学意义(P<0.01),其中3支病变、重度狭窄或闭塞hs-CRP、Lp(a)、CysC最高,ApoA最低;单支病变、轻度狭窄hs-CRP、Lp(a)、CysC最低,ApoA最高。结论:hs-CRP、CysC、Lp(a)、ApoA与GRACE评分密切相关,联合检测对早期危险分层、预后评估及诊疗方案的选择重要参考价值。

Objective： To investigate the correlations between serum high-sensitivity C-reactive protein（ hs-CRP）,Cystatin C（ Cys C）,apolipoprotein A（ Apo A）,lipoprotein（ a） [Lp（ a） ] and global registry of acute coronary evects（ GRACE） score in non ST-elevation acute coronary syndromes（ NSTE-ACS） patients. Methods： One hundred and thirty patients with NSTE-ACS and 80 patients without NSTE-ACS were divided into the NSTE-ACS group and control group,respectively. The clinical data of patients were collected,the serum levels of hs-CRP,Cys C,Apo A and Lp（ a） were detected on the second day of admission,and the GRACE score was assessed. The NSTE-ACS patients were subdivided into the low risk group（ GRACE score≤99）,middle risk group（ 140 ≥GRACE score 99） and high risk group（ GRACE score 140） according to the GRACE risk score. Results： The age,gender,creatinine,history of hypertension and diabetes,hs-CRP,Lp（ a）,Cys C and GRACE score in NSTE-ACS group were higher than those in control group（ P〈0. 05 to P〈0. 01）,while the level of Apo A in NSTE-ACS group was significantly lower than that in control group（ P〈0. 01）. The differences of the coronary artery lesion between three groups were not statistically significant（ P〉0. 05）,while the differences of the coronary artery stenosis degree between three groups were statistically significant（ P〈0. 05）. The serum levels of hs-CRP and Lp（ a） in middle risk group and high risk group were significantly higher than those in low risk group（ P〈0. 01）,but the serum levels of Apo A in middle risk group and high risk group were significantly lower than those in low risk group（ P〈0. 01）. The serum levels of Lp（ a） and Cys C in high risk group were significantly higher than those in middle risk group（ P〈0. 01）,the serum level of Apo A in high risk group was significantly lower than that in middle risk group（ P〈0. 01）,and the serum level of Cys C in high risk group was significantly higherthan that in low risk group（ P〈0. 01）. The differences of the levels of hs-CRP,Apo A,Lp（ a） and Cys C in different coronary artery lesions and stenosis degrees were statistically significant（ P〈0. 01）. In three-vessel coronary artery lesions and severe stenosis or occlusion of coronary artery patients,the levels of hs-CRP,Lp（ a） and Cys C were the highest,and the level of Apo A was the lowest. In single-vessel coronary artery lesion and mild stenosis of coronary artery patients,the levels of hs-CRP,Lp（ a） and Cys C were the lowest,and the level of Apo A was the highest. Conclusions：The levels of hs-CRP,Cys C,Lp（ a） and Apo A are closely related to the GRACE score. The joint detection has important clinical reference values in the early risk stratification,prognosis assessment and diagnosis scheme.