不同糖代谢状态下急性冠脉综合征患者血清胱抑素C与冠脉病变的相关性研究

Study on the relationship between serum cystatin C and coronary artery lesions in patients with acute coronary syndrome under different glucose metabolism

目的探讨不同糖代谢状态下急性冠脉综合征(ACS)患者血清胱抑素C(CysC)与冠状动脉(简称冠脉)病变严重程度的关系。方法204例住院经冠脉造影检查诊断为冠心病(CHD)病人的ACS患者,按不同糖代谢状态分为糖耐量正常(NGT)组、糖尿病前期(IGR)组、糖尿病(DM)组。检测血清CysC、生化指标和颈动脉内-中膜厚度(IMT),并计算Gensini评分;进一步按Gensini评分的三分位数将患者分为低分组71例(≤14分)、中分组68例(15~44分)及高分组65例(≥45分),比较上述指标的差异。采用多元线性回归分析血清胱抑素C与Gensini评分的相关性。结果(1)在不同糖代谢组,血清CysC、Gensini评分、FBG、HbA1c随着血糖升高逐渐升高,DM组与NGT组比较差异均有统计学意义(P<0.05)。(2)在不同Gensini评分组,血清CysC水平各组间比较差异无统计学意义,HbA1c各组间两两比较异均有统计学意义(P<0.05)。(3)多元线性回归分析显示,血清CysC不是Gensini评分的独立危险因素,而HbA1c是其独立危险因素。结论在不同糖代谢状态合并ACS患者中,血清CysC尚不能作为反映冠脉病变严重程度的独立危险因素。

Objective To investigate the relationship between serum cystatin C(Cys C)and coronary artery lesions in patients with acute coronary syndrome(ACS)under different glucose metabolism.Methods 204 patients with ACS were diagnosed by coronary angiography and divided into NGT group,IGR group and DM group according to the different glucose tolerance.Cys C,other biochemical indexes and carotid intima-media thickness(IMT)were measured and the Gensini score was calculated.According to Gensini score,the patients were divided into 71 cases of low score group(≤14 points),68 cases of middle score group(15-44 points)and 65 cases of high score group(≥45 points).The differences of the above indexes were compared.The correlation between serum Cys C and Gensini score was evaluated by multivariate linear regression analysis.Results(1)Serum Cys C,Gensini score,FBG and HbA1c increased with the increase of blood sugar in different glycometabolic groups.There was significant difference between DM group and NGT group(P<0.05).(2)There was no significant difference in serum Cys C level among different Gensini score groups,but there was significant difference in HbA1c between two groups(P<0.05).(3)Multivariate linear regression analysis showed that serum Cys C was not an independent risk factor for Gensini score,but HbA1c was an independent risk factor.Conclusion Serum Cys C is not an independent risk factor for the severity of coronary artery disease in patients with ACS in different glycometabolism states.