血浆生长分化因子15及和肽素和血清半乳糖凝集素3与冠状动脉粥样硬化性心脏病患者冠状动脉病变的相关性研究

Correlation among plasma growth differentiation factor-15,copeptin,galactose lectin-3 and coronary artery lesions in patients with coronary atherosclerotic heart disease

目的探讨血浆生长分化因子15(GDF-15)、和肽素及血清半乳糖凝集素3(Gal-3)与冠状动脉病变的相关性。方法选取2017年1月至2018年1月在四川大学华西医院行冠状动脉造影检查的疑似冠状动脉粥样硬化性心脏病(冠心病)患者310例,根据冠状动脉病变情况分为冠心病组(241例)和非冠心病组(69例)。冠心病组患者中单支病变86例、双支病变(包括左主干病变)84例、三支病变71例,Gensini积分<32分63例(低分组)、32~82分99例(中分组)、>82分79例(高分组)。比较冠心病组与非冠心病组患者血脂和血肌酐、血尿酸、血浆GDF-15、和肽素及血清Gal-3水平,并对不同Gensini积分和不同冠状动脉病变支数组冠心病患者血浆GDF-15、和肽素及血清Gal-3水平进行比较,分析冠心病组患者血浆GDF-15、和肽素及血清Gal-3水平与Gensini积分的相关性。结果冠心病组与非冠心病组患者总胆固醇、三酰甘油、血肌酐和血尿酸水平比较差异均无统计学意义(均P>0.05)。冠心病组血清高密度脂蛋白胆固醇水平低于非冠心病组[(1.07±0.23)mmol/L比(1.18±0.33)mmol/L],血清低密度脂蛋白胆固醇、血浆GDF-15、和肽素及血清Gal-3水平高于非冠心病组[(2.9±0.9)mmol/L比(2.2±1.0)mmol/L、(1257±333)ng/L比(347±87)ng/L、(25.3±14.4)pmol/L比(11.2±9.1)pmol/L、(56.2±18.4)ng/L比(16.9±2.8)ng/L](均P<0.05)。三支病变组血浆GDF-15、和肽素及血清Gal-3水平均高于单支病变组和双支病变组[(2177±454)ng/L比(857±244)、(1470±363)ng/L,(27.1±11.3)pmol/L比(9.9±1.9)、(20.7±9.4)pmol/L,(77.6±15.0)ng/L比(44.6±10.5)、(69.7±22.0)ng/L],且双支病变组上述指标水平均高于单支病变组(均P<0.05)。Gensini积分高分组患者血浆GDF-15、和肽素及血清Gal-3水平均高于中分组和低分组[(2176±513)ng/L比(797±352)、(1574±432)ng/L,(32.2±7.8)pmol/L比(9.3±2.8)、(18.8±5.6)pmol/L,(71.2±12.8)ng/L比(39.2±9.4)、(66.8±13.9)ng/L],且中分组上述指标水平均高于低分组(均P<0.05)。冠心病组患者血浆GDF-15、和肽素及血清Gal-3水平与Gensini积分均呈正相关(r=0.682、0.573、0.629,均P<0.05)。结论血浆GDF-15、和肽素及血清Gal-3水平与冠心病患者冠状动脉病变程度呈正相关,对上述指标水平进行检测有助于预测冠心病患者冠状动脉病变程度,从而指导临床检查和治疗方法的选择,改善患者的风险分层。

Objective To investigate the correlation among plasma growth differentiation factor-15(GDF-15),copeptin,galactose lectin-3(Gal-3)and coronary artery lesions in patients with coronary atherosclerotic heart disease(CHD).Methods A total of 310 patients with suspected CHD were enrolled from January 2017 to January 2018 in West China Hospital,Sichuan University.According to coronary angiography results,they were divided into CHD group(241 cases)and non-CHD group(69 cases).In CHD group there were86 patients with single-vessel disease,84 patients with double-vessel disease(including left main disease),71 patients with three-vessel disease,63 patients with Gensini score<32(low Gensini score group),99 patients with Gensini score 32-82(medium Gensini score group)and 79 patients with Gensini score>82(high Gensini score group).Blood lipids,creatinine,uric acid,GDF-15,copeptin and Gal-3 levels were detected.Correlation among GDF-15,copeptin,Gal-3 and Gensini score was analyzed.Results There were no significant differences in total cholesterol,triacylglycerol,serum creatinine and uric acid between CHD group and non-CHD group(all P>0.05).High-density lipoprotein cholesterol in CHD group was lower than that in non-CHD group[(1.07±0.23)mmol/L vs(1.18±0.33)mmol/L](P<0.05).Low-density lipoprotein cholesterol,GDF-15,copeptin and Gal-3 in CHD group were higher than those in non-CHD group[(2.9±0.9)mmol/L vs(2.2±1.0)mmol/L,(1257±333)ng/L vs(347±87)ng/L,(25.3±14.4)pmol/L vs(11.2±9.1)pmol/L,(56.2±18.4)ng/L vs(16.9±2.8)ng/L](all P<0.05).GDF-15,copeptin and Gal-3 in three-vessel disease patients were higher than those in single-vessel disease and double-vessel disease patients[(2177±454)ng/L vs(857±244),(1470±363)ng/L;(27.1±11.3)pmol/L vs(9.9±1.9),(20.7±9.4)pmol/L;(77.6±15.0)ng/L vs(44.6±10.5),(69.7±22.0)ng/L];the levels in double-vessel disease patients were higher than those in single-vessel disease patients(all P<0.05).GDF-15,copeptin and Gal-3 in high Gensini score group were higher than those in medium and low Gensini score groups[(2176±513)ng/L vs(797±352),(1574±432)ng/L;(32.2±7.8)pmol/L vs(9.3±2.8),(18.8±5.6)pmol/L;(71.2±12.8)ng/L vs(39.2±9.4),(66.8±13.9)ng/L];the levels in medium Gensini score group were higher than those in low Gensini score group(all P<0.05).Gensini score was positively correlated with plasma GDF-15,copeptin and Gal-3 levels in CHD patients(r=0.682,0.573,0.629,all P<0.05).Conclusion Plasma GDF-15,copeptin and Gal-3 are positively correlated with the severity of coronary artery disease.