血清中性粒细胞明胶酶相关载脂蛋白在冠心病疾病评估及诊断中的作用

Role of serum neutrophil gelatinase-associated apolipoprotein in the assessment and diagnosis of coronary heart disease

目的:研究血清中性粒细胞明胶酶相关载脂蛋白(NGAL)在评估冠状动脉粥样硬化病变严重程度中的作用及在冠心病诊断中的价值。方法:选取行冠脉造影检查并确诊冠心病的病人135例作为冠心病组(CHD组),以冠脉造影检查排除冠心病30例作为对照组(CON组)。CHD组病人分为稳定性心绞痛组(SAP组)、不稳定性心绞痛组(UA组)和急性心肌梗死组(AMI组),比较各组临床资料、一般生化指标及血清hs-CRP水平。分析NGAL、超敏-C反应蛋白(hs-CRP)及Gensini评分间的相关性。受试者工作曲线(ROC)分析血清NGAL在冠心病诊断中的价值。结果:SAP组、UA组和AMI组血清hs-CRP水平高于CON组(P<0.05),且SAP组、UA组和AMI组间hs-CRP差异均有统计学意义(P<0.05)。血清NGAL和hs-CRP水平随Gensini积分增加逐渐升高(P<0.01);Gensini评分30分组、30~60分组和>60分组血清NGAL和hs-CRP水平差异均有统计学意义(P<0.05~P<0.01)。血清NGAL和Gensini评分、hs-CRP水平呈正相关关系(r=0.733、0.908,P<0.05),血清hs-CRP与Gensini评分呈正相关关系(r=0.708,P<0.05)。CHD组血清NGAL的浓度高于CON组(P<0.05)。当截断值为59.02 ng/mL,血清NGAL诊断冠心病的ROC曲线下面积为0.875,95%CI 0.820~0.929,灵敏度为74.8%,特异度为96.0%。结论:血清NGAL与hs-CRP及冠状动脉粥样硬化的病变严重程度相关,可作为诊断冠心病的辅助指标。

Objective:To study the value of serum neutrophil gelatinase-associated apolipoprotein(NGAL)in assessing the severity of coronary atherosclerosis,and its diagnostic value in coronary heart disease.Methods:One hundred and thirty-five patients with coronary heart disease(CHD)diagnosed by coronary angiography and 30 patients without coronary heart disease diagnosed by coronary angiography were divided into the coronary heart disease group(CHD group),and control group(CON group).The CHD patients were subdivided into the stable angina pectoris group(SAP group),unstable angina pectoris group(UA group)and acute myocardial infarction group(AMI group).The clinical data,general biochemical indicators and serum high sensitive C-reactive protein hs-CRP level were compared among all groups.The correlations among NGAL,hs-CRP and Gensini score in all cases were analyzed.The value of serum NGAL in the diagnosis of coronary heart disease was analyzed by receiver operating(ROC)characteristic curve.Results:The serum levels of hs-CRP in SAP group,UA group and AMI group were higher than that in CON group(P<0.05),and the differences of hs-CRP level among SAP group,UA group and AMI group were statistically significant(P<0.05).The serum levels of NGAL and hs-CRP increased gradually with the increasing of Gensini score(P<0.01).The differences of serum levels of NGAL and hs-CRP were statistically significant among the Gensini score<30 group,30-60 group and>60 group(P<0.05~P<0.01).The serum level of NGAL was positively correlated with Gensini score and hs-CRP level(r=0.733,0.908,P<0.05),and the serum level of hs-CRP was positively correlated with Gensini score(r=0.708,P<0.05).The concentration of NGAL in CHD group was higher than that in CON group(P<0.05).When the cut-off value was 59.02 ng/mL,the area under ROC curve of serum NGAL in the diagnosis of coronary heart disease was 0.875,the 95%CI was 0.820-0.929,the sensitivity was 74.8%,and the specificity was 96.0%.Conclusions:The serum NGAL is correlated with the hs-CRP level and severity of coronary atherosclerosis,and can be used as an auxiliary index in the diagnosis of coronary heart disease.