一氧化氮、内皮素-1和同型半胱氨酸对冠心病的辅助诊断价值

Roles of nitric oxide,endothelin-1 and homocysteine for the auxiliary diagnosis of coronary heart disease

目的探讨血清一氧化氮(NO)、内皮素-1(ET-1)及同型半胱氨酸(Hcy)检测对冠心病的辅助诊断价值及与冠心病的关联性。方法检测264例冠心病患者和90名体检健康者(正常对照组)血清NO、ET-1和Hcy水平。采用受试者工作特征(ROC)曲线评价NO、ET-1、Hcy对冠心病的辅助诊断价值,根据得出的最佳临界值确定3项指标的敏感性和特异性。引入常规危险因素(年龄、性别、糖尿病、高血压、血脂异常、吸烟、肥胖)进行校正,采用非条件Logistic回归分析评估NO、ET-1、Hcy作为冠心病危险因素的价值及与冠心病的关联强度。结果冠心病组血清NO水平明显低于正常对照组(P<0.001),而ET-1、Hcy水平明显高于正常对照组(P<0.001)。NO、ET-1、Hcy辅助诊断冠心病的ROC曲线下面积分别为0.723、0.742、0.718。非条件Logistic回归分析显示NO、ET-1、Hcy的比值比(OR)分别为2.254、5.116、2.308,95%可信区间(CI)分别为1.028~4.938、2.498~10.479、1.038~5.131,与冠心病的关联强度由高到低依次为ET-1、Hcy、NO。结论血清NO、ET-1、Hcy对冠心病有一定的辅助诊断价值,是冠心病的危险因素。

Objective To investigate the roles of serum nitric oxide(NO),endothelin-1(ET-1)and homocysteine(Hcy)for the auxiliary diagnosis of coronary heart disease and their correlations.Methods Serum levels of NO,ET-1 and Hcy were determined in 264 patients with coronary heart disease and 90 healthy subjects(healthy control group).The roles of NO,ET-1 and Hcy for the auxiliary diagnosis of coronary heart disease were evaluated by receiver operating characteristic(ROC)curve.The sensitivities and specificities of the 3 indices were determined according to optimal cut-off values.The risk factors,including age,sex,diabetes mellitus,hypertension,dyslipidemia,smoking and obesity,were used to correct the 3 indices.Unconditional Logistic regression analysis was used to assess the roles of NO,ET-1 and Hcy as risk factors for coronary heart disease and their correlations with coronary heart disease.Results The level of serum NO in coronary heart disease group was lower than that in healthy control group(P<0.001),while the levels of ET-1 and Hcy were higher than those in healthy control group(P<0.001).The areas under ROC curves of serum NO,ET-1 and Hcy for the auxiliary diagnosis of coronary heart disease were 0.723,0.742 and 0.718,respectively.The unconditional Logistic regression analysis showed that the odds ratios(OR)of NO,ET-1 and Hcy were 2.254,5.116 and 2.308,and 95%confidence intervals(CI)were 1.028-4.938,2.498-10.479 and 1.038-5.131,respectively.The indices having correlation intensities with coronary heart disease from high to low were ET-1,Hcy and NO.Conclusions Serum NO,ET-1 and Hcy play roles for the auxiliary diagnosis of coronary heart disease,and they are risk factors for coronary heart disease.