老年冠心病患者血清小而密低密度脂蛋白和视黄醇结合蛋白4及纤维蛋白表达特点与冠状动脉病变程度及预后的关系研究

The relationship between the expression of serum sd-LDL,RBP-4 and Fn and the severity and prognosis of coronary artery disease in elderly patients with CHD

目的探讨老年冠心病(coronary heart disease,CHD)患者血清小而密低密度脂蛋白(small and dense low density lipoprotein,sd-LDL)、视黄醇结合蛋白4(retinal binding protein,RBP-4)、纤维蛋白(fibrin,Fn)表达特点与冠状动脉病变程度及预后的关系.方法选取2017年10月至2018年10月在我院住院的CHD患者80例作为研究对象,分为不稳定型心绞痛(UA)组49例和稳定型心绞痛(SA)组31例.另选取同期健康体检志愿者60例作为对照组.检测各组sd-LDL、RBP-4、Fn水平,对CHD患者行冠状动脉造影并行Gensini评分,分析检验指标与Gensini评分的相关性.随访1年,观察不同预后患者检验指标差异.结果三组sd-LDL、RBP-4、Fn水平从低到高均为对照组、SA组和UA组,差异均具有统计学意义(P<0.05)[sd-LDL:(0.83±0.32)mmol/L比(1.07±0.52)mmol/L比(1.33±0.47)mmol/L,F=18.673,P<0.001;RBP-4:(29.37±4.48)mg/L比(37.76±6.43)mg/L比(46.75±8.19)mg/L,F=98.978,P<0.001;Fn:(223.23±41.09)mg/L比(281.08±61.19)mg/L比(331.48±98.67)mg/L,F=32.224,P<0.001].UA组Gensini评分显著高于SA组,差异具有统计学意义(P<0.05)[(62.49±9.18)比(37.28±8.31),t=12.405,P<0.001].按照Gensini评分进行分组,随着Gensini评分的升高,sd-LDL、RBP-4、Fn水平均显著升高(P<0.05)[sd-LDL:(0.96±0.17)mmol/L比(1.21±0.37)mmol/L比(1.46±0.61)mmol/L,F=7.583,P<0.001;RBP-4:(36.14±3.67)mg/L比(42.29±5.36)mg/L比(51.38±6.17)mg/L,F=47.315,P<0.001;Fn:(251.19±66.18)mg/L比(298.47±73.26)mg/L比(365.17±96.34)mg/L,F=11.609,P<0.001].Spearman分析显示,sd-LDL水平与Gensini评分呈正相关关系(r=0.602,P=0.000);RBP-4水平与Gensini评分呈正相关关系(r=0.554,P=0.000);Fn水平与Gensini评分呈正相关关系(r=0.411,P=0.000).经1年的随访,共有11例患者出现MACE事件,依据预后进行分组,结果显示,发生MACE事件的患者sd-LDL、RBP-4、Fn水平显著较高,差异均具有统计学意义(P<0.05)[sd-LDL:(1.83±0.11)mmol/L比(1.24±0.12)mmol/L,t=16.220,P<0.001;RBP-4:(67.51±4.09)mg/L比(48.21±2.2)mg/L,t=23.353,P<0.001;Fn:(418.36±81.37)mg/L比(290.82±63.42)mg/L,t=5.953,P<0.001].结论sd-LDL、RBP-4、Fn水平与CHD患者冠状动脉病变严重程度和预后密切相关,sd-LDL、RBP-4、Fn水平的升高能够在一定程度上反应患者冠状动脉病变严重以及预后不良.

Objective To investigate the relationship between the expression of serum sd-LDL,RBP-4 and Fn and the severity and prognosis of coronary artery disease in elderly patients with coronary heart disease(CHD).Methods 80 CHD patients hospitalized in our hospital from October 2017 to October 2018 were selected as the study subjects.They were divided into 49 cases of unstable angina pectoris(UA)and 31 cases of stable angina pectoris(SA).Another 60 healthy volunteers in the same period were selected as control group.The levels of small and dense low density lipoprotcin(sd-LDL),retinal binding protcin(RBP.-4)and fibrin(Fn)in each group were measured.Coronary angiography and Gensini score were performed in CHD patients.The correlation between test indexes and Gensini score was analyzed.Follow-up for 1 year to observe the difference of prognostic indicators in patients with different prognosis.Results The levels of sd-LDL,RBP-4 and Fn in the three groups from low to high were all in the control group.SA group and UA group and the difference was statistically significant(P<0.05)[sd-LDL:(0.83±0.32)mmol/L vs.(1.0710.52)mmol/L vs.(1.3310.47)mmol/L,F=18.673,P<0.001;RBP-4;(29.37±4.48)mg/L vs.(37.76±6.43)mg/L vs.(46.75±8.19)mg/L,F=98.978,P<0.001;Fn:(223.23±41.09)mg/L vs.(281.08±61.19)mg/L vs.(331.48±98.67)mg/L,F=32.224,P<0.001].Gensini score in UA group was significantly higher than that in SA group(P<0.05)[(62.49±9.18)vs.(37.28±8.31),1=12.405,P<0.001].According to Gensini score,the levels of sd-LDL,RBP-4 and Fn increased significantly with the increase of Gensini score(P<0.05)[sd-LDL:(0.96±0.17)mmol/L vs.(1.21±0.37)mmol/L vs.(1.46±0.61)mmol/L,F=7.583,P<0.001;RBP-4:(36.14±3.67)mg/L vs.(42.29=5.36)mg/L vs.(51.38±6.17)mg/L,F=47.315,P<0.001;Fn:(251.19±66.18)mg/L vs.(298.47±73.26)mg/L vs.(365.17±96.34)mg/L.F=11.609,P<0.001].Spearman analysis showed that sd-LDL level was positively correlated with Gensini scoro(r=0.602,P=0.000);RBP-4 level was positively correlated with Gensini score(r=0.554,P=0.000);Fn level was positively correlated with Gensini score(r=0.411,P=0.000 ).After one year's follow-up,11 patients had MACEcvents.The results showed that the levels of sd-LDL,RBP-4 and Fn in patients with MACE events weresignificantly higher than those in patients with MACE events( P<0.05)[sd-LDL:(1.8340.1l)mmol/L vs.(1.24±0.12)mmol/L,t=16.220,P<0.001;RBP-4;(67.51±4.09)mg/L vs.(48.21±2.23)mg/L.t=23.353,P<0.001;Fn:(418.36±81.37)mg/L vs.(290.82±63.42)mg/L,1=5.953,P<0.001]. Conclusion The levels of sd-LDL,RBP-4 and Fn are closely related to the severity and prognosis of coronary artery disease in CHD patients.Theclevation of serum levels of sd-LDL,RBP-4 and Fn can reflect the severity of coronary artery discase and poorprognosis to some extent.