血清LPE、LPC对急性冠脉综合征的早期诊断及预后评估价值

Value of lysophosphatidyl ethanolamine and lysophosphatidyl choline in early diagnosis and prognosis of acute coronary syndrome

目的 探讨血清溶血磷脂酰乙醇胺(LPE)及溶血磷脂酰胆碱(LPC)在急性冠状动脉综合征(ACS)患者早期诊断及预后评估中的价值。方法 选取2021年1月至2022年6月在该院诊治的108例ACS患者作为ACS组,60例稳定型心绞痛(SAP)患者作为SAP组,另选取同期50例健康查体的健康人作为对照组。应用高效液相色谱-串联质谱法检测各组血清LPE、LPC水平。Pearson相关分析血清LPE,LPC水平与肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)的相关性。受试者工作特征(ROC)曲线分析血清LPE、LPC、cTnT对ACS的早期诊断价值。分析血清LPE、LPC水平与全球急性冠状动脉事件注册(GRACE)危险评分的关系。多因素Logistic回归分析影响ACS患者预后的因素。结果 相比于对照组和SAP组,ACS组血清高血压发生率、LPE、LPC、cTnT、CK-MB水平明显较高(均P<0.05)。ACS患者血清LPE、LPC水平与血清cTnT、CK-MB水平均呈正相关(r=0.612、0.568、0.408、0.426,均P<0.05)。GRACE危险评分高危组、中危组及低危组ACS患者血清LPE、LPC水平比较差异有统计学意义(P<0.05)。ROC曲线分析显示,血清LPE、LPC、cTnT 3项指标单独检测对ACS诊断的曲线下面积(95%CI)分别为0.698(0.660~0.736)、0.780(0.757~0.822)、0.798(0.746~0.814),三者联合检测的曲线下面积为0.877(0.834~0.897)。相比于单项检测,三者联合检测诊断价值明显较高(P<0.05)。血清LPE、LPC、cTnT水平升高及左心室射血分数降低是影响心脏不良事件发生的独立危险因素(P<0.05)。结论 ACS患者血清LPE、LPC水平升高,二者表达水平与ACS危险程度有关,是ACS预后不良的独立危险因素。血清LPE、LPC、cTnT联合检测对ACS具有较高的诊断价值。

Objective To investigate the early diagnosis and prognosis value of serum lysophosphatidyl ethanolamine(LPE)and lysophosphatidyl choline(LPC)in patients with acute coronary syndrome(ACS).Methods A total of 108 patients with ACS treated in this hospital from January 2021 to June 2022 were selected as the ACS group,60 patients with stable angina pectoris(SAP)were selected as the SAP group,and 50 healthy people with physical examination during the same period were selected as the control group.The levels of serum LPE and LPC in each group were detected by high performance liquid chromatography-tandem mass spectrometry.Pearson correlation analysis was used to analyze the correlation between serum LPE and LPC levels and troponin T(cTnT)and creatine kinase isozyme(CK-MB).The value of serum LPE,LPC and cTnT in the early diagnosis of ACS was analyzed by receiver operating characteristic(ROC)curve.The relationship between serum LPE and LPC levels and the global registry of acute coronary events(GRACE)risk score was analyzed.In addition,multivariate Logistic regression analysis was used to analyze the factors affecting the prognosis of patients with ACS.Results Compared with the control group and the SAP group,the incidence of serum hypertension,the levels of LPE,LPC,cTnT and CK-MB in the ACS group were significantly higher(P<0.05).Serum LPE and LPC levels in ACS patients were significantly positively correlated with serum cTnT and CK-MB levels(r=0.612,0.568,0.408,0.426,all P<0.05).There were statistically significant differences in serum LPE and LPC levels among high-risk group,medium-risk group and low-risk group(P<0.05).ROC curve analysis showed that the area under the curve(95%CI)of serum LPE,LPC and cTnT for the diagnosis of ACS were 0.698(0.660-0.736),0.780(0.757-0.822)and 0.798(0.746-0.814),respectively,and the area under the curve of the three combined detection was 0.877(0.834-0.897).Compared with single detection,the diagnostic value of the three combined detection was significantly higher(P<0.05).The increase of serum LPE,LPC and cTnT and the decrease of left ventricular ejection fraction were the independent risk factors for major adverse cardiovascular events(P<0.05).Conclusion Serum levels of LPE and LPC are elevated in ACS patients,and their expression levels are related to the risk degree of ACS,and are independent factors for poor prognosis of ACS.The combined detection of serum LPE,LPC and cTnT has high diagnostic value for ACS.