3种血清指标与老年急性冠状动脉综合征病情程度的相关性研究

Association between three serum indexes and severity of acute coronary syndrome in the elderly

目的探讨血清高迁移率族蛋白B1(HMGB1)、基质金属蛋白酶9(MMP-9)、骨膜蛋白与老年急性冠状动脉综合征(ACS)患者病情程度的关系。方法选取老年ACS患者220例,分为急性心肌梗死(AMI)组105例和不稳定性心绞痛(UAP)组115例,另选取健康体检者110例为对照组。对比各组血清HMGB1、MMP-9、骨膜蛋白水平,采用ROC曲线分析预测价值。结果 AMI组和UAP组血清HMGB1、MMP-9、骨膜蛋白水平明显高于对照组,且AMI组较UPA组更高(P<0.05)。血清HMGB1、MMP-9、骨膜蛋白为老年ACS发生的危险因素(P<0.01)。血清HMGB1、MMP-9、骨膜蛋白水平与冠状动脉病变支数(r=0.521,r=0.592,r=0.596,P<0.01)、Gensini评分(r=0.589,r=0.594,r=0.601,P<0.01)、病情程度(r=0.621,r=0.614,r=0.629,P<0.01)呈正相关。ROC曲线分析显示,血清HMGB1预测预后的曲线下面积为0.897,略高于血清MMP-9和骨膜蛋白,差异无统计学意义(P>0.05)。结论血清HMGB1、MMP-9、骨膜蛋白水平是老年ACS发生的重要危险因素,与冠状动脉病变支数、Gensini评分呈正相关,动态检测其水平,可为临床评估病情程度、判断预后提供指导。

Objective To study the association of high mobility group protein B1(HMGB1),MMP-9 and periostin expressions with severity of ACS in the elderly.Methods Two hundred and twenty elderly ACS patients were divided into AMI group(n=105) and UAP group(n=115) with 110 healthy subjects undergoing physical examination served as a control group.Their serum HMGB1,MMP-9 and periostin levels were measured.The value of serum HMGB1,MMP-9,and periostin levels in predicting the outcome of ACS in the elderly was analyzed by ROC curve analysis.Results The serum HMGB1,MMP-9 and periostin levels were significantly higher in AMI group and UAP group than in control group and in AMI group than in UAP group(P<0.05),and were the risk factors for ACS in the elderly(P<0.01).The serum HMGB1,MMP-9 and periostin levels were positively related with the number of lesioned coronary arteries,Gensini score,severity of ACS in the elderly(r=0.521,r=0.592,r=0.596,P<0.01;r=0.589,r=0.594,r=0.601,P<0.01;r=0.621,r=0.614,r=0.629,P<0.01).ROC curve analysis showed that the area under the ROC curve for serum HMGB1 was 0.897,which was slightly higher than that for serum MMP-9 and that for periostin in predicting the outcome of ACS in the elderly(P>0.05).Conclusion Serum HMGB1,MMP-9 and periostin levels are the important risk factors for ACS in the elderly and are positively related with the number of lesioned coronary arteries and Gensini score,and can thus guide the clinical assessment of ACS,the selection of treatment plans for ACS,and judge the outcome of ACS in the elderly.