血清γ-谷氨酰转移酶在冠心病血清学诊断中的临床价值

Clinical value of serumγ-glutamine transferase in serological diagnosis of coronary heart disease

目的:探讨血清γ-谷氨酰转移酶(GGT)水平与冠状动脉粥样硬化性心脏病(冠心病)冠脉病变稳定性、严重程度及冠心病主要危险因素的关系。方法:选取经冠状动脉造影检查确诊为冠心病的患者167例作为冠心病组,依据病变累及的血管数判断冠状动脉病变的严重程度,并分为单支、双支和三支组,根据临床类型判断冠状动脉病变的稳定性,分为稳定型心绞痛(SAP)组和急性冠脉综合征(ACS)组,并以同期梧州市红十字会医院健康体检者127例作为对照组。比较各组年龄、性别、收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、吸烟史、高血压及糖尿病病史等一般资料以及血清GGT、空腹血糖(FBG)、总胆固醇(TCH)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆红素(TB)、尿酸(UA)和同型半胱氨酸(HCY),分析GGT与冠脉病变稳定性、严重程度及冠心病危险因素的关系,利用Lo gistics回归分析冠心病的影响因素,并应用受试者工作特征曲线(ROC)分析GGT对冠心病的诊断效能。结果:冠心病组GGT、FBG、TC H、TG、LDL-C、TB、UA和HCY明显高于对照组,HDL-C明显低于对照组,差异均有统计学意义(P<0.05)。冠心病患者血清GGT水平不随冠脉病变血管支数增多而升高(P>0.05),SAP及ACS组血清GGT水平比较,差异无统计学意义(P>0.05)。Logistics回归分析显示,GGT是冠心病的独立危险因素;ROC曲线分析显示,GGT的曲线下面积(AUC)为0.70(95%CI 0.637~0.756,P<0.001),当以22.50 U/L为GGT诊断界值时,其预测冠心病的敏感度为67.1%,特异度为66.1%,阳性似然比为1.98,阴性似然比为0.50,阳性预测值为0.723,阴性预测值为0.604,约登指数为0.332。结论:GGT与冠心病传统危险因素具有相关性,是冠心病的独立危险因素,与冠心病冠脉病变稳定性及严重程度无关,对冠心病的临床诊断具有一定价值,可作为冠心病实验室诊断的筛查指标。

Objective:To explore relationships among serumγ-glutamine transferase(GGT)level and stability,severity and main risk factors of coronary heart disease.Methods:167 patients diagnosed with coronary heart disease by coronary angiography were selected as coronary heart disease group.According to the number of vessels used for determining the severity of coronary artery disease,these patients were divided into single vessel,double vessel and three vessel groups.According to the clinical types used to determine the stability of the disease,these patients were divided into stable angina pectoris(SAP)group and acute coronary syndrome(ACS)group.127 health people for health examination in Wuzhou red cross hospital were set as control group.The general clinical data were compared among these groups,including age,gender,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),smoking history,history of hypertension and diabetes.Then,the levels of serum GGT,fasting blood glucose(FBG),and total cholesterol(TCH),triacylglycerol(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total bilirubin(TB),uric acid(UA)and homocysteine Acid(HCY)were compared.The relationships among GGT and the stability,severity and risk factors of coronary heart disease were analyzed.Logistics regression was used to analyze the influencing factors of coronary heart disease.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of GGT for coronary heart disease.Results:The levels of GGT,FBG,TCH,TG,LDL-C,TB,UA and HCY in the coronary heart disease group were significantly higher than those in the control group,HDL-C level was significantly lower than that in the control group,and the differences were statistically significant(P<0.05).The level of serum GGT in the patients with coronary heart disease did not increase with the increase of the number of involved vessels(P>0.05).There was no significant difference in the serum GGT level between the SAP group and the ACS group(P>0.05).Logistics regression analysis showed that GGT was an independent risk factor of coronary heart disease.ROC curve analysis showed that the area under the curve(AUC)of GGT was 0.70(95%CI 0.637-0.756,P<0.001).When 22.50 U/L was used as the GGT diagnostic cutoff,the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value,negative predictive value and Jordan index were 67.1%,66.1%,1.98,0.50,0.723,0.604 and 0.332,separately.Conclusions:GGT is associated with the traditional risk factors for coronary heart disease and is an independent risk factor for coronary heart disease.Moreover,GGT is not related with the stability and severity of coronary heart disease.Overall,it has a certain value for the clinical diagnosis of coronary heart disease,and can be used as a laboratory diagnosis screening indicator.