ACS患者PCI术后血清S1P、补体C3水平及其预后评估的价值分析

Levels of serum sphingosine 1-phosphate and third component of complement and their value in prognosis reviewing in patients with acute coronary syndrome after PCI

目的检测急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后血清1-磷酸鞘氨醇(S1P)、补体第三组分(C3)水平,探讨二者与患者预后的关系。方法选取2017年1月至2019年9月于长沙市中心医院收治的首次接受PCI的ACS患者100例(ACS组)为研究对象,随访6个月后,按照是否发生心血管事件分为心血管事件组21例和无心血管事件组79例;选取同时期本院健康体检者100例为对照组。收集所有患者既往病史、血常规(中性粒细胞与淋巴细胞之比)及生化检测结果并测定体质指数(BMI);采用酶联免疫吸附(ELISA)法检测血清中S1P、补体C3水平。Pearson法分析S1P、补体C3与血脂的相关性。采用受试者工作曲线(ROC)分析血清S1P、补体C3及联合检测对ACS患者PCI术后预后不良预测价值。采用COX法分析影响ACS患者PCI术后不良预后的因素。结果与对照组相比,ACS组患者血清S1P、补体C3水平较高(P<0.05)。与无心血管事件组相比,心血管事件组患者血清中性粒细胞与淋巴细胞比值、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、S1P及补体C3水平较高(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平较低(P<0.05)。S1P与LDL-C、TC、TG呈正相关(P<0.05),与HDL-C呈负相关(P<0.05);补体C3与LDL-C、TC、TG呈正相关(P<0.05),与HDL-C呈负相关(P<0.05),S1P、补体C3联合对ACS患者PCI术后不良预后诊断的AUC为0.853,灵敏度为87.30%,特异度为76.20%。结论ACS患者PCI术后血清S1P、补体C3水平上调,预示患者预后不良,二者联合诊断价值更佳。

Objective To detect the levels of sphingosine 1-phosphate(S1P)and third component of complement(complement C3)and discuss the relationship among them and prognosis in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods ACS patients undergone PCI(n=100)were chosen into ACS group from Central Hospital of Changsha City from Jan.2017 to Sept.2019.After followed up for 6 months,ACS group was divided,according to whether or not incidence of cardiovascular events,into cardiovascular events group(n=21)and non-cardiovascular events group(n=79).At the same time healthy controls were chosen into control group(n=100).The patients’data of previous medical history,results of blood routine examinations[neutrophil/lymphocyte ratio(NLR)]and biochemical detection,and body mass index(BMI)were collected.The levels of S1P and complement C3 were detected by using ELISA.The correlation among S1P,complement C3 and blood fat was analyzed by using Pearson method.The predictive value of S1P,complement C3 and combined detection of S1P and complement C3 to poor prognosis was detected by using receiver operating curve(ROC)in ACS patients after PCI.The factors of poor prognosis were analyzed by using COX in ACS patients after PCI.Results The levels of S1P and complement C3 were higher in ACS group than those in control group(P<0.05).Compared with non-cardiovascular events group,the levels of NLR,triglyceride(TG),total cholesterol(TC),low-density lipoprotein-cholesterol(LDL-C),S1P and complement C3 were higher(P<0.05)and level of high-density lipoprotein-cholesterol(HDL-C)was lower(P<0.05)in cardiovascular events group.S1P was positively correlated to LDL-C,TC and TG(P<0.05)and negatively correlated to HDL-C(P<0.05).Complement C3 was positively correlated to LDL-C,TC and TG(P<0.05)and negatively correlated to HDL-C(P<0.05).The AUC of combined detection of S1P and complement C3 was 0.853,sensitivity was 87.30%and specificity was 76.20%in diagnosis of poor prognosis in ACS patients after PCI.Conclusion The up-regulations of S1P and complement C3 levels predict poor prognosis in ACS patients after PCI,and combined detection of S1P and complement C3 have higher diagnostic value.