尿8-异-前列腺素F2α评估2型糖尿病合并不稳定型心绞痛患者罪犯血管斑块破裂的价值

Value of urinary 8-iso-prostaglandin F2αto risk assessment of plaque rupture in type 2 diabetes mellitus patients with unstable angina pectoris

目的观察2型糖尿病(type 2 diabetes mellitus,T2DM)合并不稳定型心绞痛(unstable angina pectoris,UAP)罪犯血管斑块破裂患者尿8-异-前列腺素F2α(8-iso-prostaglandin F2α,8-iso-PGF2α)水平变化,探讨尿8-iso-PGF2α预测T2DM合并UAP患者罪犯血管斑块破裂的价值。方法T2DM合并UAP患者130例,依据冠状动脉造影检查结果确定罪犯血管,对罪犯血管斑块行血管内超声检查,65例斑块破裂者为斑块破裂组,65例斑块未破裂者为非斑块破裂组。比较2组一般资料,校正尿8-iso-PGF2α及血清高敏C反应蛋白、糖化血红蛋白(hemoglobin A1c,HbA1c)、非高密度脂蛋白胆固醇(non-high density lipoprotein cholesterol,non-HDL-C)、三酰甘油水平等;比较2组罪犯血管及多支血管病变比率,血管外弹力膜横截面积、斑块横截面积、斑块负荷、斑块长度、斑块体积及冠状动脉重构指数;多因素logistic回归分析T2DM合并UAP患者罪犯血管斑块破裂发生的影响因素;绘制ROC曲线评估校正尿8-iso-PGF2α预测T2DM合并UAP患者罪犯血管斑块破裂发生风险的效能。结果斑块破裂组吸烟比率(69.23%)大于非斑块破裂组(52.30%),糖尿病病程[3.1(1.2,5.2)年]长于非斑块破裂组[2.2(1.0,4.2)年],校正尿8-iso-PGF2α[138.0(87.2,188.2)pmol/mmolCr]、高敏C反应蛋白[21(11,36)mg/L]、HbA1c[(7.4±1.2)%]、non-HDL-C[(3.64±0.77)mmol/L]水平及冠状动脉重构指数(1.04±0.15)高于非斑块破裂组[95.4(73.7,148.5)pmol/mmolCr,9(6,34)mg/L,(6.9±1.1)%,(3.31±0.73)mmol/L,0.98±0.18](P<0.05);2组罪犯血管及多支血管病变比率、血管外弹力膜横截面积、斑块横截面积、斑块负荷、斑块长度及斑块体积比较差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,HbA1c(OR=1.554,95%CI:1.076~2.243,P=0.018)、non-HDL-C(OR=1.838,95%CI:1.067~3.166,P=0.028)和校正尿8-iso-PGF2α(OR=1.009,95%CI:1.003~1.015,P=0.002)是T2DM合并UAP患者罪犯血管斑块破裂发生的影响因素。ROC曲线分析结果显示,校正尿8-iso-PGF2α以102 pmol/mmolCr为最佳截断值,预测T2DM合并UAP患者罪犯血管斑块破裂发生风险的AUC为0.674(95%CI:0.581~0.767,P=0.001),灵敏度为0.569,特异度为0.738。结论T2DM合并UAP患者校正尿8-iso-PGF2α水平升高与罪犯血管斑块破裂密切相关,校正尿8-iso-PGF2α水平在评估T2DM合并UAP患者罪犯血管斑块破裂发生风险中有一定价值。

Objective To observe the changes of urinary 8-iso-prostaglandin F2α(8-iso-PGF2α)in patients with rupture of culprit lesions complicated with type 2 diabetes mellitus(T2DM)and unstable angina pectoris(UAP),and to investigate the value of urinary 8-iso-PGF2αto the prediction of rupture of culprit lesions in patients with T2DM and UAP.Methods A total of 130 T2DM patients with UAP underwent coronary angiography to identify the culprit lesion.The vessels with culprit lesion received intravascular ultrasound,by which 130 patients were equally divided into ruptured plaque group and non-ruptured plaque group.The general data,and calibrated urinary 8-iso-PGF2α,and the level of serum high-sensitivity C-reactive protein(hs-CRP),hemoglobin A1c(HbA1c),non-high-density lipoprotein cholesterol(non-HDL-C)and triacylglycerol were compared between two groups.The percentages of culprit vessels and multi-vessel lesions,the external elastic membrane cross sectional area(CSA),plaque CSA,plaque load,plaque length,plaque volume and coronary modeling index were compared between two groups.Multivariate logistic regression analysis was used to assess the influencing factors of culprit plaque rupture in T2DM patients with UAP.ROC was drawn to evaluate the efficacy of calibrated urinary 8-iso-PGF2αon predicting the risk of plaque rupture in T2DM patients with UAP.Results Ruptured plaque group had higher percentage of smokers(69.23%),longer diabetes history(3.1(1.2,5.2)years),higher levels of calibrated urinary 8-iso-PGF2α(138.0(87.2,188.2)pmol/mmolCr),hs-CRP(21(11,36)mg/L),HbA1 c((7.4±1.2)%)and non-HDL-C((3.64±0.77)mmol/L),and higher remodeling index(1.04±0.15)than non-ruptured plaque group(52.30%,2.2(1.0,4.2)years,95.4(73.7,148.5)pmol/mmolCr,9(6,34)mg/L,(6.9±1.1)%,(3.31±0.73)mmol/L,0.98±0.18)(P<0.05).There were no significant differences in the percentages of culprit vessel and multi-vessel lesion,external elastic membrane CSA,plaque CSA,plaque load,plaque length and plaque volume between two groups(P>0.05).Multivariate logistic regression analysis showed HbA1 c(OR=1.554,95%CI:1.076-2.243,P=0.018),non-HDL-C(OR=1.838,95%CI:1.067-3.166,P=0.028)and calibrated urinary 8-iso-PGF2αlevel(OR=1.009,95%CI:1.003-1.015,P=0.002)were the influencing factors of culprit plaque rupture.ROC showed when the optimal cut-off value of calibrated urinary 8-iso-PGF2αwas102 pmol/mmolCr,the AUCfor predicting plaque rupture was 0.674(95%CI:0.581-0.767,P=0.001),the sensitivity was 0.569,and the specificity was 0.738.Conclusion The increased calibrated urinary 8-iso-PGF2αlevel is closely correlated with culprit plaque rupture in T2DM patients with UAP.The calibrated urinary 8-iso-PGF2αhas certain value to the risk assessment of coronary plaque rupture in T2DM patients with UAP.