血清肝素结合表皮生长因子mRNA与急性冠脉综合征的关系

Relationship between serum heparin-binding epidermal growth factor mRNA and acute coronary syndrome

目的 观察分析血清肝素结合表皮生长因子(HB-EGF)信使核糖核酸(mRNA)与急性冠脉综合征(ACS)的关系,探讨血清HB-EGF mRNA对ACS发病的预测价值及发病早期的诊断价值。方法 收集青海省人民医院急诊科2019年12月至2022年3月收治的经冠脉造影(CAG)确诊为ACS患者113例,分为急性心肌梗死(AMI)组58例和不稳定型心绞痛(UA)组55例,以同期在门急诊或体检时经CAG或冠脉CT检查无狭窄并有含高血压、糖尿病或吸烟的人群51例为对照组。采用实时荧光定量聚合酶链式反应(RT-qPCR)检测ACS患者血清HB-EGF mRNA的表达水平。运用多元有序Logistic回归分析HB-EGF mRNA与ACS的关系。根据Gensini不同评分将ACS患者分为低分组(n=34)、中分组(n=56)和高分组(n=23),比较三组患者血清HB-EGF mRNA水平,并分析两组ACS患者血清HB-EGF mRNA与冠脉病变程度之间的相关性。应用ROC曲线下面积(AUC)评估血清HB-EGF mRNA对ACS患者的诊断价值。结果 多元有序Logistic回归分析显示,HB-EGF mRNA是ACS的危险因素(OR=10.994, 95%CI4.005~30.182,P<0.001)。血清HB-EGF mRNA水平低分组<中分组<高分组(P<0.05)。UA组(r_(s)=0.667,P<0.001)和AMI组(r_(s)=0.857,P<0.001)血清HB-EGF mRNA与冠脉病变程度呈正相关。UA组和AMI组血清HB-EGF mRNA的AUC分别为0.911和0.979(P值均<0.001),以约登指数最大值所对应的值为最佳截断值,得到最佳工作点(optimal operating point, OOP)分别为1.68和2.14。结论 血清HB-EGF mRNA升高与ACS有关,HB-EGF mRNA在动脉粥样硬化的发生、发展中可作为一个独立的危险因子。

Objective To analyze the predictive value of serum heparin-binding epidermal growth factor(HB-EGF) mRNA in the onset of acute coronary syndrome(ACS) and early diagnostic value by observing the relationship between serum HB-EGF mRNA level and ACS. Methods A total of 113 patients admitted to the emergency department of Qinghai Provincial People′s Hospital from December 2019 to March 2022 were diagnosed as ACS by coronary angiography(CAG), and were divided into the acute myocardial infarction(AMI) group(n=58) and the unstable angina(UA) group(n=55), and 51 patients with hypertension, diabetes or smoking who had no stenosis by CAG or coronary CT examination in outpatient emergency or physical examination during the same period were selected as the control group. Real-time quantitative polymerase chain reaction(RT-qPCR) was used to detect the expression levels of serum HB-EGF mRNA in the patients with ACS. The relationship between HB-EGF mRNA and ACS was analyzed by multivariate ordered Logistic regression. ACS patients were divided into low group, middle group and high group according to different scores of Gensini, serum HB-EGF mRNA levels in three groups were compared and the correlation between serum HB-EGF mRNA and the degree of coronary lesion in the two groups of ACS were analyzed. The area under the ROC curve(AUC) was used to evaluate the diagnostic value of serum HB-EGF mRNA in the patients with ACS. Results The results of multivariate ordered Logistic regression showed that HB-EGF mRNA was a risk factor for ACS(OR=10.994, 95%CI 4.005-30.182, P<0.001). According to different Gensini scores, serum HB-EGF mRNA level of the patients was in low group(r_(s)=0.667, P<0.001) and AMI group(r_(s)=0.857, P<0.001) were positively associated with coronary lesions. The AUC of serum HB-EGF mRNA in the UA group and the AMI group were 0.911 and 0.979(both P<0.001), respectively, and the optimal operating point(OOP) obtained by taking the maximum value of the Youden index as the best cut-off value was 1.68 and 2.14 respectively. Conclusions Serum HB-EGF mRNA elevation is associated with ACS and can exist as an independent risk factor in the development of atherosclerosis.