非ST段抬高型急性冠状动脉综合征患者中外周血透明质酸酶2和CD44异构体6的表达及其与斑块不稳定性的关系

Expressions of peripheral blood hyaluronidase 2 and CD44 isomer 6 in patients with non-ST-segment elevation acute coronary syndrome and their relationship with plaque instability

目的探讨非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者中外周血透明质酸酶2和CD44异构体6(CD44v6)的表达及其与斑块不稳定性的关系。方法选取2019年3月至2021年9月在首都医科大学附属北京友谊医院诊治的62例NSTE-ACS患者作为NSTE-ACS组,48例稳定型心绞痛(SAP)患者作为SAP组。采用荧光定量聚合酶链反应法检测2组外周血透明质酸酶2、CD44v6表达水平。Pearson相关分析方法分析外周血透明质酸酶2、CD44v6水平与血管内超声指标的相关性。多因素Logistic回归分析NSTE-ACS发生的危险因素。受试者工作特征(ROC)曲线分析透明质酸酶2、CD44v6单独及联合检测对NSTE-ACS的诊断价值。结果NSTE-ACS组外周血透明质酸酶2、CD44v6相对表达量均高于SAP组[(9.2±2.3)比(3.3±0.5)、(16.9±3.6)比(7.3±1.3)](均P<0.001)。NSTE-ACS组外周血透明质酸酶2、CD44v6表达与最小管腔外弹力膜面积、斑块负荷、斑块坏死核心面积比呈正相关(均P<0.05)。多因素Logistic回归分析结果显示,高密度脂蛋白胆固醇降低、透明质酸酶2升高及CD44v6升高是NSTE-ACS发生的独立危险因素(均P<0.05)。ROC曲线分析结果表明,外周血透明质酸酶2、CD44v6单独及联合检测对NSTE-ACS诊断的曲线下面积分别为0.696、0.757、0.820,透明质酸酶2、CD44v6联合检测的曲线下面积明显大于单一指标检测(Z=4.661,P<0.001;Z=3.885,P=0.001)。结论NSTE-ACS患者外周血透明质酸酶2、CD44v6水平升高且与斑块稳定性有关,是NSTE-ACS发生的独立危险因素,二者联合检测对NSTE-ACS的诊断有一定的临床价值。

Objective To investigate the expressions of peripheral blood hyaluronidase 2 and CD44 isomer 6 in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)and their relationship with plaque instability.Methods From March 2019 to September 2021,62 patients with NSTE-ACS diagnosed and treated in Beijing Friendship Hospital,Capital Medical University were selected as NSTE-ACS group,and 48 patients with stable angina pectoris(SAP)were selected as SAP group.The expression levels of peripheral blood hyaluronidase 2 and CD44 isomer 6 of the two groups were detected by fluorescence quantitative polymerase chain reaction method.Pearson correlation analysis method was used to analyze the correlation between the levels of peripheral blood hyaluronidase 2 and CD44 isomer 6 and intravascular ultrasound indicators.Multivariate Logistic regression analysis was used to analyze the risk factors of NSTE-ACS.The diagnostic values of hyaluronidase 2 and CD44 isomer 6 in single and combined detection of NSTE-ACS were analyzed by receiver operating characteristic(ROC)curve.Results The relative expressions of peripheral blood hyaluronidase 2 and CD44 isomer 6 in NSTE-ACS group were higher than those in SAP group[(9.2±2.3)vs(3.3±0.5),(16.9±3.6)vs(7.3±1.3)](both P<0.001).The expressions of peripheral blood hyaluronidase 2 and CD44 isomer 6 in NSTE-ACS group were positively correlated with the minimum extraluminal elastic membrane area,plaque load and the ratio of plaque necrosis core area(all P<0.05).Multivariate Logistic regression analysis showed that the reduction of high-density lipoprotein cholesterol,and the increase of hyaluronidase 2 and CD44 isomer 6 were independent risk factors for NSTE-ACS(all P<0.05).The results of ROC curve analysis showed that the areas under the curve of diagnostic value of hyaluronidase 2 and CD44 isomer 6 in single and combined detection of NSTE-ACS were 0.696,0.757 and 0.820,respectively.The area under the curve of hyaluronidase 2 and CD44 isomer 6 in the combined detection was significantly larger than that of single indicator detection(Z=4.661,P<0.001;Z=3.885,P=0.001).Conclusion The levels of peripheral blood hyaluronidase 2 and CD44 isomer 6 increase and are related to plaque stability in patients with NSTE-ACS,being independent risk factors for the occurrence of NSTE-ACS.The combined detection of the two has a high diagnostic value for NSTE-ACS.