高密度脂蛋白颗粒大小及Gal-3、NT-proBNP水平预测冠心病介入治疗术后预后的临床价值

Clinical Value of High-density Lipoprotein Particle Size and Levels of Gal-3 and NT-proBNP in Predicting the Prognosis of Coronary Heart Disease After Interventional Therapy

目的探究高密度脂蛋白(HDL)颗粒大小及半乳糖凝集素(Gal-3)、N末端脑钠肽前体(NT-proBNP)水平预测冠心病介入治疗术后预后的临床价值。方法选择132例于我院接受介入治疗的冠心病患者,均检测HDL颗粒大小、血清Gal-3、NT-proBNP水平,根据术后6个月预后分为预后良好组(104例)和预后不良组(28例),分析两组患者一般资料及检测结果差异,以受试者工作特征(ROC)曲线评价三个指标对预后的评估价值。结果预后不良组年龄高于预后良好组(P<0.05),合并糖尿症病例多于预后良好组(P<0.05),左室射血分数(LVEF)、高密度脂蛋白胆固醇(HDL-C)脂蛋白A-I(apoA-I)水平低于预后良好组(P<0.05),心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平高于预后良好组(P<0.05);预后不良组HDL颗粒大小、Gal-3、NT-proBNP水平显著高于预后良好组(P<0.05);经年龄、合并糖尿病、LVEF、cTnI、CK-MB水平的传统不良心血管事件危险因素校正后,logistics回归分析显示:高水平Gal-3、NT-proBNP是影响冠心病患者预后的独立危险因素(OR=2.067,8.365,P<0.05),HDL颗粒大小是影响冠心病患者预后的独立保护因素(OR=0.510,P<0.05);HDL颗粒大小、Gal-3、NT-proBNP水平评估冠心病患者预后截断值为0.89、14.77 ng/ml、589.6 pg/ml,敏感性分别为67.86%、78.00%及78.57%,特异性为64.42%、82.69%及75.96%;三者联合检测可获得更高检测效能。结论低水平的HDL颗粒大小及高水平Gal-3、NT-proBNP是影响冠心病患者介入治疗术后预后的独立危险因素,三者可用于患者术后预后评价,且联合诊断评估效能更高。

Objective To explore the clinical value of high-density lipoprotein(HDL)particle size and levels of galectin(Gal-3)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in predicting the prognosis of coronary heart disease after interventional therapy.Methods Totally 132 patients with coronary heart disease who received interventional therapy in our hospital were selected.HDL particle size and levels of serum Gal-3 and NT-proBNP were detected.According to the prognosis at 6 months after surgery,the patients were divided into good prognosis group(28 patients)and poor prognosis group(28 patients).The general data and detection results were analyzed in the two groups,and receiver operating characteristic(ROC)curve was used to evaluate the value of the three indicators on prognosis.Results The age of poor prognosis group was higher than that of good prognosis group(P<0.05),and the number of cases with diabetes was more than that of good prognosis group(P<0.05),and the left ventricular ejection fraction(LVEF),high-density lipoprotein cholesterol(HDL-C)and apolipoprotein A-I(apoA-I)were lower than those of good prognosis group(P<0.05)while the cardiac troponin I(cTnI)and creatine kinase isomer-MB(CK-MB)were higher than that of good prognosis group(P<0.05).The HDL particle size and levels of Gal-3 and NT-proBNP in poor prognosis group were significantly higher than those in good prognosis group(P<0.05).After adjusting for risk factors of traditional adverse cardiovascular events including age,diabetes,LVEF,cTnI,and CK-MB,logistics regression analysis showed that high levels of Gal-3 and NT-proBNP were independent risk factors affecting the prognosis of patients with coronary heart disease(OR=2.067,8.365,P<0.05),and HDL particle size was an independent protective factor affecting the prognosis of patients with coronary heart disease(OR=0.510,P<0.05).When the cut-off values were 0.89,14.77 ng/ml and 589.6 pg/ml,the sensitivities of HDL particle size,Gal-3 and NT-proBNP in assessing the prognosis of patients with coronary heart disease were 67.86%,78.00%and 78.57%,and the specificities were 64.42%,82.69%and 75.96%.The predictive value of combined detection of the three on the prognosis of patients with coronary heart disease after interventional therapy was better than that of individual detection.Conclusion Low-level HDL particle size and High-level Gal-3 and NT-proBNP are independent risk factors that affect the prognosis of patients with coronary heart disease after interventional therapy.And the three can be used for postoperative prognosis evaluation and combined diagnosis has higher evaluated efficacy.