组织型纤溶酶原激活物-抑制剂复合物与冠心病风险的相关性研究

The study on the association between tissue plasminogen activator-plasminogen activator inhibitor-1 complex and risk of coronary disease

目的探讨组织型纤溶酶原激活物－抑制剂复合物（t－PAIC）在预估冠状动脉粥样硬化性心脏病发生风险中的临床价值。方法回顾性分析。选取2017年1月至2018年3月于武汉大学人民医院心血管内科收治的冠心病患者203例，并选取同期对照组130例。对所有患者的血浆t－PAIC，全血红细胞、血红蛋白、白细胞和其他常规生化标志物的血清浓度进行定量。结果与对照组7.70（6.10～9.41）ng/ml相比，冠心病患者具有较高的t－PAIC 12.75（9.0～17.93）ng/ml水平，差异有统计学意义（Z＝9.208, P〈0.001）。Logistic回归结果显示：TG、LPa、t－PAIC是冠心病发病的独立危险因素[OR值（95% CI）]，[1.762（1.076～2.884）; 1.002 （1.000～1.003）；1.338（1.171～1.529）]。血浆t－PAIC浓度与冠心病严重程度呈正相关，冠状动脉堵塞轻微组（11.64±0.59）ng/ml、严重组（15.84±0.72）ng/ml血浆t－PAIC浓度逐步升高，且血浆t－PAIC与Gensini评分呈正相关（r＝0.471, P〈0.001）。多元回归分析表明：血浆t－PAIC与LDL－C、Glu、WBC（β系数＝0.673、0.305、0.263，P＝0.037、0.002、0.006）呈正相关。此外，在预后不良的患者中，t－PAIC水平异常升高（H＝82.210, P〈0.001）。结论血浆t－PAIC是冠心病的独立危险因素，该指标升高提示发生冠心病的可能性增加和冠心病患者的预后不良。

Objective The aim of this study was to discuss the effect and clinical value of plasma Tissue Plasminogen Activator-Plasminogen Activator Inhibitor-1 Complex （t-PAIC） in the coronary heart disease （CAD）.Methods This is a retrospective study. From January 2017 to March 2018, 203 patients with CAD were recruited from Renmin Hospital of Wuhan University. 130 cases were selected for control group at the same period. Plasma concentrations of t-PAIC, blood RBC, Hb, WBC and other routine biochemical markers were quantified.Results The plasma t-PAIC level in CAD group 12.75（9.0-17.93） ng/ml was significantly higher than that in healthy control group 7.70（6.10-9.41） ng/ml （Z=9.208, P〈0.001）. Logistic regression analysis showed that the TG, LPa, t-PAIC were independent risk factors for CAD[OR（95%CI）], [1.762（1.076-2.884）; 1.002（1.000-1.003）; 1.338 （1.171-1.529）]. The t-PAIC level was positively correlated with the severity of CAD. Compared with control group, the level of t-PAIC was higher in mild group（11.64±0.59）ng/ml and severe group（15.84±0.72）ng/ml, and the plasma t-PAIC level was positively correlated with Gensini score（r=0.471, P〈0.001）. Multiple linear regression analysis showed that there was a positive correlation among the plasma t-PAIC and LDL-C, Glu, WBC （β coefficient=0.673, 0.305, 0.263, P=0.037, 0.002, 0.006）. In addition, there was abnormal increase of plasma t-PAIC in CAD patients with poor prognosis （H=82.210, P〈0.001）.Conclusion Plasma t-PAIC is an independent risk factor of CAD. The significantly increase of plasma t-PAIC might be an important predictor of incidence of CAD and unfavourable prognosis.