血清标志物水平变化与冠心病患者冠状动脉狭窄程度的相关性

Correlation on changes of serum indexes levels with degree of coronary artery stenosis in patients with coronary heart disease

目的探讨血清同型半胱氨酸(Hcy)、C-反应蛋白(CRP)、心肌酶水平变化与冠心病患者冠状动脉(冠脉)狭窄程度的相关性。方法选择2019年1月—2022年1月金湖县人民医院收治的75例冠心病患者作为观察组,根据冠脉狭窄程度分为冠脉狭窄>75%组(40例)及冠脉狭窄≤75%组(35例);将同期该院75例健康体检者纳入对照组。收集所有受检者血清样本,开展Hcy、CRP、肌酸激酶(CK)、乳酸脱氢酶(LDH)及天冬氨酸转氨酶(AST)、肌酸激酶同工酶(CK-MB)检测;比较组间以及不同狭窄程度冠心病患者上述指标的水平差异;采用Pearson相关性分析法对血清学相关指标与冠脉狭窄程度之间的关系进行分析;绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),分析上述指标对冠脉狭窄程度的预测价值。结果观察组Hcy、CRP、CK-MB、CK、LDH、AST水平均明显高于对照组[Hcy(μmol/L):20.14±2.34比8.38±1.12,CRP(mg/L):9.52±1.15比3.38±0.45,CK-MB(U/L):45.63±4.32比14.25±2.04,CK(U/L):230.41±12.54比151.14±10.36,LDH(U/L):208.96±11.58比121.41±8.96,AST(U/L):75.56±6.82比36.52±4.23,均P<0.05];冠脉狭窄>75%组的Hcy、CRP、CK-MB、CK、LDH、AST水平均明显高于冠脉狭窄≤75%组[Hcy(μmol/L):25.02±3.74比16.14±2.25,CRP(mg/L):12.35±2.01比7.52±1.13,CK-MB(U/L):57.59±5.52比36.41±4.19,CK(U/L):255.69±15.14比202.14±10.79,LDH(U/L):238.69±13.48比182.14±10.13,AST(U/L):90.41±7.89比68.41±6.15,均P<0.05]。血清Hcy、CRP、CK-MB、CK、LDH、AST水平与Gensini评分均呈正相关(r值分别为0.605、0.449、0.519、0.467、0.419、0.475,P值均为0.000)。ROC曲线分析显示,血清Hcy、CRP、CK-MB、CK、LDH、AST联合检测预测冠脉狭窄程度的AUC为0.928,高于各指标单独检测。结论血清Hcy、CRP、心肌酶的水平与冠脉狭窄程度之间表现为正相关的关系,早期检测该类指标水平能够预测冠脉狭窄程度,能够在临床治疗方案制定中发挥指导作用。

Objective To investigate the correlation between changes of serum homocysteine(Hcy),C-reactive protein(CRP)and myocardial enzymes and the degree of coronary stenosis in patients with coronary heart disease(CHD).Methods The 75 patients with CHD admitted to Jinhu County People's Hospital from January 2019 to January 2022 were selected as observation group.According to the degree of coronary artery stenosis,they were divided into coronary artery stenosis>75%group(40 cases)and coronary artery stenosis≤75%group(35 cases).Other 75 healthy examinees in the hospital during the same period were included in control group.Serum samples of all subjects were collected,and Hcy was detected using enzyme cycle assay,CRP was detected using latex enhanced immunoassay,creatine kinase isoenzyme(CK-MB)was detected using immunosuppressive assay,creatine kinase(CK)was detected using phosphocreatine substrate assay,and lactate dehydrogenase(LDH)and aspartate aminotransferase(AST)were detected using International Federation of Clinical Chemistry(IFCC)method.The differences of the above indicators between observation group and control group,as well as patients with different degrees of CHD stenosis were compared.The correlation between serum indicators and the degree of coronary artery stenosis was analyzed using Pearson correlation analysis method.The receiver operator characteristic(ROC)curve was drawn and the area under ROC curve(AUC)was calculated to analyze the predictive value of above indicators for the degree of coronary artery stenosis.Results The levels of Hcy,CRP,CK-MB,CK,LDH and AST in observation group were higher than those in control group[Hcy(μmol/L):20.14±2.34 vs.8.38±1.12,CRP(mg/L):9.52±1.15 vs.3.38±0.45,CK-MB(U/L):45.63±4.32 vs.14.25±2.04,CK(U/L):230.41±12.54 vs.151.14±10.36,LDH(U/L):208.96±11.58 vs.121.41±8.96,AST(U/L):75.56±6.82 vs.36.52±4.23,all P<0.05].The levels of Hcy,CRP,CK-MB,CK,LDH and AST in coronary stenosis>75%group were higher than those in coronary stenosis≤75%group[Hcy(μmol/L):25.02±3.74 vs.16.14±2.25,CRP(mg/L):12.35±2.01 vs.7.52±1.13,CK-MB(U/L):57.59±5.52 vs.36.41±4.19,CK(U/L):255.69±15.14 vs.202.14±10.79,LDH(U/L):238.69±13.48 vs.182.14±10.13,AST(U/L):90.41±7.89 vs.68.41±6.15,all P<0.05].Serum Hcy,CRP,CK-MB,CK,LDH and AST levels were positively correlated with Gensini score(r values were 0.605,0.449,0.519,0.467,0.419,0.475,P values were all 0.000).ROC curve analysis showed that the AUC of combined detection of Hcy,CRP,CK-MB,CK,LDH and AST for predicting the degree of coronary artery stenosis was 0.962,which was higher than that of each index alone.Conclusion The levels of serum Hcy,CRP and myocardial enzymes are directly proportional to the degree of coronary artery stenosis.Early detection of these indicators could predict the degree of coronary artery stenosis and provide guidance for the development of clinical treatment plans.