冠心病患者血清CTRP3与Lp-PLA2水平监测的临床价值分析

Clinical value of monitoring serum CTRP3 and Lp-PLA2 levels in patients with coronary heart disease

目的探讨血清补体C1q/肿瘤坏死因子相关蛋白3(CTRP3)、脂蛋白相关磷脂酶A2(Lp-PLA2)与冠心病患者发生急性心肌梗死(AMI)的关系。方法采用病例-对照的研究方法,选择2017年8月至2018年2月中日友好医院住院患者,其中心绞痛组99例,年龄(60.4±10.4)岁,AMI组105例,年龄(61.7±14.3)岁;收集健康体检者60名为对照组,年龄(43.6±9.5)岁。利用酶联免疫法检测血清CTRP3水平,全自动生化分析仪检测Lp-PLA2。Logistic回归分析CTRP3、Lp-PLA2与冠心病患者发生AMI的相关性。受试者工作特征(ROC)曲线及其曲线下面积(AUC)分析各指标的诊断效能。结果AMI组血清Lp-PLA2水平高于心绞痛组[(313.1±68.1)U/L比(205.8±71.4)U/L],而CTRP3水平低于心绞痛组[(64.2±18.5)μg/L比(84.8±25.0)μg/L],差异均有统计学意义(P<0.001)。在充分调整协变量后,Logistic回归显示血清CTRP3与AMI发病呈负相关(OR=0.964,95%CI 0.935~0.994,P=0.019),Lp-PLA2与AMI发病呈正相关(OR=1.020,95%CI 1.008~1.032,P=0.001)。ROC曲线分析表明,CTRP3诊断AMI的AUC(95%CI)为0.753(0.685~0.821),Lp-PLA2诊断AMI的AUC(95%CI)为0.884(0.833~0.935),二者联合诊断时的AUC(95%CI)为0.910(0.870~0.950)(P均<0.001)。结论血清CTRP3和Lp-PLA2水平在AMI患者中存在异常表达,且均为冠心病患者发生AMI的相关因素,二者联合检测可提高对AMI的诊断效能。

Objective To investigate the clinical value of monitoring serum complement C1q/tumor necrosis factors-associated protein 3(CTRP3)and lipoprotein-associated phospholipase A2(Lp-PLA2)levels in patients with coronary heart disease,especially patients with acute myocardial infarction(AMI).Methods This case-control study included 99 patients with angina pectoris aged(60.4±10.4)years,105 patients with AMI aged(61.7±14.3)years,and 60 healthy individuals aged(43.6±9.5)years.Serum CTRP3 was detected by ELISA,and Lp-PLA2 was detected by automatic biochemical analyzer.Logistic regression analysis was performed to determine the correlation between CTRP3,Lp-PLA2 in angina pectoris and AMI patients.The diagnostic efficiency of each index was analyzed by receiver operating characteristic(ROC)curve.Results Serum Lp-PLA2 was significantly higher in AMI group than in angina pectoris group([313.1±68.1]U/L vs[205.8±71.4]U/L,P<0.001),while CTRP3 was significantly lower in AMI group than in angina pectoris group([64.2±18.5]μg/L vs[84.8±25.0]μg/L,P<0.001).Logistic regression showed that serum CTRP3 was negatively correlated with AMI(OR=0.964,95%CI 0.935-0.993,P=0.019),and Lp-PLA2 was positively correlated with AMI(OR=1.020,95%CI 1.008-1.032,P=0.001).ROC analysis showed that the AUC(95%CI)of AMI diagnosed by CTRP3 was 0.753(0.685-0.821),P<0.001;the AUC(95%CI)of AMI diagnosed by Lp-PLA2 was 0.884(0.833-0.935),P<0.001;the AUC(95%CI)of diagnosis efficacy by combined indices was 0.910(0.870-0.950),P<0.001.Conclusions Lower serum CTRP3 and higher serum Lp-PLA2 levels are associated with increased risk for AMI.Combined detection of both indices can improve the diagnostic efficacy of AMI.