血浆可溶性致癌抑制因子2联合Gensini评分对急性冠状动脉综合征患者的临床价值

Clinical evaluation of plasma soluble suppression of tumotigenicity 2 combined with Gensini score in patients with acute coronary syndrome

目的探讨血浆可溶性致癌抑制因子2(sST2)联合Gensini评分对急性冠状动脉综合征(ACS)患者的评估价值。方法选择2018年1月至5月在徐州市中心医院拟诊ACS住院诊治的135例患者作为研究对象,根据临床表现、心电图、心肌坏死标记物、冠状动脉造影结果,将135例患者分为ACS组(108例)与对照组(27例)。108例ACS组患者进一步分为不稳定性心绞痛(UA)组(21例)、非ST段抬高性心肌梗死(NSTEMI)组(26例)和ST段抬高性心肌梗死(STEMI)组(61例)3个亚组。比较患者的一般资料、肌酐、脂蛋白a、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、胱抑素、Gensini评分、尿酸、中性粒细胞与淋巴细胞比值(NLR)和sST2表达水平。采用受试者工作特征(ROC)曲线分析Gensini评分、NLR、sST2、sST2联合Gensini评分对ACS患者的预测价值,并用Z检验比较其曲线下面积(AUC)。结果ACS组和对照组患者Gensini评分[(66±43)分vs.(21±6)分]、NLR[(4.8±2.8)vs.(2.2±0.8)]及sST2[(61.2±44.8)mg/L vs.(31.0±8.7)mg/L]表达水平比较,差异均有统计学意义(t=9.385、6.323、5.563,P均<0.001)。UA组、NSTEMI组和STEMI组患者Gensini评分[(28±11)分、(59±23)分、(82±48)分]、NLR[(2.3±0.9)、(4.6±2.6)、(5.7±2.8)]及sST2[(30.2±1.4)mg/L、(51.5±1.6)mg/L、(72.7±2.1)mg/L]表达水平比较,差异均有统计学意义(F=16.655、14.678、7.498,P均<0.001)。进一步两两比较发现,NSTEMI组和STEMI组患者Gensini评分、NLR及sST2水平均较UA组显著升高(P均<0.05);STEMI组患者Gensini评分及sST2水平均较NSTEMI组升高(P均<0.05)。将Gensini评分、NLR、sST2及sST2联合Gensini评分纳入ROC曲线分析,结果显示,Gensini评分[AUC=0.903,95%置信区间(CI)(0.874,0.980)]、NLR[AUC=0.825,95%CI(0.724,0.926)]、sST2[AUC=0.799,95%CI(0.667,0.931)]及sST2联合Gensini评分[AUC=0.933,95%CI(0.884,0.981)]均对ACS具有预测价值(P均<0.001)。且sST2联合Gensini评分与Gensini评分、NLR、sST2的AUC比较,差异均有统计学意义(Z=3.783、5.271、5.682,P=0.036、0.013、0.004)。结论sST2联合Gensini评分可以增强对ACS患者的预测能力,优于单独应用sST2或Gensini评分。

Objective To evaluate the value of plasma soluble suppression of tumotigenicity 2(sST2)combined with Gensini score in patients with acute coronary syndrome(ACS).Methods From January to May 2018,135 patients to be diagnosed with ACS in Xuzhou Central Hospital were selected as the subjects.They were divided into an ACS group(108 cases)and a control group(27 cases)according to their clinical manifestations,electrocardiogram,myocardial necrosis markers and coronary angiography results.Patients in the ACS group were further divided into an unstable angina(UA)group(21 cases),a non-ST-segment elevation myocardial infarction(NSTEMI)group(26 cases)and a ST-segment elevation myocardial infarction(STEMI)group(61 cases).The general data,creatinine,lipoprotein a,high density lipoprotein(HDL),low density lipoprotein(LDL),cystatin,Gensini score,uric acid,neutrophil to lymphocyte ratio(NLR)and sST2 of patients were compared.The predictive values of Gensini score,NLR,sST2,and sST2 combined with Gensini score for ACS patients were analyzed using the receiver operating characteristic(ROC)curve,and the areas under the curve(AUC)were compared using the Z-test.Results There were significant differences in the levels of Gensini score[(66±43)vs.(21±6)],NLR[(4.8±2.8)vs.(2.2±0.8)]and sST2[(61.2±44.8)mg/L vs.(31.0±8.7)mg/L]between the ACS group and control group(t=9.385,6.323,5.563;all P<0.001).In addition,the Gensini score[(28±11),(59±23),(82±48)],NLR[(2.3±0.9),(4.6±2.6),(5.7±2.8)]and sST2[(30.2±1.4)mg/L,(51.5±1.6)mg/L,(72.7±2.1)mg/L]in the UA group,NSTEMI group and STEMI group were significantly different(F=16.655,14.678,7.498;all P<0.001).Further pairwise comparison showed that the Gensini score,NLR and sST2 in NSTEMI and STEMI groups were all significantly higher than those in the UA group(all P<0.05).The Gensini score and sST2 in the STEMI group were significantly higher than those in the NSTEMI group(both P<0.05).The Gensini score,NLR,sST2,and sST2 combined with Gensini score were included in the ROC curve which showed that the Gensini score[AUC=0.903,95%confidence interval(CI)(0.874,0.980)],NLR[AUC=0.825,95%CI(0.724,0.926)],sST2[AUC=0.799,95%CI(0.667,0.931)],and sST2 combined with Gensini score[AUC=0.933,95%CI(0.884,0.981)]all had predictive values for ACS(all P<0.001).Furthermore,there were significant differences in AUCs between sST2 combined with Gensini score and Gensini score,NLR,sST2(Z=3.783,5.271,5.682;P=0.036,0.013,0.004).Conclusion sST2 combined with Gensini score can enhance the predictive value for ACS patients,which is better than using the sST2 or Gensini score alone.