冠心病患者血清肌腱蛋白C水平变化及临床意义

Changes of serum tenasin-C level in patients with coronary heart disease and its clinical significance

目的探讨冠心病患者血清肌腱蛋白C(TNC)水平的变化及临床意义。方法选取2017年1月至2018年1月于本院心内科住院行经皮冠状动脉介入治疗(PCI)冠心病患者200例,按照冠心病类型分为稳定型心绞痛组(SAP组,88例)和急性冠状动脉综合征组(ACS组,112例)。记录患者的临床资料,检测血清TNC水平,并分析TNC对主要不良心血管事件(MACEs)的预测价值和风险比。结果200例患者中,男性102例(51.0%)。ACS组的体质指数、高血压和糖尿病率、TNC、肌钙蛋白I、C反应蛋白和肌酐水平均明显高于SAP组(均为P<0.05)。随访12个月,4例(2.0%)失访。MACEs共发生21例,SAP组和ACS组的MACEs发生率无显著差异(10.2%比10.7%,P=0.911)。受试者工作特征曲线分析发现,TNC预测MACEs的最佳截断值为52.3 ng/ml,曲线下面积为0.755。多因素Cox回归分析发现,吸烟(HR=2.43,95%CI:1.56~2.37)、糖尿病(HR=1.26,95%CI:1.19~1.87)、TNC(HR=1.27,95%CI:1.16~1.65)和肌钙蛋白I(HR=1.14,95%CI:1.08~1.44)是发生MACEs的危险因素。结论TNC水平升高是冠心病患者预后不良的独立预测因素。

Objective To investigate the clinical significance of changes of serum tenascin C(TNC)levels in patients with coronary artery disease(CAD).Methods Two hundred patients with CAD who were treated with percutaneous coronary intervention in our hospital from January 2017 to January 2018 were selected.Clinical data was recorded,and serum TNC levels were measured.Besides,we also evaluate the predictive value of TNC for major adverse cardiovascular events(MACEs)and its hazard ratio.Results A total of 200 patients were enrolled,and 102(51.0%)were men.The body mass index,hypertension and diabetes rates,TNC,troponin I,C-reactive protein,and creatinine levels in the ACS group were significantly higher than those in the SAP group(all P<0.05).After 12 months of follow-up,4 cases(2.0%)were lost.A total of 21 cases of MACEs occurred,and there was no significant difference in the incidence of MACEs between the SAP group and the ACS group(10.2%vs.10.7%,P=0.911).Receiver operating characteristic curve showed that the best cut-off value of MACEs predicted by TNC was 52.3 ng/ml and the area under the cure was 0.755.Multivariate Cox regression analysis indicated that smoking(HR=2.43,95%CI:1.56-2.37),diabetes(HR=1.26,95%CI:1.19-1.87),TNC(HR=1.27,95%CI:1.16-1.65)and Troponin I(HR=1.14,95%CI:1.08-1.44)were risk factors for MACEs.Conclusions Increased TNC level is an independent predictor of poor prognosis for patients with CAD.